Exposure, Refeeding, and the Development of Mindfulness


Executive Director Dr. Wendy Oliver-Pyatt, M.D., FAED, CEDS and Clinical Director Stephanie Diamond, Ph.D. share an excerpt from an upcoming presentation, “Exposure, Refeeding, and the Development of Mindfulness in the residential treatment of Anorexia, Bulimia, and Binge Eating Disorders,” at the Eating Disorder Information Network in Atlanta, Georgia on February 21, 2014. Dr. Diamond’s clinical and research interests include women’s issues in general, and eating disorders in particular, as well as comorbidity and personality style. Prior to working at Oliver-Pyatt Centers, she had worked as part of an Eating Disorder Unit in Montreal, Canada; had facilitated various eating disorder support groups; and had treated women who struggled with eating disorders on an outpatient basis. Her clinical style can best be described as interpersonal, individualized, and strength-based. 

Would a person with an elevator phobia overcome their elevator fear by taking the stairs?  This is a question we pose on Family Friday at Oliver-Pyatt Centers to help families understand the phobic paralysis that their loved ones may experience around food.

Patients with eating disorders often lack an internal compass to guide them intrapersonally, interpersonally, and in their relationship with food. Without an internal compass, a person with an eating disorder is unable to navigate their relationship with food, clinging to their eating disorder thoughts as their only pathway. The person affected by the eating disorder is alone, ricocheting off of intrusive irrational and judgmental thoughts and emotions, resulting in fear-based living.  The decision to enter treatment is terrifying in that on some level the patient may recognize that treatment means facing these fears– entering the elevator.

Eating disorders are both phobias and disorders of the self. In residential treatment, we are working to address both aspects via exposure and the development of mindfulness. Humane treatment must encompass an understanding and sensitivity to the enormity of the food phobia, and the need to challenge these fears experientially through exposure. Mindfulness is an integral part of the gateway to a new paradigm and provides a foundation upon which the patient can develop trust in self and subsequently develop an internal compass. An attuned response from the provider is critical to the work. Without an attuned response, the provider can either under-expose/insufficiently challenge, or over-expose/flood the patient. The attuned response is also important in the development of mindfulness. It is often through the therapeutic relationship that the patient develops a self, and the capacity to tune into the developing self, creating a foundation for trust.

The refeeding process is where the rubber meets the road– it is the cross section of phobia, exposure, development of self, mindfulness, physical healing, and psychological healing. It is imperative that nutrition treatment takes into account the medical and psychological healing processes. Furthermore, in understanding the eating disorder as a phobia, and exposure as the treatment, the relationship with the provider is the conduit that will lead the person through the difficult process of exposure therapy.

When a patient asks us, how much weight they will gain, they are asking us to be careful with them as they enter the elevator and need comfort, security, reassurance, and an attuned guide who will find their “doable edge” as they ascend in their healing process.

To attend this presentation, and earn 2 CEU’s, please RSVP to Colleen Stephens by February 17, 2014. The event will be held on Friday, February 21, 2014, 8:30am at the Villa Christina Restaurant at Perimeter Summit, 4000 Summit Boulevard, Atlanta, Georgia.