Practically Speaking: Behind the Episode - E Is For “Enhanced”: CBT-E For Eating Disorders
By Dr. Kevin Holloway & Dr. Suzanne Straebler
Eating disorders are a significant and often underreported issue within the U.S. military, affecting service members' health, readiness, and overall well-being. These disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder, present unique challenges in the military environment due to the intense physical and psychological demands placed on personnel. The pressure to maintain certain weight standards and physical fitness levels can exacerbate the risk of developing unhealthy eating behaviors, contributing to the prevalence of these disorders among service members.
Listen to the full discussion here: E Is For “Enhanced”: CBT-E For Eating Disorders
One of the primary factors contributing to eating disorders in the military is the stringent weight and fitness requirements. Military personnel are required to meet specific body composition standards, sometimes leading to extreme measures to achieve and maintain these standards. This pressure can result in disordered eating behaviors, such as excessive dieting, purging, and over-exercising. Additionally, the stigma associated with failing to meet these standards can prevent individuals from seeking help, further exacerbating the problem.
The unique stressors of military life also play a significant role in the development and maintenance of eating disorders. Deployments, high operational tempos, and the constant threat of combat can lead to heightened stress and anxiety, which are known risk factors for eating disorders. The culture of toughness and resilience in the military can also discourage individuals from acknowledging their struggles with eating disorders, leading to a lack of support and resources for those affected.
And yet, for many behavioral health providers working with Service members, eating disorders may be one of the last things we are thinking about when in a clinical encounter unless it is explicitly stated as the presenting concern. This may be due to a number of factors, including screening and assessing for other behavioral health concerns (e.g. PTSD, depression, or anxiety), not feeling competent to assess for or treat eating disorders unless having received specific training, or even perhaps the erroneous assumption that eating disorders “take care of themselves” in the military in which severe eating disorders are easy to identify and readily lead to medical discharge.
What can be done? Fortunately Dr. Suzanne Staebler joined us for the most recent Practical For Your Practice podcast episode to discuss the problem and implications of eating disorders among military personnel, but also suggestions regarding how behavioral health providers can be part of the solution. She emphasized that many of us have biases and make assumptions about eating disorders, including who suffers, how much control an individual has regarding eating disorders, and how easily they may be detected. She explained, “We had this image, that the individuals who got eating disorders were young, white, affluent females… And thankfully the field has moved on, but a lot of that view, it's still out there. And so we know that eating disorders impact all individuals across races, ages, genders, ethnicity, socioeconomic status, and across body shape and size.”
The good news is that we have effective, evidence-based psychotherapy for eating disorders, CBT-E. And as Dr. Straebler explains, “the E stands for enhanced” meaning that while most providers are familiar with standard cognitive behavioral therapy on which CBT-E is based, there are some important differences in the implementation of CBT for eating disorders, hence the “E”. She further explains, “Well-implemented CBT-E, for people who complete it, over two thirds of patients can make long and lasting recovery. So eating disorders are treatable, especially when the treatment that they receive is a good, well-implemented therapy.”
CDP is excited to host Dr. Straebler presenting a two-day training workshop in CBT-E on August 28-29, 2024 (and hopefully more future workshops!) and invite all providers to register and participate.
Join us in the discussion here.
Also save the date for P4P’s upcoming “Live” episode in which we want to hear from YOU our listeners! On Aug 13, 2024 1000-1200 Eastern, you can be part of the conversation and the podcast! Have a question for our hosts? Reactions to previous episodes? Want to share your “What is your why?” origin story? Give us a call! 301-715-8592, code 4878058925#. And if you can’t call us at that time, you are welcome to leave us a voice-mail message at speakpipe.com/cdpp4p or send us an email at cdp-podcast-ggg@usuhs.edu. The episode will not be broadcast live, but will be recorded and edited before release, so don’t let that deter you!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kevin Holloway, Ph.D., is a licensed clinical psychologist working as Director of Online Training, Technology and Telehealth (OT3) at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, he leads a team of subject matter experts and support staff to develop and present workshops across the world to military and civilian audiences on topics in deployment behavioral health and evidence-based therapies for Posttraumatic Stress Disorder (PTSD).
Suzanne Straebler, Ph.D., PMH-BC, is the clinical director of the Center for Eating Disorders Partial Hospital Program and Outpatient Specialty Clinic at Weill Cornell Medicine – New York Presbyterian Hospital. She holds an academic appointment at Weill Cornell Medicine as a research associate in psychiatry. She is a lead trainer for the CBT-E training group and has trained and supervised therapists around the world. For over a decade Suzanne was a Senior Research Clinician at the Centre for Research on Eating Disorders at Oxford (CREDO) headed by Professors Christopher Fairburn and Zafra Cooper. While there, she received extensive clinical training, was a contributing author of the CBT-E treatment manual, assisted in the creation of a web-based CBT-E training program, and completed her doctoral thesis on improving therapist training in evidence-based treatments.
