Written by Katrina Kostro, BA, and Christine Call, AB.
At first glance, eating disorders may appear to be simple behavioral issues with equally simple solutions: just eat and there won’t be a problem. If our two years as research assistants at the Columbia Center for Eating Disorders have taught us anything, it’s that eating disorders are never as simply solved, as much as we might wish, by “just eating.” Our interactions with patients and our involvement in the research studies underway at our program have taught us that eating disorders stem from a complicated combination of factors—biological, genetic, and environmental—and that effective treatments have to address an equally tangled web of problematic thoughts, feelings, and behaviors. In order to better understand these illnesses, science must rely on a full range of methods, including brain scans, psychological interviews, and laboratory meals. Working closely with clinicians and patients on multifaceted research studies, we have learned some important lessons about how – and why – our group is dedicated to the work it does.
I. Relationships matter.
Although research assistants do not provide clinical treatment — we have not completed medical school or PhD programs (yet) — we serve as liaisons between the doctors and patients. As research assistants we are sometimes considered to be ‘the voice of the clinic,’ and we aim to be a friendly and helpful voice. The first step for most individuals seeking to participate in research is to call the main clinic line, which we answer Monday through Friday, 9am-5pm. If patients are eligible to participate in research and receive treatment, we coordinate appointments and administer many of the study procedures. In the time we spend talking with patients — on the phone, in the waiting room, and during procedures — it is important to us that they feel valued and respected. Over the last two years, we’ve come to see just what a significant contribution to science patients in our program make.
II. Unusual tasks teach us a lot!
Scientific studies often rely on unusual tasks (some of which appear unrelated to what we are actually investigating). For example, patients with anorexia nervosa who were receiving treatment on our inpatient unit were recently asked to tap a keyboard hundreds of times to earn a reward: they were able to choose either exercise or money. What in the world can keyboard taps teach us about anorexia nervosa? This particular paradigm was modeled on animal studies assessing motivation and reward, where animals press a lever to receive a desired substance — for example, sugar water. Those lever presses inform us about what the animal finds rewarding and motivating. These principles have been adapted to substance abuse research to assess how rewarding specific drugs are to individuals with and without substance disorders. Our study investigated how reinforcing, or rewarding, physical activity was to patients with anorexia nervosa before and after treatment, and compared their activity levels (and the reinforcing properties of the exercise) to those of healthy controls. The rationale for this study was to learn more about physical activity in a patient group that sometimes struggles with over-exercise despite being underweight so that new interventions to help can be developed. No matter how unusual the task, the Center’s studies are cleverly designed in the service of learning more about eating disorders and their treatment.
III. Every meal is a process.
On Fridays, research assistants lead a meal-process lunch group with inpatients at the program. This group provides support for patients during and immediately following a meal; it is a time for reflection in which patients can discuss challenges, goals, and steps toward recovery. For us, meal-process is one of the most informative and unique experiences on the job. In co-leading this group, we are directly confronted by one of the most complicated struggles of those with eating disorders — the act of eating. As one of our program’s psychologists, Dr. Amanda Brown, recently wrote, for an individual with an eating disorder, mealtime is like a battlefield. The Friday meal-process group gives research assistants a chance to step out of their research-specific roles and join patients in their battle.
IV. Patients move on, but they are never forgotten.
Most of our research occurs at discrete time points (often when symptoms are at their worst and sometimes immediately following treatment). But that doesn’t mean that a patient’s research participation grinds to a halt once he or she exits the building on the last day of treatment. Our team wants to know how individuals struggling with eating disorders fare in the years following their involvement with us. We therefore ask patients to participate in brief annual follow-up interviews for ten years after their stay. This information will ultimately help us to understand the effectiveness of our program specifically, and to answer important general questions about recovery and relapse. The annual conversation, though brief, is a welcome opportunity for us to stay in touch with patients, to let them know of our findings, and to be helpful in any other ways we can.
During our time as research assistants at the Center, we have learned so much about eating disorders and clinical research, while interacting with a wide range of people (research participants, colleagues, and supervisors), and balancing multiple projects to accomplish as much as we can in the name of science. We want to thank everyone involved at the Center, participants and staff alike. We will certainly continue to stay connected, to follow The Feed Blog, and we invite you to do so too!
