How to Find Good Virtual Treatment for an Eating Disorder

Initially, virtual treatment was part of the necessary changes to continue any therapy during the worst parts of the pandemic. Now virtual work has become the norm.

Prior to the pandemic, I had written many posts about one of the biggest issues in treating eating disorders: access to care. There weren’t enough clinicians or programs to go around even in the most populous parts of the country, let alone in more rural areas.

Virtual work opened up opportunities for people to seek care much more widely, a needed change. As new virtual opportunities for care expand, the possibility that everyone can get help might be realized.

Expansion of care exposed another issue in eating disorder treatment, namely the quality of care. There is no standard training, certificate or degree for treating people with eating disorders. While virtual access improves, more clinicians are necessary, and the likelihood of inexperienced treatment providers in unsupervised settings increases dramatically.

Online treatment varies from therapy to all day programs to weekly coaching programs. The expense of treatment is high, and the ability to assess its efficacy very limited. In addition, programs that include meal support have an even higher bar to climb because tracking whether someone finishes a meal is even harder on a video call.

Grappling with the virtual landscape demands an even higher level of vetting by the patient to be successful. These are some ideas to consider and ask directly when making decisions about care.

First, ask providers and programs about their credentials. Any virtual treatment needs to start with well trained professionals with successful clinical practices who have the expertise to navigate helping people recover online.

Second, have a conversation about how any treatment works virtually and how the program adapts to online work. This modality can be very successful but not as a virtual version of the same treatment. The explanation of the differences will reveal how thoughtful the provider is.

Third, it’s essential that any treatment uses criteria to assess progress and has a plan at the ready for virtual work to be successful. Many providers and programs will say that if their treatment doesn’t work, they’ll recommend a “higher level of care,” a euphemism that the clinician does not know what else to do. Asking for more specific guidelines will be revealing of the person’s overall thoughts about treatment.

Virtual care fully enacted during the pandemic is here to stay. The pros of this work outweighs the cons. Seeking the best virtual care tasks patients to ask the right questions to ensure the treatment is effective.

Traversing the Altered Landscape of Eating Disorder Treatment: Overview

The pandemic changed the already confusing eating disorder treatment world immeasurably. The demand for treatment remains extremely high, and the avenues to find appropriate care are increasingly difficult to find.

A few major changes have had the most impact, and I will use the next few posts to discuss all the issues in detail. This post will focus on the few biggest ones.

The first big change is that virtual mental health treatment is quickly becoming the norm. In eating disorder treatment, virtual work is particularly hard since eating food together is an integral part of much of the work. Deciding whether virtual work can be helpful and when in person work is essential can be complicated.

The second change is the extraordinary array of options. The explosion of treatment programs, in person and virtual, therapists, coaching, support networks and mentor programs is dizzying. The number of clinicians professing eating disorder expertise is extraordinary, and there is no degree or certificate to prove any experience at all. Choosing providers has become very complex.

The third change is the enormous growth in residential programs funded by private equity firms. These programs are run at the corporate level by experienced clinicians and financiers aimed at growth, profit and eventually selling the company. Many of the day to day clinicians are inexperienced people early in their career and often at their first job. Some of them are excellent, but the varied skill levels are hard to assess. Providing the need for access of care is a boon to many but also has come at a cost.

These are the three most pressing changes to eating disorder treatment. I’ll discuss each one in more detail in the next several posts.

Psychedelic Medications in Psychiatry: Early Thoughts

Psychedelic drugs now used as psychiatric medications are a wave of the future. Psychopharmacology is effective and safe for many people, but there is still a significant number of people who get little or no benefit from this form of treatment. Any new direction for helping people with mental illness is intriguing and important.

Ketamine is already available and can be used by infusion, nasal spray, intramuscular injection or lozenge. Psilocybin should be available at some point in 2023.

The early data about both medications are very promising. People with many mental illnesses including depression, OCD and PTSD appear to derive benefit from the psychedelics. Although people who work with these medications report benefit for even more disorders, there isn’t enough known yet to substantiate the claims.

Unlike psychiatric medications, psychedelics don’t directly reduce symptoms. Instead, they increase brain plasticity—the flexibility of the brain to break stuck routines and change automatic thoughts and reactions. The effect of the medications is more effective when the program includes mental exercises or writing that enhances and focuses on changing certain patterns in the brain. For instance, trauma therapy using psilocybin shows significant promise.

Of note, there is no clear benefit for these medications for people with eating disorders, though any peripheral benefit for other psychiatric symptoms can benefit eating disorder treatment.

It’s crucial to note that psychedelic medications don’t follow the typical FDA method of approval for new drugs. And once approved, there is no clear method of treatment either. Psychiatrists cannot just prescribe the medications and pharmacies do not dispense the drugs. Ketamine is prescribed in specific clinics and can even be ordered as a lozenge on various websites without medical supervision at all.

The lack of regulation, unclear medical follow-up and minimal guidelines for use make it important for anyone using these medications to find a reputable source for attaining and using them. The patient has the responsibility to search for the safe and effective way of trying the medications and of assessing its benefit.

Psychedelic medications are an exciting new direction for psychiatry. The holes in care for mental illness demand new options to help those undertreated by the current available options. As long as a patient is educated and clear about their decisions, these new medications can be a very effective alternative. However, it’s important for patients to heed the risks and work with knowledgeable doctors through the process.