Eating Disorders Clinical and Research Program

Clinical Program

The Eating Disorders Clinical and Research Program is led by Kamryn Eddy, PhD and Jennifer Thomas, PhD. The mission of the EDCRP is to deliver high-quality, evidence-based, time-limited patient care; conduct innovative research with clinical implications; offer training and dissemination of evidence-based treatments and research for students, early-career professionals, and the community; and provide education to the public about eating disorders.

Multidisciplinary Coordination of Care

In order to provide optimal care for our patients, we deliver mental health treatment within a multidisciplinary team. We have found that patient interests are best served when primary care and mental health clinicians practice within the same hospital system and can communicate easily with one another about treatment progress and planning.

We offer a detailed diagnostic evaluation with each new patient who is seeking to begin treatment for an eating disorder or related concerns. This comprehensive evaluation will:

• Evaluate current and past eating disorder symptoms
• Review previous psychiatric care
• Identify immediate and long-term medical concerns
• Formulate a treatment plan based on current evidence-based approaches

We give patients immediate feedback on the recommended treatment plan.

Treatment Options

The Eating Disorders Clinical and Research Program (EDCRP) provides comprehensive evaluation and a variety of outpatient treatment options for individuals ages ten and up struggling with eating disorders from compassionate and knowledgeable leaders in the field.

Our clinic offers many treatments shown to be effective in large-scale research studies as well as novel treatments that are currently being evaluated through our program’s research studies. Our clinicians will recommend the treatment best matched to your individual needs. If you are eligible for one of our treatment studies, this may be the treatment you are offered.

The COUNTERACT Study for Avoidant/Restrictive Food Intake Disorder (ARFID)

For children/adolescents ages 10-18 with ARFID

For children and adolescents ages 10-18 with ARFID, we are currently offering a study testing two treatments for ARFID: Cognitive-Behavioral Therapy for ARFID (CBT-AR) and Nutrition Counseling. Past research studies have shown early evidence that CBT-AR, a talk therapy, might be effective at helping people with ARFID reduce their symptoms and improve their well-being. Similarly, many patients report that they have found Nutrition Counseling helpful for ARFID as well. It's important for us to learn whether CBT-AR and NC work the way we think they do, because what we learn will help us understand ARFID better, and that will help us create even better types of treatment for ARFID. Both CBT-AR and NC can be individual or family-supported format, depending on patient age. To find out more, visit the COUNTERACT rally page. If you are interested in receiving treatment through this study, you can complete our pre-screen survey.

Twenty-Session Cognitive Behavioral Therapy for Anorexia Nervosa (CBT-20-AN)

For adults (18+) with anorexia nervosa

We are testing outcomes of a new CBT treatment designed for people with anorexia nervosa (AN), that is briefer than the original 40-session version of CBT but still allows sufficient time for weight restoration. The new treatment, CBT-20-AN, lasts just 20 sessions and has been designed to allow individuals with AN to benefit from CBT in less time, increasing access to care and shortening time to symptom reduction. Within one month prior to starting treatment, you must have met with your primary care physician, Adolescent Medicine physician, or consulting physician at Massachusetts General Hospital and see them regularly throughout the study treatment. If you are an adult interested in receiving CBT for anorexia nervosa, please contact Lily Palmer at lpalmer6@mgh.harvard.edu or call 617-724-0799.

Cognitive Behavioral Therapy for Eating Disorders

Cognitive behavioral therapy (CBT) is based on the premise that many of the psychological features of eating disorders are actually caused by under-eating—regardless of whether you are underweight, overweight or anywhere in between. CBT is designed to help you understand how all of your eating disorder symptoms fit together and then identify strategies for targeting each one. By recording your food intake, you can identify your own unique triggers for engaging in eating disorder behaviors such as restricting, binge eating or purging. If the scale or mirror dictates how you feel about yourself, CBT can help you improve your body image and identify alternate sources of self-esteem. Later sessions focus on relapse prevention so you feel properly equipped to handle setbacks.

There are multiple variations of CBT for eating disorders that our team practices. The number of sessions, frequency of sessions, and length of treatment will be determined by clinicians for individual patient needs. In all cases, CBT is a time-limited treatment.

To learn more about CBT, read Overcoming Binge Eating by Christopher Fairburn or Cognitive Behavior Therapy for Adolescents for Eating Disorders by Riccardo Dalle Grave and Simona Calugi.

To learn more about FBT, read Treatment Manual for Anorexia Nervosa: A Family-Based Approach by James Lock, Daniel Le Grange, W. Stewart Agras, and Christopher Dare.

