How dietitians at Sööma incorporate various therapeutic modalities into their nutrition interventions

Sööma’s approach is based on providing collaborative, explorative and inclusive care. This means that the registered dietitians at the clinic want to better understand your history and how various coping mechanisms, beliefs around food and past experiences have contributed to your relationship with food. Below, we describe various therapeutic approaches that we incorporate in our nutrition interventions and provide a brief summary of how these could be used.

Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT), unlike most therapies, does not focus on alleviating symptoms, rather it teaches skills for living a meaningful life. Behaviors, thoughts, and emotions are not evaluated based on true or false, good or bad, instead their quality is based on if they help in the pursuit of a meaningful life. This concept is often referred to as ‘workability’. In brief, ACT is about accepting what you cannot control so that you can commit to a meaningful life.

 

How this is incorporated into nutrition work:

 

Acceptance

  • Helping the client’s emotions around food and their body exist without trying to change them

 

Values

  • Allowing the client to identify values around food, body image and physical activity in order to clarify what’s important to them

 

Committed Action and Defusion

  • When a client is engaging in an exposure or pursuing an action in line with the nutrition behavior they want to change, they may experience uncomfortable thoughts and emotions. Defusion will allow them to detach from these thoughts and emotions, allowing more space to act

Dialectical Behavioral Therapy

From a dialectical behavioral therapy (DBT) perspective, a maintenance factor for most all disorders is emotional dysregulation. Ergo, building skills around emotion regulation and related areas is the proposed treatment in DBT.

How this is incorporated into nutrition work:

 

Distress tolerance

  • Clients who suffer from eating disorders or disordered eating often use food to manage uncomfortable emotions
  • Offering distress tolerance skills allows clients to calm their nervous system when experiencing heightened emotions and urges to engage in problematic behaviors with food (e.g. bingeing, purging)

 

Emotion regulation

  • Emotion regulation allows clients to develop alternative strategies to manage uncomfortable emotions in order to heal a relationship with food.
  • An example of this could be a client who often comes home after a stressful day at work and uses food to numb all of the emotions that they experienced throughout the day. Emotion regulation skills would explore what alternatives the client could incorporate in order to prevent turning to food.

 

Mindfulness

  • The goal of mindfulness is to allow clients to connect to the present moment. Because many individuals who have engaged in chronic dieting or have experienced an eating disorder are often disconnected from their bodies, it becomes difficult for them to become attuned to their body’s needs and signals. Mindfulness allows clients to practice turning inward for cues of what and when to eat rather than relying on external guidance.

Cognitive Behavioral Therapy

Cognitive Behavioural Therapy (CBT) is based on the idea that one’s thoughts, feelings, and behaviours are all interconnected, with thoughts and behaviours being the target for intervention. The goal of CBT is to dismantle unhelpful beliefs and attitudes as well as encourage pleasant and/or helpful acts

 

How this is incorporated into nutrition work:

 

Exposures

  • Food exposures are a core component of nutrition interventions with clients with disordered eating and eating disorders.
  • The goal of the food exposure is to identify foods that are currently avoided due to discomfort that arises at the thought of consuming them and assisting the client in approaching these foods and slowly building a capacity to tolerate the distress that arises.
  • Typically, over time, the anxiety and distress experienced with said food decreases and clients are able to increase variety and quantity in their food intake.

 

Problem Solving

  • Clients may come to a registered dietitian wanting to change their relationship with food, but experience a great amount of distress when trying to pursue this.
  • A tenant of CBT is problem solving where the dietitian would explore a circumstance around food and explore various options available to the client in terms of response
  • Consider a client who is struggling to buy chips at the grocery store because the client believes other people are judging them when they buy “unhealthy” foods. As an intervention, time can be spent breaking down the cognitive distortion by analyzing the facts, and questioning the believability of the thought. Behaviourally, an exposure paradigm and/or role playing could be used to assist the client with buying a wide variety of foods.

Family Based Treatment

Family-Based Treatment (FBT) is a family therapy for the treatment of adolescent eating disorders. The goal of the treatment is that therapists take a non-authoritarian stance in treatment and empower the parents to bring about the recovery of their child. FBT consists of three phases:

 

  1. Refeeding and weight restoration
  2. Restoring control of eating back to the adolescent
  3. Returning to normal adolescent development

 

How this is incorporated into nutrition work:

 

  • When treating young individuals with eating disorders, the registered dietitians at Sööma often prefer to include the family in order to offer appropriate support to the adolescent and empower parents to refeed and nourish their child.
  • Dietitians will often provide guidance on weight restoration requirements, engage in the family meal, which is a core component of FBT and support the family during the refeeding and restoration of control phase.
  • Dietitians will often work in conjunction with a psychologist who will support the adolescent and the family from a cognitive, emotional and developmental perspective.