Castlewood Eating Disorder Treatment Center Blog
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Exposure Therapy at Castlewood

Recovery from an eating disorder is a journey, with different phases and stages along the way. While not everyone has the exact same journey, it’s certainly not uncommon for our clients to begin in an intensive, residential program before transitioning into a partial hospitalization program (PHP). Ultimately, as clients make these transitions, our treatment approach encompasses more and more exposure therapy, wherein clients are asked to identify some situations that cause them anxiety—situations that they might normally either avoid or have trouble tolerating without ritualizing or doing harm to themselves. We gradually and repetitively place clients into these situations, offering guidance and support to prevent them from engaging in rituals or in self-harm. Through this repetition, clients learn that their fears about these situations are ill-founded, and they become more comfortable and more independent in dealing with them head-on, without ritual or harm.

A Typical Day in PHP

In a sense, the transition from the initial inpatient care level to PHP is one of increased independence: While Castlewood staff members are very much available to support all our clients, those who are in PHP are encouraged to make more decisions for themselves, to implement the skills they’ve learned, and to address challenges without as much direct engagement from the Castlewood staff. This is what exposure therapy is centered on. As the client moves into PHP, he or she will be placed into stressful situations that call for the practical application of learned skills, which at first is daunting but in time becomes more comforting, even empowering. There are several examples of how exposure therapy can work:
  • While we will initially portion meals for most Castlewood clients, in accordance with a dietitian’s guidance, those who are in PHP may be encouraged to portion their own meals, and to use what they’ve learned to put their own plates together.
  • Accountability is another big part of exposure therapy. While clients in residential care may have Castlewood staff members checking to ensure they are eating rich, varied diets, those in PHP are often expected to maintain those standards without someone looking over their shoulders.
  • Some of our exposure therapies may involve off-site activities. Going to the grocery store to pick out food, or even dining out with other Castlewood clients, are important ways for our clients to develop normalized approaches to food preparation and eating.
  • Speaking of food preparation, client creations is another key exposure therapy—essentially, evenings set aside for advanced PHP clients to work together to make a community meal, drawing on what they’ve learned from their therapists and nutritionists.
Exposure therapies are done both in individual and group settings, and will vary a bit from one client to the next. Of course these exposures are done with some supervision from our staff, but we also encourage independence throughout the process. Often, our staff members will encourage clients to tackle their struggles using their own judgment and critical thinking.

Exposure and Response Prevention

It’s also important to note that clients are treated with various exposure therapies, including exposure and response prevention; this is an effective form of treatment for those who struggle with OCD or other anxiety disorders, in addition to their eating disorder. What this means is that each client’s underlying issues are addressed, rather than their symptoms merely being swapped around. Here’s how it works: Clients are asked to identify anxiety-provoking situations that they usually just avoid, or have difficulty tolerating, without resorting to ritualistic or self-harming behaviors. Our therapists gradually and repetitively expose clients to these situations while encouraging them not to engage in ritual behaviors to cope. It is through this consistent exposure to anxiety-provoking scenarios that clients allow themselves to see that what they fear will happen in a given situation won’t actually occur; thus, their fear and anxiety are reduced naturally.

Eating Disorder Recovery at Castlewood Treatment Center

All of these activities are challenging, and they’re meant to be. Recovery isn’t easy, and it’s not without its stressors and its temptations. These challenges serve a purpose, however, and it’s important to emphasize just how many concepts clients absorb from the therapeutic program; the exposure therapy really puts these concepts to the test, and helps the individual to experience different things within a safe, controlled setting. This is an approach that ultimately yields results for many clients, and it’s something we’d love you to learn more about. Contact us at Castlewood to inquire about our treatment approach. Share your experience with exposure therapy in the comments.  
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