Cognitive Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder

We also offer a new CBT program for individuals with avoidant/restrictive food intake disorder (CBT-AR) ages ten and up. CBT-AR developed here at Mass General focuses on normalizing eating, increasing macronutrient intake via food intake rather than dietary supplements and (if needed) restoring weight and growth. CBT-AR also targets the maintaining mechanisms of avoidant/restrictive eating, including sensory sensitivities, lack of interest in eating and/or fear of aversive consequences of eating (e.g., vomiting or choking) using exposure-based techniques.

CBT-AR can be delivered in an individual or family-supported format depending on patient age and treatment goals. CBT-AR is designed to last 20-30 sessions over 6-12 months.

CBT for Rumination Disorder

We offer brief CBT for rumination disorder (CBT-RD) for both children and adults. CBT-RD is designed to last five to eight sessions and involves general CBT techniques tailored specifically for RD. Primary interventions include psychoeducation and self-monitoring to enhance patient awareness of regurgitation timing and triggers, diaphragmatic breathing as a habit reversal strategy, patient-specific strategies for reducing residual regurgitation episodes and relapse prevention.

Family-Based Treatment for Eating Disorders

For underweight children, adolescents and young adults, family-based treatment (FBT) empowers parents to take charge of normalizing their child’s eating. Rather than focusing solely on the patient, the therapist meets with the entire family (including both parents and siblings) to mobilize them to fight back against the eating disorder. FBT features specialized coaching deigned to absolve parents of blame, separate the child from the illness and help parents re-nourish their child at home.

Later sessions gradually transition eating opportunities back to the adolescent and help the adolescent return to the developmentally appropriate task of growing up—from which he or she has typically been derailed by the eating disorder.

FBT is a time-limited treatment designed to last 20 sessions over the course of 6-12 months.

To learn more about FBT, read Help Your Teen Beat an Eating Disorder by James Lock and Daniel Le Grange.

Psychopharmacology for Eating Disorders

Medication management may be a useful tool for treating eating disorders and co-occurring psychiatric disorders, either alone or in conjunction with psychotherapy, following an initial psychiatric evaluation. As part of a psychopharmacological evaluation, one is provided with detailed medication information to allow one to make an informed decision if a psychotropic medication appears to be indicated for treatment. After initiating medication, the EDCRP works collaboratively with all treatment team members in order to closely monitor benefits and any possible side-effects that arise over the course of treatment. In order to be considered for ongoing psychiatric treatment at the EDCRP, all prospective patients must have a MGH-based PCP or work with an MGH-based eating disorder specialist.

Group Treatment for Eating Disorders

Some individuals find group therapy helpful, either instead of or in addition to individual or family-based treatment. We currently offer a dialectical behavioral therapy (DBT) group for eating disorders. This 16-week skills-based group is appropriate for adults (18 and up) seeking therapist and peer support to reduce eating disorder behaviors.

Pharmacotherapy

If needed, we also offer medication treatment in combination with therapy. Although medications are not a standalone cure against eating disorders, they can improve treatment response and help prevent future relapses. Eating disorders are often diagnosed along with other psychiatric conditions, which can be effectively managed with medication. We approach each case with a personalized plan based on the individual’s needs, backed by cutting-edge expertise in psychopharmacology.

Higher Levels of Care

Some individuals find that they are not able to beat their eating disorder through outpatient support alone. To learn more about treatment options, see the medical guidelines from the Academy for Eating Disorders.

While the EDCRP is an outpatient program, we often collaborate with our Harvard Medical School affiliates that offer high levels of care for eating disorders, including:

• Klarman Eating Disorders Center at McLean Hospital
• Boston Children’s Hospital

Appointments at the EDCRP

In order to be seen for a diagnostic evaluation, you MUST have a primary care physical at Mass General. Exceptions are made only for individuals interested in receiving treatment through a research study. If you have already established care with a primary care provider at Mass General, we may be able to provide ongoing care. However, we currently have a waiting list of several months, and our ability to follow patients depends on the capacity of our clinicians.

Please Note: We are an exclusively outpatient service. Our experience has taught us that some patients will benefit from either a partial hospitalization program or inpatient care to address urgent medical and nutritional issues prior to outpatient care in our program in order to achieve their therapeutic goals.

We are happy to provide feedback about the recommended clinical setting for initiating care in the pre-appointment screening.

Team Approach and Specialty Services

Our patients with an eating disorder often encounter medical problems and nutritional concerns that benefit from specialty care. We focus on treating the individual with a team approach, identifying appropriate clinical services to coordinate care.

• Department of Medicine
• Dialectical Behavior Therapy Program
• Division of Adolescent and Young Adult Medicine
• Division of Gastroenterology
• Klarman Eating Disorders Center at McLean Hospital
• Mass General Weight Center
• Nutrition Services
• Neuroendocrine Unit
• Obsessive-Compulsive and Related Disorders Unit
• Pediatric Gastroenterology
• Women’s Health Associates

Research

Our research efforts have been supported by the National Institutes of Health, the Rubenstein Foundation, the Hilda and Preston Davis Foundation, the Klarman Family Foundation and other generous patrons. 

