The complexity of eating disorders challenges us to seek new therapeutic approaches that can enrich the treatment process and promote patient recovery. As part of the nutritional therapy, we help patients regulate their weight and improve their eating habits, but we also guide them in transforming the relationship with themselves, their shape and food. Since food is the feared object and the body is frequently portrayed as the enemy, in order to overcome existing barriers and create a real motivation to transcend the status quo, the integrative model and coaching techniques are invaluable tools in the work of registered dietitians (RD) specializing in eating disorders, or Certified Eating Disorder Specialists (CEDRD).

The integrative model is a patient-centered approach, that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies1.  Some of the principles that characterize it are:

  • Patient and practitioner are partners in the healing process.
  • All factors that influence health, wellness, and disease are taken into consideration, including mind, spirit, and community, as well as the body.
  • Parallel to the concept of treatment, there is a strong emphasis on health promotion and disease prevention.
  • Appropriate use of both conventional and alternative methods facilitates the body’s innate healing response.
  • Practitioners of integrative medicine should be an example of its principles and commit to permanent self-exploration and self-development.

Since interdisciplinary work is a cornerstone of Integrative Medicine, medical doctors, psychologists, RDs and complementary therapists all work together under the common goal of guiding the patient on the path of recovery, to achieve greater coherence in a physical, mental and spiritual level. The dietitian is a central part of the team, as she helps patients regain control of their body, learn key concepts of health, establish peace with food and meet their physical needs.

The RD needs to elaborate an appropriate dietetic intervention tailored to the specific needs of each patient. In the initial stages of treatment, sometimes a high degree of direction is needed due to the existence of malnutrition or destructive behaviors, which impede the patient from making appropriate decisions. As we advance through the process, I recommend empowering patients so they become attuned with their own needs and begin taking care of their own self-care and learning how to make better decisions that favor their overall health. We shift from a professional care centered on direction and control, to providing guidance and feedback to the patient.

This change process arises from within the patient´s own motivations, values and own needs.  Thus, the RD provides the space for patients to explore their motivation to change, while patients recognize the ambivalence they are experiencing and are able to appreciate how their current behaviors are conflicting with their purposes or more intrinsic values. The patient is an active part of the process and, through empowerment and awareness of his or her current situation, gradually starts taking charge of his health. 3. 4. 5

In the Integrative Model, the therapeutic relationship between the patient and RD is crucial to impulse positive behavior change. An appropriate use of nonverbal language and of neuro-linguistic programming support this relationship. It is also important to create a therapeutic environment characterized by trust, empathy and non-judgment, which will stimulate a meaningful conversation between the RD and the patient, resulting in the patient feeling listened to and respected and as a consequence feeling more encouraged to change his or her lifestyle.

In my experience, when the patient has advanced through the recovery process, it is advisable to use complementary techniques such as biofeedback and Neurofeedback for managing anxiety and increasing motivation6,7. In addition, it is helpful to use “mindfulness” and mindfulness meditation, whose benefits have been documented in the treatment of obesity-related behaviors (binge eating and emotional eating, among others) 8, 9,10 and binge eating disorder, addictions, depression and anxiety 3, 11.

During the healing process, people suffering from an eating disorder need compassionate, optimistic and passionate professionals who work synergistically in favor of the patient, and, above all, who firmly believe that full recovery is possible.

Referencias

  1. Duke Integrative Medicine. (2015). What is integrative medicine. Acceso 7-7-15 al sitio web: dukeintegrativemedicine.org
  2. Arizona Center for Integrative Medicine (2015). What is integrative medicine. Acceso 5-7-15 al sitio web: http://integrativemedicine.arizona.edu/about/definition.html
  3. Maizes, V; Rakes, D.; Niemiec, C. Integrative medicine and patient-centered care. 2009, 5:277-289.
  4. Rollnick S, Heather N, Bell A. Negotiating behavior change in medical settings: the development of brief motivational interviewing. Journal of Mental Health. 1992, 1:25-37.
  5. Lussier MT, Richard C. The motivational interview: in practice. Canadian Family Physician, 2007. 53:2117-2118.
  6. Hammond, D.C. Neurofeedback Treatment of Depression and Anxiety. Journal of Adult Development, 2005. 12(2-3), 131-137
  7. MacInnes, J, Dickerson, K, Chen, Nan-kuei, Adcock, R.A. Cognitive Neurostimulation: Learning to Volitionally Sustain Ventral Tegmental Area Activation. Neuron, 2016
  8. Kristeller, J.; Wolever, R.Q.y Sheets, V. (2013). Mindfulness-Based Eating Awareness Training (MB-EAT) for Binge Eating: A Randomized Clinical Trial. Vol 3 (4).
  9. Dalen, J., Smith, B. W., Shelley, B. M., Sloan, A. L., Leahigh, L., & Begay, D. Pilot study: Mindful Eating and Living (MEAL): Weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complementary Therapies in Medicine, 2010, 18(6), 260–264.
  10. O´Reilly, G.A.; Cook, L; Spruit-Metz, D. y Black, D.S. Minduflness-based interventions for obesity-related eating behaviours: a literature review. Obesity Review. 2014, 15(6): 453-61.
  11. Rubia, K. (2009). The neurobiology of meditation and its clinical effectiveness in psychiatric disorders. Biological Psychology, 82, 1– 11. doi: 10.1016/ j.biopsycho. 2009.04.003.
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