Rewards Matter for Eating Disorder Patients

By Vicki Berkus M.D., Ph.D., CEDS, Remuda Ranch Medical Advisor

People who are struggling with their eating disorders (ED) and refusing to cooperate in treatment often need rewards they can work toward. Being in treatment would be hard for anyone; but, it’s especially hard for adolescents and for those who don’t yet have coping skills or a mind that’s fed well enough to fully function.

Privileges as Rewards

To encourage patients to follow their treatment plans, most programs use levels of activity as rewards. Anything that patients tend to look forward to–going on outings, going to a movie, more exercise time, eating somewhere other than the treatment group table for a meal — can serve as motivation for patients to adhere to their treatment regimens.

I used to be stopped in the hall by my patients with requests. “Can I _________?” they would say. They couldn’t help themselves. The idea that their entire treatment team would have to make the decision, not just me, was not in their thoughts at the moment of the request.

I decided to come up with a system that would help them know exactly what they needed to do to earn one of the privileges they wanted.

Actions Replace Words

I would have patients fill out a “request sheet” every Monday. On the sheet they were asked to write down what they wanted to do most at the end of the week — exercise more, go on an outing, etc. They also would have to write down what would be required for them to be allowed to do what they asked. (e.g., eating 100 percent for the three days prior to the activity, or not needing to be reminded to limit their movement when sitting.)

Depending on each patient’s need, the clinical team would either set the criteria for them or the patient would sit with the therapist to develop the criteria. Either way, the patient knew and agreed upon exactly what they needed to do on their part to get the added perks.

I was amazed at how quickly their behavior changed. Instead of finding me and putting a lot of energy into “making their case,” they would get excited for the change and for the challenge of meeting their goals. They would then hear from the clinical team by Thursday what the weekend would look like in terms of activities and changes.

It sounds simple but ED patients are adept at holding onto the yardstick that compares their peers’ eating disorder behaviors to their own. The ability to put on “emotional blinders” and focus on their treatment is just not in their skill set in the beginning of treatment. Having structured reward systems help them to achieve that focus.

A Team Approach

It is important for treatment teams to be consistent with patients and for each team member to be fully up to date on the latest information about their behavior and their risks. Patients need to know that the team members have access to their daily behaviors including, meal consumption, fluid consumption or daily weights. They also need our united front on the decisions we make that have such a significant impact on them during their treatment.

At Remuda Ranch at The Meadows, we use a consistent team approach every day and work with each person individually based on their strengths. With the support of our teams, our patients achieve much greater success toward their recovery.

If you would like to find out more about Remuda Ranch, please call 866–390–5100 or contact us.

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