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Is Residential or Day Treatment the Right Choice for Eating Disorders?

When someone close to you gets a diagnosis of an eating disorder, it can be hard to know what the best course of action is.You may argue, or feel you or the person in question did something wrong – and these feelings are normal. However, negativity doesn’t accomplish anything. The important thing is to take action and get him or her the help they need. The most essential choice you’ll make together is finding the right treatment center for eating disorders. Often this means choosing between a day treatment (outpatient) and residential (inpatient) treatment programs.

Treatment Is Largely the Same with Either Option

The idea that day treatment is the lesser of two options often leads to making the wrong choice for an individual’s situation. Although residential treatment is a higher level of care, not every person with an eating disorder needs round-the-clock supervision or medical care as would be provided in-house. Luckily, aside from the medical/psychiatric care provided at residential and day treatment centers, many of the treatment options are the same with both options.

Eating disorder treatment consists of various psychotherapeutic methods designed to change eating behaviors and rehabilitate body image. Performed in groups or individually, these treatments are largely identical in both formats. Coming into a treatment center for a psychotherapy session a few times a week is more convenient than leaving home and staying in a facility, and similar appointments can be made for dietary education, mindful movement, and co-occurring disorder treatment (i.e. 12 step programs for substance abuse).

Some of the treatment techniques used in both residential and day treatment programs include:

  • Cognitive Behavioral Therapy (CBT)

CBT is perhaps the most prominent of mental health treatments for changing disordered behaviors and negative thinking. It examines the relationships between feelings, thoughts, and behaviors. Namely, CBT posits that feelings influence behaviors, which influence the way we think, which in turn affects the way we feel. This cycle can reinforce disordered eating and exercise behaviors. Through Socratic questioning on the part of the therapist, clients can identify how disordered thoughts are affecting their behaviors, and gradually work to point out that these thoughts are in fact flawed. Being able to identify flawed thinking allows the client to avoid acting on them moving forward.

  • Dialectical Behavioral Therapy (DBT)

An offshoot of CBT, DBT is becoming more frequent in treating major behavioral disorders like anorexia nervosa, bulimia nervosa, OCD, and others. Where CBT has a more objective, logical focus that helps individuals identify and remove negative thoughts and emotions, DBT is more focused on mindfulness. Mindfulness is a concept common to both mental health treatment and mediation – it’s the idea of being attuned to the present situation and accepting it. DBT is useful for extreme emotional disorders such as borderline personality disorder. It also helps clients identify disordered or negative thoughts and feelings, but helps the person accept them without acting on them, instead of replacing them.

  • Trauma counseling

Past trauma is one of the most potent triggers for disordered eating behaviors, and PTSD is diagnosed in as much as 40% of people with an eating disorder. PTSD can last for years after the traumatic event, and acute episodes cause incredible stress, emotional distress, and panic. Many forms of self-destructive behavior like substance abuse, self-harm, and disordered eating act as coping mechanisms for the distress caused by PTSD. There are many therapeutic methods used to treat PTSD, but recently a lot of focus has been put on Cognitive Processing Therapy (CPT). A series of 12 distinct sessions, CPT works similarly to CBT, except it focuses on the traumatic event and associated feelings rather than more general ones. The client is encouraged to understand their feelings about the trauma and identify how it is negatively affecting their actions. Like CBT and DBT, trauma counseling can be effectively performed via either residential or day treatment programs.

  • Dietary Education

Although eating disorders are generally more about a need to regain control over an aspect of a person’s life than eating per se, dietary education is usually needed. In many cases, a dietician’s help is necessary to restore weight and/or nutritional deficiencies. In residential treatment, this can be performed on a meal-by-meal basis, with education on how to make nutritious meals after discharge. In day treatment, there may be meals, but it’s more likely that the educational component will be more prominent. In both treatment situations, the other focus is the concept of intuitive eating. Many people with eating disorders are used to dieting and avoiding food (although this varies from person to person and by what kind of disorder they have), so training is provided to help them eat more intuitively. This means eating when they’re hungry, eating to the point of satiety, and eating the foods they like. Intuitive eating also helps people avoid feelings of guilt or shame about eating.

