When Is Day Treatment a Better Option for Eating Disorder Recovery?

Eating disorders such as bulimia nervosa and anorexia nervosa are deeply complex and sometimes life-threatening mental health disorders that require specialized treatment. For this reason, some people who need help (or their loved ones trying to get them help) might think that they need residential mental health treatment to promote recovery. However, in many cases, a residential program is not the optimal choice for a person in recovery. These might include a person responsible for the care of a young child, a professional who cannot take off 30 days from work, or an adolescent getting ready for college who can’t miss school.

Even when there aren’t any responsibilities preventing someone from going into residential treatment, not every case requires the highest level of care. While one individual might need the structure and particularly medical oversight that a residential program provides, for others, day treatment programs are more accessible and offer more flexibility in scheduling. An eating disorder day treatment program can be ideal for individuals who need therapeutic sessions as well as the freedom to continue work or school. Here we’ll lay out what day treatment for eating disorders looks like and try to assuage some fears that it might not be as efficacious as residential treatment.

What Exactly Is Eating Disorder Day Treatment?

Day treatment, in contrast to residential treatment, is a program in which the individual attends regular meetings with a therapeutic team. Sometimes these sessions will be daily, or they may be spread out over a few sessions per week. Although by necessity, day treatment cannot provide round-the-clock medical and psychiatric coverage, it’s a more than viable option in most cases. For the large part, the therapeutic services offered by a day treatment program for eating disorders provide the same types of therapy and treatment as their residential counterparts.

The relative unavailability of medical and psychiatric care compared to residential programs is the only prominent difference between day and residential treatment. For people at medical risk due to malnutrition or other symptoms of a severe eating disorder, initially, a residential stay is recommended (after medical stabilization at a hospital), to be followed by day treatment, partial hospitalization, or intensive outpatient program. For people who need therapy but not intensive medical coverage, starting with day treatment is often the wisest choice.

Some forms of day treatment can have a medical component, however – such as the aforementioned PHP and IOP programs. Throughout the individual’s time in an eating disorder day treatment program, they’ll have regular sessions with psychiatric professionals who can help coordinate with medical teams to provide these services if needed. Once the medical and psychiatric risks have been stabilized, a day treatment center will focus on talk therapy with an individual focus.

Just Like Residential Treatment, Day Treatment Must Take the Individual Into Account

Although the science behind evidence-based day treatment programs recognizes that eating disorders often have carefully specified diagnostic criteria that remain the same from individual to individual, each person requires their own unique treatment plan. The individualized treatment plan recognizes that despite the many similarities, each individual in treatment has characteristics that can’t be effectively addressed by a “one-size-fits-all” program.

As an example, a program designed for a 16-year-old who restricts food intake due to anorexia nervosa won’t be effective for a person with orthorexia nervosa, who restricts food intake due to concerns over the “healthiness” of food rather than actively attempting to lose weight.   Differences in upbringing, sexuality and gender identification, socioeconomic background, and a host of other variables all contribute to the design of a person’s treatment plan.

Though they both share a diagnosis of an eating disorder, each of those people will have different life experiences that must be acknowledged and respected to regain their healthy selves. Most people expect this level of individualization from a residential eating disorder program; thankfully it’s also standard for any quality day treatment program.

Day Treatment and Residential Treatment Incorporate Many of the Same Methodologies

The core of any eating disorder treatment program is therapy. You may picture a person laying on a psychiatrist’s couch and weeping when you hear the term (and sometimes it’s true!), but modern therapy generally applies an evidence-based, clinically-backed approach to recovery. This is especially true when it comes to mental health conditions that require behavioral retraining, such as OCD, borderline personality disorder, and most eating disorders. These complex disorders need a more complex treatment plan that goes beyond simple therapy.

