Table 2 Brief summary of the main activities/goals of each session of the HAPIFED pilot study
STAGE 1 | |
Session 1 | Information about the treatment: real-time recording of eating behavior, weighing and treatment goals. Psychoeducation on eating disorders and the transdiagnostic cognitive-behavioral model of eating disorders. |
Session 2 | Assessment of participants’ real-time recording of their eating behavior and assessment of their eating habits. Psychoeducation on eating disorders continues. Information on behavioral weight loss therapy. |
Session 3 | Psychoeducation on the importance of regular eating. Information on physical activity including discussion on healthy and excessive exercise. |
Session 4 | Review of participants’ understanding of the behavioral weight loss therapy. Discussion on purging and its negative consequences. Nutritional education. |
Session 5 | Discussion of factors that can lead to and maintain binge eating. Discussion on how feelings of fullness after eating can trigger eating disorder behaviors. |
Session 6 | Discussion of participants’ engagement in physical activity. Review of participants’ understanding of the difference between healthy and excessive exercising. |
Session 7 | Discussions on how significant others (e.g. family and friends) can be helpful in helping participants improve their eating behaviors. Mindful eating activity and discussion. |
STAGE 2 | |
Session 8 | Slow breathing activity. Review of participants’ progress with the treatment and identification of potential barriers to change. Review and personalization of the transdiagnostic cognitive-behavioral model of eating disorders. |
Session 9 | Progressive muscle relaxation. Review of participants’ progress with the treatment and identification of potential barriers to change. Review and personalization of the transdiagnostic cognitive-behavioral model of eating disorders. |
STAGE 3 | |
Session 10 | Discussion on the negative consequences of overvaluation of the importance of body shape and weight. Activity on helping participants identify parts of their bodies that they like. |
Session 11 | Discussion on the importance of other domains of self-evaluation not related to body shape or weight. Activity on identifying participants’ positive characteristics (not related to body shape or weight). |
Session 12 | Discussion on the importance of participants engaging in self-nurturing activities in order to maintain a positive mindset and how this can be beneficial for their eating behavior. Discussion on excessive body shape checking or avoidance, and their negative consequences. |
Session 13 | Discussion on factors that can contribute to participants’ “feeling fat”. Discussion on ways of increasing self-confidence and its benefits. |
Session 14 | Therapists focus on Socratic questioning in order to help participants identify their cognitive distortions regarding “feeling fat” and other dysfunctional thoughts related to their eating disorder. Review and discussion of the transdiagnostic cognitive-behavioral model of eating disorders. |
Session 15 | Discussion on black/white (dichotomous) thinking and perfectionism related to eating disorders. Activity on helping participants reflect on the origins of overvaluation of the importance of body shape and weight. |
Session 16 | Discussion on the “eating disorders mindset”. Discussion on how participants could create and maintain social connections with people that are supportive (and not detrimental) of their recovery from the eating disorder. |
Session 17 | Discussion on the negative effects of strict and unhealthy dietary restraint. Discussion on the negative consequences of overvaluation of the importance of body shape and weight, and the benefits of developing other core values and engagement in healthy activities related to these new values. |
STAGE 4 | |
Session 18 | Discussion of relapse prevention strategies. Discussion on strategies to respond in a healthy manner to event-related negative changes in eating. Activity on proactive problem solving. |
Session 19 | Discussion on residual binges by reviewing factors that may contribute to their maintenance. Discussion on strategies to respond in a healthy manner to mood-related negative changes in eating. Discussion on unhelpful thinking styles that contribute to the maintenance of eating disorders. |
Session 20 | Discussion on participants’ plans for healthy eating after the treatment has finished, relapse prevention and new core values. End of treatment. |