Because a comprehensive diagnostic system is critical for etiological inquiry, clinical communication, case detection and treatment planning, our classification research explores how eating disorder categories can be improved by refining specific diagnostic criteria or adding new diagnoses. Our ongoing classification studies are done in partnership with investigators in the Mass General Neuroendocrine Unit. This work focuses on neurobiological, endocrine and genetic underpinnings of these disorders.

PIs Thomas/Lawson/Holsen:
https://reporter.nih.gov/search/C3JCrOFjHUisyPHvuZdoJA/project-details/10517967

Studies Open to Enrollment

COUNTERACT: CBT or Use of Nutrition Treatment: Early Randomized ARFID Clinical Trial

Children and teens between the ages of 10-18 years old who struggle with picky eating, are afraid to eat, or don’t feel interested in eating.

REACT: Restrictive Eating and Athlete Cognition Trial

Research has shown that females with eating disorders have lower levels of estrogen, leading to irregular or missed periods. Estrogen is involved in mental flexibility and reward responsiveness. This study aims to investigate whether replacing estrogen levels in young females with restrictive eating and/or athletes who have irregular periods will improve mental flexibility and reward responsiveness.

Project FEED: Fear of Eating Experiences in Daily life

Learn more with Rally.

ANSWER: Adult Neurobiology Study With Eating Restriction

See flyer or learn more about ARFID in this recent news story from WCVB Boston: "Is your 'picky eater' actually struggling with an eating disorder?"

Additional Research: Gastrointestinal Health and Eating Disorders

A Biobehavioral Approach to Understand Problematic Avoidant/Restrictive Eating in Adults with Functional Dyspepsia
Helen Burton Murray, PhD was awarded an NIH Career Development Award (K23 DK131334) under the mentorship of Drs. Braden Kuo (MGH Gastroenterology), Jennifer Thomas (MGH EDCRP), and Elizabeth Lawson (MGH Neuroendocrine Unit). Through this award, two research studies will be conducted to evaluate: (1) differences in gastric sensorimotor functions and satiety hormones among adults with functional dyspepsia and avoidant/restrictive food intake disorder (ARFID), functional dyspepsia without ARFID, and healthy controls; and (2) pilot feasibility, preliminary efficacy, and preliminary mechanisms of an exposure-based cognitive-behavioral treatment in patients with functional dyspepsia and ARFID. Opportunities are available for trainees to be involved in these projects, including as CBT interventionists (for psychology graduate and post-graduate trainees).

Additional Research: Genetic and Neuroendocrine Studies

In addition to our diagnostic classification studies, EDCRP and Neuroendocrine Unit studies aim to understand and treat osteopenia and osteoporosis, which are common consequences of anorexia nervosa and other low weight eating disorders. This research endeavors to develop and test novel hormonal treatments for anorexia nervosa and the common comorbid symptoms of depression and anxiety.

Hormonal Factors in the Treatment of Anorexia Nervosa
Principal Investigator: Anne Klibanski, MD
Funded by: National Institute of Mental Health
Closed to enrollment

Effects of Anorexia Nervosa on Peak Bone Mass
Principal Investigator: Anne Klibanski, MD
Funded by: National Institute of Diabetes and Digestive and Kidney Diseases
Closed to enrollment

IGF-I and Bone Loss in Women with Anorexia Nervosa
Principal Investigator: Anne Klibanski, MD
Funded by: National Institute of Diabetes and Digestive and Kidney Diseases
Closed to enrollment

Genetics and Neurobiology of Food Motivation Pathways in Anorexia Nervosa
Principal Investigator: Elizabeth A. Lawson, MD
Funded by: National Institute of Mental Health, Claflin Fellowship, Behavior Research Foundation NARSAD Young Investigator award
Closed to enrollment

Fat Mediated Modulation of Reproductive and Endocrine Function in Young Athletes
Principal Investigator: Madhu Misra, MD, MPH
Funded by: National Institute of Child Health and Human Development
Closed to enrollment

P. Evelyna Kambanis, PhD

• Clinical and Research Fellow

Dr. Kambanis is a Licensed Clinical Psychologist, specialized in the treatment of eating disorders. She received her PhD in Clinical Psychology from the University of Wyoming and completed her predoctoral internship at Massachusetts General Hospital (MGH)/Harvard Medical School. She is now a Fellow at the MGH Eating Disorders Clinical and Research Program.

Lilian Palmer

• Clinical Research Coordinator
  
  
  
  

Cathryn Freid, PhD

• Supervising Psychologist
  
  
  

Sophie Scharner, MD

• Child-and Adolescent Psychiatry Fellow
  
  

Teen Mentor Program

This program offers adolescent girls the opportunity to learn to promote positive self-image. Participants participate in mentoring workshops and an educational curriculum that covers topics from culture and media to self-esteem which supports the prevention of eating disorders and fosters positive self-image. We accept nominations of high school students who demonstrate leadership and have an interest in promoting wellness and positive body image awareness each fall.