Some of the behavioral therapies included as part of a day treatment plan might include:

• Cognitive Behavioral Therapy

Almost every eating disorder treatment center makes use of cognitive behavioral therapy for eating disorder treatment. This form of therapy centers around identifying disordered thoughts and then systematically and rationally debunking them. Cognitive behavioral therapy can be done individually or with a group – during group sessions, individuals get to learn from one another, and during individual sessions, the client and therapist can build on prior progress in a more intimate way. During this process, back-and-forth dialogue between the participants commences. Over time the therapist will ask questions that help the client recognize that these thoughts are distorted – that they’re not objectively true but instead a reflection of their eating disorder. Eventually, CBT can help individuals recognize and experience these disordered thoughts without acting on them.

• Dialectical Behavior Therapy

Dialectical Behavior Therapy is built around a framework of repeated sessions that slowly reshape the way a person processes and identifies their feelings. This therapy module gets to the heart of emotional dysregulation issues that complicate the process of becoming recovered. As an example, a feeling of stress from work might prompt someone to binge eat as a coping mechanism. DBT allows them to identify this behavior as compulsive and detrimental, and work on replacing it with a healthier coping skill.

• Acceptance and Commitment Therapy (ACT)

ACT is a creative, mindfulness-based therapy that hinges on acceptance and values-driven action. You do not need to be well-versed in the theory of ACT to integrate ACT techniques into everyday sessions. ACT revolved around acceptance of your emotions and a rational, mindful path to experiencing them without feeling forced to act on them. ACT sessions teach people that they are not the same as their emotions. Just because a recurring urge to engage in disordered eating behaviors persist, a person does not have to act on them. Rather, an individual in ACT learns to accept these feelings and move on. Mindfulness is a core concept of ACT therapy. It is also useful in avoiding guilt or shame over disordered behaviors – learning to treat oneself with more compassion and forgiveness.

In addition to regular sessions examining disordered eating behaviors and emotions, other important components can be implemented on a day treatment basis. Group and family counseling sessions with an eye toward providing support to people with eating disorders are often part of a complete program, and available on a day treatment basis. Many graduates of eating disorder recovery programs point to group therapy as the most important part of their treatment – getting the perspectives of others is invaluable when understanding yourself.

Nutrition is also paramount for people with eating disorders. Whether on a weight restoration plan, a weight gain plan or no plan at all, people with eating disorders benefit greatly in the long run from understanding how nutrition affects a person’s life. It affects brain function as well as physical function, and these affect emotions and thoughts as well as physical health. Day treatment often includes nutritional education and meal-panning lessons that help individuals create delicious, satiating meals that also provide proper nutrition.

Virtual Programming Allows More Accessibility Than Ever

So day treatment consists of regularly attending therapy sessions and educational classes. Does this always have to be done at an office or a psychologist’s workspace? Absolutely not.

Telehealth already existed before 202, of course. However, the COVID-19 crisis and its attendant quarantines led to a nationwide proliferation that made mental health care more widely accessible than ever. Day treatment for eating disorders, unsurprisingly, translates very well to a virtual setting. Practically every one-on-one therapy like CBT, DBT, and ACT can be performed online. Group therapy sessions are possible as well, although they may be more difficult due to connectivity lags and the lack of easy interpretation of body language and expression.

The best news is that most insurances that cover day treatment also cover virtual treatment. These make online eating disorder recovery perhaps the best option for someone who doesn’t require medical care.

Wrapping Up

A modern, compassionate day treatment program focuses on helping individuals become fully recovered and embrace their healthy selves while allowing them the freedom to continue working, attending school, or providing childcare. In many cases, the staff is also recovered and knows firsthand what it’s like to repair their thoughts and actions in a healthy, food-positive way.

An eating disorder recovery journey isn’t like the way it’s sometimes portrayed in the media – it’s not always a residential treatment plan. Even when it is residential, it’s nothing like the “mental asylum” nightmare often portrayed in the media as an example of mental health treatment Day treatment options that provide the necessary levels of care, balanced with medical and psychiatric ways, are a perfectly viable option for a full recovery from any eating disorder.