By Dr. Kevin Holloway & Dr. Suzanne Straebler
Eating disorders are a significant and often underreported issue within the U.S. military, affecting service members' health, readiness, and overall well-being. These disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder, present unique challenges in the military environment due to the intense physical and psychological demands placed on personnel. The pressure to maintain certain weight standards and physical fitness levels can exacerbate the risk of developing unhealthy eating behaviors, contributing to the prevalence of these disorders among service members.
Listen to the full discussion here: E Is For “Enhanced”: CBT-E For Eating Disorders
One of the primary factors contributing to eating disorders in the military is the stringent weight and fitness requirements. Military personnel are required to meet specific body composition standards, sometimes leading to extreme measures to achieve and maintain these standards. This pressure can result in disordered eating behaviors, such as excessive dieting, purging, and over-exercising. Additionally, the stigma associated with failing to meet these standards can prevent individuals from seeking help, further exacerbating the problem.
The unique stressors of military life also play a significant role in the development and maintenance of eating disorders. Deployments, high operational tempos, and the constant threat of combat can lead to heightened stress and anxiety, which are known risk factors for eating disorders. The culture of toughness and resilience in the military can also discourage individuals from acknowledging their struggles with eating disorders, leading to a lack of support and resources for those affected.
And yet, for many behavioral health providers working with Service members, eating disorders may be one of the last things we are thinking about when in a clinical encounter unless it is explicitly stated as the presenting concern. This may be due to a number of factors, including screening and assessing for other behavioral health concerns (e.g. PTSD, depression, or anxiety), not feeling competent to assess for or treat eating disorders unless having received specific training, or even perhaps the erroneous assumption that eating disorders “take care of themselves” in the military in which severe eating disorders are easy to identify and readily lead to medical discharge.
What can be done? Fortunately Dr. Suzanne Staebler joined us for the most recent Practical For Your Practice podcast episode to discuss the problem and implications of eating disorders among military personnel, but also suggestions regarding how behavioral health providers can be part of the solution. She emphasized that many of us have biases and make assumptions about eating disorders, including who suffers, how much control an individual has regarding eating disorders, and how easily they may be detected. She explained, “We had this image, that the individuals who got eating disorders were young, white, affluent females… And thankfully the field has moved on, but a lot of that view, it's still out there. And so we know that eating disorders impact all individuals across races, ages, genders, ethnicity, socioeconomic status, and across body shape and size.”
The good news is that we have effective, evidence-based psychotherapy for eating disorders, CBT-E. And as Dr. Straebler explains, “the E stands for enhanced” meaning that while most providers are familiar with standard cognitive behavioral therapy on which CBT-E is based, there are some important differences in the implementation of CBT for eating disorders, hence the “E”. She further explains, “Well-implemented CBT-E, for people who complete it, over two thirds of patients can make long and lasting recovery. So eating disorders are treatable, especially when the treatment that they receive is a good, well-implemented therapy.”
CDP is excited to host Dr. Straebler presenting a two-day training workshop in CBT-E on August 28-29, 2024 (and hopefully more future workshops!) and invite all providers to register and participate.
Join us in the discussion here.
Also save the date for P4P’s upcoming “Live” episode in which we want to hear from YOU our listeners! On Aug 13, 2024 1000-1200 Eastern, you can be part of the conversation and the podcast! Have a question for our hosts? Reactions to previous episodes? Want to share your “What is your why?” origin story? Give us a call! 301-715-8592, code 4878058925#. And if you can’t call us at that time, you are welcome to leave us a voice-mail message at speakpipe.com/cdpp4p or send us an email at cdp-podcast-ggg@usuhs.edu. The episode will not be broadcast live, but will be recorded and edited before release, so don’t let that deter you!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kevin Holloway, Ph.D., is a licensed clinical psychologist working as Director of Online Training, Technology and Telehealth (OT3) at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, he leads a team of subject matter experts and support staff to develop and present workshops across the world to military and civilian audiences on topics in deployment behavioral health and evidence-based therapies for Posttraumatic Stress Disorder (PTSD).
Suzanne Straebler, Ph.D., PMH-BC, is the clinical director of the Center for Eating Disorders Partial Hospital Program and Outpatient Specialty Clinic at Weill Cornell Medicine – New York Presbyterian Hospital. She holds an academic appointment at Weill Cornell Medicine as a research associate in psychiatry. She is a lead trainer for the CBT-E training group and has trained and supervised therapists around the world. For over a decade Suzanne was a Senior Research Clinician at the Centre for Research on Eating Disorders at Oxford (CREDO) headed by Professors Christopher Fairburn and Zafra Cooper. While there, she received extensive clinical training, was a contributing author of the CBT-E treatment manual, assisted in the creation of a web-based CBT-E training program, and completed her doctoral thesis on improving therapist training in evidence-based treatments.