Letters to Our Younger Selves: A Documentary on Body Image

The students in the 2014-2015 Teen Mentor Program created this short film as a culmination of their work. The original film, "Letters to Our Younger Selves", features fellow classmates sharing advice to their younger selves about confidence and self-image.

Nominate a teen mentor

Eating Disorder Resources

• Cognitive-Behavioral Therapy for Rumination Syndrome (CBT-RS)
  Helen Burton-Murray, PhD, Jennifer J. Thomas, PhD, and Adrienne S. Juarascio, PhD.
• Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults
  Jennifer J. Thomas, PhD and Kamryn T. Eddy, PhD
• Almost Anorexic: Is My (Or My Loved One’s) Relationship with Food a Problem?
  Jennifer J. Thomas, PhD and Jenni Schaefer
• The Picky Eater’s Recovery Book (Overcoming Avoidant/Restrictive Food Intake Disorder)
  Jennifer J. Thomas, PhD, Kendra R. Becker, PhD, and Kamryn T. Eddy, PhD

Professional Training & Education

The Eating Disorders Clinical and Research Program is committed to providing educational resources for individuals, families and the wider community with the tools they need to recognize, understand, and help others struggling with disordered eating. We help trainees cultivate expertise in empirically supported treatments and clinical research techniques. We also provide clinical consultation and off-site workshops to practitioners outside of Mass General.

• Cognitive Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: An Online Introduction
• Evidence-Based Psychological Treatments for Eating Disorders: Children, Adolescents, and Adults

Clinical Training

MGH Eating Disorders Psychology Advanced Practicum Program
The MGH Eating Disorders Psychology Advanced Practicum Program consists of a 12-month, interdisciplinary rotation. Practicum activities take place across two programs: the MGH Eating Disorders Clinical and Research Program and the GI Behavioral Health Program in the MGH Center for Neurointestinal Health. Practicum trainees may participate in a variety of supervised activities including assessment, consultation, and evidenced based interventions for pediatric and adult patients with various eating disorders and chronic GI conditions.

Practicum trainees will also have the opportunity to attend educational presentations, such as lectures, grand rounds and seminars, relevant to pediatric conditions and professional development of healthcare providers. By providing such opportunities, we hope to contribute to the trainee’s professional growth, education and competence. In addition, trainees may be asked to assist with research projects and program development.

For more information or to submit an application, please call 617-724-0799.

Mass General Internship in Clinical Psychology
Our clinical faculty provides supervision for several psychology interns per year in cognitive-behavioral therapy for eating disorders. Interns may arrange for 6-month or 12-month clinical electives and can receive training in both individual and group psychotherapy. Mentorship, supervision and case mix will be selected to create a foundation in evidence-based treatment for diagnostically diverse and complex patients.

Mass General/McLean Adult Psychiatry Residency
The PGY III Psychopharmacology of Eating Disorders module provides didactic training and supervision on pharmacologic management of eating disorders. PGY IV residents may also arrange for 6-month or 12-month clinical electives at the EDCRP. Mentorship, supervision and case mix will be selected to create a foundation in psychotherapeutic and pharmacologic management of diagnostically diverse and complex patients.

Multidisciplinary Eating Disorders Case Conference
A one-hour team clinician-to-clinician consultation is available as a pro bono service to clinicians managing challenging cases within the metro-Boston community. Clinicians are asked to present their cases at a clinical case conference and are provided with team feedback. These one-time consultations focus on topics such as optimizing communication within multidisciplinary teams, selecting the optimal level of care for a specific patient and engaging a patient who is ambivalent about relinquishing valued symptoms.

Off-Site Evidence-Based Treatment Workshops
The EDCRP is dedicated to the dissemination of empirically supported treatments to interested real-world practitioners. Our faculty members have led interactive workshops on the use of cognitive-behavioral therapy and family-based treatment for eating disorders locally, regionally and nationally.

To inquire about faculty availability and fee structure, please call 617-724-0799.

Research Training

Please note: Per hospital-wide policy, we cannot offer unpaid research assistantships. With the exception of the Summer Research Fellowships, students who wish to work with us must first arrange to earn course credit from their undergraduate or graduate institution.

Mass General/McLean Adult Psychiatry Residency and Mass General Internship in Clinical Psychology
Residents and interns who wish to undertake clinical research in eating disorders are invited to contact program faculty to discuss their interests and possible mentorship opportunities. A 6- to 12-month commitment is required.

Summer Research Fellowships
Each summer, the EDCRP mentors emerging scientists and students, giving them the resources and guidance they need to undertake an eight-week independent research project.