  • Mindful movement

Compulsive exercise and/or excessive exercise are common in people with eating disorders. They can cause severe stress on the body, including injury, exhaustion, and nutritional deficiencies. Mindful movement programs help people in treatment continue exercising more healthfully. Often, this includes yoga and other low-impact, meditative movement classes. Other examples include walking meditation, breathing exercises, and low-intensity bicycling. Mindful movement classes are generally available in both day treatment and residential settings.

A Note About Virtual Eating Disorder Treatment

Day treatment is traditionally thought of as a series of trips to a particular location to receive treatment, and that’s still true for PHP and IOP options. However, as telehealth options have expanded, virtual day treatment sessions are an increasingly popular option. With the rise of the COVID-19 crisis and its accompanying social distancing regulations, it’s become the primary lifeline for many people in need of eating disorder treatment. Fortunately, most of the treatment techniques described above are available via telehealth sessions as well. Please check out the available virtual treatment options available when selecting an eating disorder treatment facility.

What to Know About Day Treatment for Eating Disorders

Day treatment, or outpatient treatment, is ideal for a variety of treatment situations. It’s a less intensive program than residential treatment and usually comes at a lower cost than residential treatment. During day treatment, the client will visit the center several times a week, or daily, to progress through talk therapy with the staff. One of the most compelling of these is to use this type of treatment as a step-down from the more intensive treatment that residential care offers.

Often the transition from a full residential program to a return to daily life is a difficult one. Even after 30 or more days in intensive treatment, further therapy is needed to prevent relapse and provide resolution for emotional and behavioral progress made during that time.

Day treatment is also the better option for parents, students, and professionals, and others who can’t afford to take a month or more away from their responsibilities. In most cases, the eating disorder treatment facility can provide after-work or weekend hours so the individual can maintain their life while still working to gain a recovered life.

The financial impact of eating disorder treatment often goes unmentioned, but recovery is too important to let it get in the way. The other major advantage of day treatment is that it’s generally less expensive than residential treatment – things like food, room and board, and 24/7 medical supervision, while necessary, can add up. Insurance providers may be more able to make accommodations for day treatment programs.

What to Know About Residential Eating Disorder Treatment

Residential treatment involves the client living at the treatment center for a length of time (usually beginning at 30 days) and receiving 24/7 care. Although 30 days is a guideline, the exact length of stay is not typically defined when an individual enters treatment because there is no one-size-fits-all treatment plan, completion date, or other aspects of care.

Residential eating disorder treatment is helpful for more intense or long-term cases of eating disorders like anorexia nervosa, bulimia nervosa, or binge eating disorder, especially those in which medical care is necessary to stabilize the individual. Many eating disorders can cause health complications that require specialized treatment, like anemia, heart failure, or malnutrition.

Residential treatment is also preferable in the case of a dual diagnosis, or co-occurring disorder. Dual diagnoses are very common with eating disorders, and they can complicate the necessary treatment program. For example, anxiety disorders such as OCD can trigger or amplify the symptoms of an eating disorder, and if they aren’t treated (after medical stabilization) at the same time, all the progress made can be lost. Co-occurring eating disorder treatment can also be useful in cases of addiction or substance abuse, which is also common in people with eating disorders. People with anorexia nervosa often abuse “diet pills” which are a form of amphetamine, and other drugs that stimulate the metabolism such as cocaine.

Most importantly, residential treatment programs offer a comprehensive program that can change a client’s life entirely. Beyond the treatment of the direct eating disorder symptoms, residential programs can change perspective on body image, stress management, interpersonal relationships, and more. It’s the better choice for more intense cases of ED as well as people who need treatment for more than one disorder.

Close to Home Or in a New Place?

For many friends and family members who are considering if a residential or outpatient treatment center for eating disorders is best for their loved one, distance may be a factor. Outpatient centers almost exclusively provide service for people living within driving distance of the facility, by necessity. Residential centers can treat people from all over the country this distance from home makes it easier for the client to focus more fully on her recovery and finding her healthy self once again. With the change of scenery (and many centers are located in aesthetically and naturally beautiful locations) at the treatment center, they can focus on getting better and making a full recovery.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.