From: Outcomes for binge eating disorder in a remote weight-inclusive treatment program: a case report
Goal | Objectives | 30-Day | 60-Day | 90-Day | 120-Day | 150-Day progress | Discharge progress |
---|---|---|---|---|---|---|---|
1. Decrease the frequency and intensity of daily bingeing and night eating episodes and increase daytime and overall nourishment Client’s words: To “not be obsessed by food”, “have a normal relationship with food”, and “cook more fresh foods” | A. Eliminate daily bingeing and night eating episodes | Bingeing less than 1×/day; Night eating occurring 1×/night | Bingeing 1-2×/week; Night eating occurring less than 1×/night | No longer bingeing; Night eating occurring more than 1×/night | Night eating occurring during 1 out of 3 wake periods | Night eating occurring 1×/night | Remains active |
B. Eat according to meal plan routinely | Improvement but lacking consistency | Accomplished at home; Applying outside of the home | Completing meal plan but having urges to restrict | Missed some meals and snacks when not at home | Met | Continues to complete 100% of meal plan | |
C. Practice mindful and intuitive eating skills daily | Recognizes fullness and completes daily meal logs | Able to honor fullness | Working on feeling hunger cues | Recognizes hunger and engages in distraction- free eating | Practicing mindful eating | Remains active | |
D. Prepare/cook and try new foods several times a week | Cooking at least 1×/week in cooking class and trying new foods more than 2×/week | Tried additional new foods and recipes | Cooking meals and trying new foods at least 2×/week | Cooking and trying new foods independent of cooking class | Met | Continues to regularly prepare/ cook and try new foods | |
2. Examine and mend her connection to her body and adopt caring thoughts about her body Client’s words: To “move more in general” and “sit less and get out of the house more” | A. Engage in gentle movement to increase strength and flexibility several times a week | Attending movement group 2×/week | Not attending movement group consistently; Moving more in daily activities | Attending movement group when available; Completing household chores | Attending movement group; Going for walks with care partner | Met | Attending fitness program up to 3×/week outside of program |
B. Experience joy in movement several times a week | Participating but not experiencing joy | Exploring types of movement that bring her joy | Creating list of dance songs and having a “dance party” at home 1×/week | Enjoying walks with care partner; Reports enjoying movement group 50% of the time | Continue to enjoy walks; Appreciates movement group more with music she likes | Remains active | |
C. Challenge negative body image thoughts and develop sense of self outside of body appearance | Reminding herself that others like her for who she is not what she looks like | Recognizing sources of beliefs about beauty and weight | Struggling with increase in negative body image thoughts | Challenging belief that positive sense of self is tied to weight | Shifting focus to other aspects of self when having negative body image thoughts | Remains active | |
3. Improve general sense of self-worth and challenge negative thoughts about herself Client’s words: To “be kinder” and more “compassionate to myself” | A. Replace negative self-talk with positive or neutral self-talk | Using affirmations daily | Struggling with increase in negative self-talk | Refraining from family interactions that trigger negative self-talk | Negative self-talk has decreased | Able to rephrase negative self-talk into more neutral statements | Remains active |
B. Explore core beliefs underlying negative self-talk and challenge | Recognizing core beliefs about being a “bad person” | Practicing challenging core belief that she is “unworthy” | Able to accept that she is “worthy” | Experiencing greater sense of self-respect | Realizing that core beliefs are not accurate | Remains active | |
C. Engage in self-care and fulfilling activities several times a week | Engaging in self-care (e.g., doing hair and makeup) 2×/week; Attending art class and spending time with pets 2×/week | Met | Unable to attend class class but spending more time with spouse | Met | Continues to engage in self-care and participate in fulfilling activities | ||
4. Decrease depressive symptoms, PTSD symptoms, and process past trauma Client’s words: To “be more mindful” and “listen more” | A. Practice mindfulness and emotion regulation daily | Practicing mindfulness daily during meals/snacks | Experiencing increased comfort with mindfulness | Using relaxation skills and working on regulating emotions by ensuring adequate sleep | Continuing to use tools daily to promote mindfulness and emotion regulation | Sharing progress with others in group | Remains active |
B. Gain greater insight into the emotional states of self and others | Developing awareness of others’ perspectives; Receiving compliments without assuming malintent | Able to understand perspective of others with greater ease | Working on identifying and understanding own emotional state | Met | Continues to recognize emotional states of self and others | ||
C. Report and monitor any SI and commit to the prepared safety plan | Denies any SI since start of program | Fleeting passive SI but no plan; Committing to safety plan | No SI in over 2 weeks | No SI for 4-6 weeks | No SI for 2-3 months | Continues to be free from SI |