New director discusses binge eating, support services

Recognizing the need for a greater focus on binge eating disorder treatment, Walden Behavioral Care recently named Kate Craigen, Ph.D., to a newly created position as clinical director, binge eating and bariatric support services.

While Walden has been offering specialized binge eating disorder treatment throughout its eight locations in New England since 2003, the organization recently decided to create the position in order to better serve a rising tide of clients seeking help. Craigen, who was employed prior to the promotion as a clinician for Walden, will lead the program’s curriculum development, staff training and clinical supervision of related intensive outpatient and outpatient programs. She will also collaborate with local surgeons for pre and post bariatric surgery treatment.

New England Psychologist’s Catherine Robertson Souter spoke with Craigen about the new role as well as the greater need for binge eating disorder and bariatric surgery treatment.

Q:  This is a new position but not a new treatment plan for Walden. What has changed?

A:  I think that Walden creating this role is really a reflection of its recognition of a need for specialized treatment for this population as well as the recognition that this is an area of treatment that is really growing based on people’s increased awareness of it.

We have had a program in existence for over a decade now but with the addition in the newest edition of the DSM of binge eating disorder as a formally recognized diagnosis, there are more people recognizing this is the name for what they have been struggling with. Walden wants to make sure that we are growing our programming and reaching as many people as possible, providing all the training and education that we need both to people within system and also to providers in our community.

Q:  Do you think that the growth is because of the greater recognition or could it also be an escalating problem?

A:  It is difficult to know whether the number of cases is really on the rise or if we are just doing a better job addressing and diagnosing the problem. We have greater public understanding and acceptance of eating disorders and that formal recognition, in many ways, leads patients to seek out treatment as well as insurance companies to cover treatment.

The data suggests binge eating disorder is the most common eating disorder. Around 4.2 million women and around 2.3 million men in the U.S. are currently suffering.  

Q:  Awareness has increased in the general public but what do people still not understand about binge eating disorder?

A:  In general, there is a real misperception around the idea of control over binge eating. We do a lot of work in treatment to help people interrupt those behaviors before they start but it is more complicated than people believe and that goes for the people struggling as well as those who support them. There is a misunderstanding about the degree to which they are able to interrupt those behaviors once they start.

Q:  What is the gold standard of care?

A:  There is probably the most scientific evidence for cognitive behavioral treatment for binge eating disorders but there is also support for interpersonal psychotherapy and some of the mindfulness intervention. We also have promising data to support dialectical behavior therapy as well as ACT, acceptance and commitment therapy.  

The binge eating disorder intensive outpatient program is a three-nights-per-week evening program. No treatment works for everyone so we do our best over the course of about six weeks to provide access to interventions from all of those treatments.

Q:  You also work with people pre and post bariatric surgery?

A:  Yes, we are working to partner with and collaborate with bariatric surgery teams across New England to support the behavioral changes that are required for successful outcomes in bariatric surgery.

Many of the skills we have an expertise in teaching are helpful in establishing long-term behavioral change with regard to emotional urges around eating and binge eating. In many cases, eating has become a coping skill so for the bariatric surgery population we aim to teach new and alternative coping skills.

Q:  What are the other coping skills you might teach for all your clients?

A:  We have many different skills; some are more behavioral in nature when it comes to participating in alternative activities to help shift the mood. Sometimes, the activities are more geared towards allowing time to elapse, so your emotional intensity will shift or change in one way or another. We start with an increased awareness of the emotions and thoughts that tend to be challenging. In some cases, the skills are not about taking away distress or discomfort but about managing the intensity of that emotion rather than necessarily believing that they have to get away from it or that they can’t handle it.

Q: What are your goals or plans for the program as you step into this role?  

A:  A big goal is education. Walden wants to increase awareness of binge eating disorder and work to decrease some of the stigma around the illness that keeps people from coming to treatment. We are doing this via videos that we are posting online and with presentations in the community and to providers.

I am also interested in developing new treatment offerings that we can use to reach more people for whom the evening intensive outpatient program doesn’t work. We are working to figure out what the other needs are for this population, for example, offering medication management or dietician counseling.

Right now, we have begun offering CBT guided self-help treatment. We are developing new treatment and supporting ongoing program development for our specialized intensive outpatient program. I am collecting data on efficacy so that we can shift and change that treatment as we discover what is most helpful for people.

The other major goal of my role is to increase specialized training to treat binge eating disorder across the company. Currently, I am working directly with one clinician in each of our clinics across Massachusetts and Connecticut who is receiving specialized training and supervision for the treatment of binge eating disorder. The goal is for them to become the expert and specialist at their site which increases the efficacy of the treatment there and my ability to provide any supervision or consultation that is needed across the system.

Q:  What would you suggest for psychologists reading this article? How can someone learn more about what they should be looking for in their clients that may necessitate referral to an eating disorder program?

A:  I think that directly querying eating behaviors would be helpful. Because of shame and guilt, patients may be hesitant to bring up this pattern of behavior. The validating and non-judgmental therapeutic setting is a great place to begin to explore some of this.

The Walden Web site has a range of binge eating disorder information. I have put in a lot of effort with the marketing team to make sure that information is accurate and accessible. The Web site is a great place to reference.