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About Temperament Based Treatment with Supports

Using neuroscience to inform treatment

EDIT: Our partner ANZAED have made one of their usually member-only webinars featuring Drs Laura Hill and Stephanie Knatz Peck available to us for December and January only so people can see what all the fuss in about. Click HERE to see webinar. Password: Temperament. 

Currently there is no eating disorder treatment that specifically addresses the biological temperamental factors that are fundamental to eating disorders. There is no current eating disorders therapeutic approach that explains why these factors are expressed in a common way in those with eating disorders compared to those who do not have this illness.  In addition, just as it is easier to address one small problem at a time, it has been easier to treat one individual at a time.  However, since eating disorders have been proven to be a biologically based mental illness, the complexities of the illness require more specialized treatment and more persons present to manage and reshape the illness. Supports (family and/or friends) are critical in the treatment process of eating disorders, especially anorexia nervosa, for both adolescents and adults due to the usually present egosyntonicity and lack of motivation . Supports need to know the why, how, when and what of the illness, along with their loved ones, in order to know what to do and what not to do to work with these challenges. (See: Innovations in Family Therapy for Eating Disorders Novel Treatment Developments Patient Insights and the Role of Carers )

A new treatment approach has been developing over the past eight years and tested in open trials over the last four.  It is now available for clinicians.  The research findings have found significant acceptability and feasibility both at the end of treatment and follow up. (See: https://www.ncbi.nlm.nih.gov/pubmed/29722047).  As of 2018 the new treatment has been named: Temperament Based Therapy with Supports (TBT-S).  This therapeutic approach addresses the temperamental contributing and maintaining factors of eating disorders which include genetic, neurobiological, character traits and other biological factors; and includes families/supports in the treatment process.  This treatment originated and was developed by Walter Kaye, MD, Stephanie Peck, PhD and Christina Wierenga, PhD at The Eating Disorders Center for Treatment and Research at UC San Diego and Laura Hill, PhD at The Center for Balanced Living in Columbus, Ohio, USA.   

A new interactive eating disorder online text has been written detailing the background of the TBT-S approach and provides the Client/Support Manual, clinical handouts, PowerPoints, clinical tools and a 3-D body/brain software at www.brainbasedeatingdisorders.org.

TBT-S is unique in three ways - the way it uses neurobiological understandings to work therapeutically with the person with the eating disorder; upskills the persons support network to allow for them to proactively support recovery; and brings together family/support units in a multi-family format to treat multiple persons at the same time while also drawing on the benefits of peer support and learning.

EDFA would like to see TBT-S available to people with AN and their families in Australia as we believe it has a number of benefits not currently readily accessible. It involves families as a critical resource, using psycho-education for both the person with the illness and their families to tailor treatment plans. It can be suitable for rural and remote families to attend as a one-week intensive program with 5-7 families/support units, after which the person can return to their local generalist outpatient team. This model provides an intensive specialised treatment method, developing a clear behavioural contract/shared action plan with the person and their supports and developing an ongoing meal plan which works for the person etc.

Alternatively the model can be adapted as a series of one day multi-family  workshops or even spread out over a series of half day workshops. Clinicians also learn many skills/activities which can be incorporated in more traditional one-on-one treatment methods.

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Prof Ivan Eisler talking about TBT-S

Dr Stephanie Knatz Peck (one of the trainers coming out in February/March 2019 to Australia and New Zealand) chats with Prof Ivan Eisler, founder of MFT-AN for adolescents.