Written by Mylène Wilhelmy, MD, and Lisa Ranzenhofer, PhD.
Research also reflects this. In longitudinal studies of patients with eating disorders, a subset of individuals—about 30-50%—continue to experience symptoms years later.
The first few months following discharge from a structured treatment (e.g., hospitalization, partial hospitalization, or IOP (intensive outpatient program)), seem to be a critical period in which relapses tend to occur. In long-term follow-up studies of patients with anorexia nervosa, up to 50% of adults require rehospitalization within a year of discharge.
Transitioning from a higher level of care to just one or two hours of treatment per week may increase the risk of relapse for a number of reasons, including that:
- Patients must rely more exclusively on their own skill set in order to implement treatment plans multiple times per day (including, in the case of anorexia nervosa, eating adequately to maintain a healthy weight range).
- After structured treatment, people typically return to “real life” and all of its inherent stress, such as school, work, family and other relationships.
- Mixed feelings about recovery are common for those with eating disorders, and this uncertainty can lead to fluctuations in motivation and adherence to treatment in a less controlled environment.
We need to learn more about how to successfully support individuals following intensive treatment. Inspired by our partners at Project Heal, we are seeking to do just that, starting with the question: Can peer mentors help patients as they transition from more to less structured treatment?
In 2016, Project HEAL, a non-profit organization whose aim is helping individuals who suffer from eating disorders, launched a new mentorship initiative across multiple sites in the United States: Communities of HEALing. This project includes several strategies such as:
- individual mentorship
- community support groups
- volunteer opportunities
As Project HEAL built their Communities of HEALing, they decided to scientifically evaluate whether or not peer mentorship is helpful to individuals in recovery. For this purpose, they have partnered with us at the Columbia Center for Eating Disorders to design a randomized controlled trial (RCT). In an RCT, participants are randomly assigned to either the group receiving the treatment of interest, or one or more comparison groups, with an equal chance of being in all of the conditions. Random allocation allows us to determine the effectiveness of the treatment compared to the other conditions.
The Communities of HEALing Study
This study is evaluating the extent to which mentorship from a recovered peer or other types of mentorship are useful add-on (i.e., adjunct) interventions for people transitioning from structured treatment to outpatient treatment. Participants in the study will either be involved in peer mentorship, social support mentorship, or be on a wait-list (as described below:
In peer mentorship, individuals are matched with mentors who have suffered from an eating disorder and have fully recovered. Mentors and mentees meet every week to discuss eating disorder symptoms and how to overcome them. The goal of this program is to reduce eating disorder symptoms directly by receiving support and guidance from someone who has been through it. If patients doubt that their hard work at recovery will pay off, mentors are living proof that achieving recovery is possible.
In social support mentorship, individuals are matched with mentors who have not personally struggled with an eating disorder but who are dedicated to providing support. Mentors meet with one or more mentees to engage in activities unrelated to the eating disorder, like going to a movie or community event, reading and discussing a book, or volunteering. The goal of this program is to reduce eating disorder symptoms indirectly by exploring who you are outside of the eating disorder.
The third group is the waitlist. Participants in this group get to be in the peer mentorship program 6 months after randomization.
The Who and The What
For this study, participants will be between ages 14-45 and must have been discharged from a structured treatment program (hospital, residential treatment, intensive outpatient treatment) in the past six months. They must also be participating in outpatient treatment for their eating disorder.
Participation in the study involves meeting for an hour weekly with a mentor (either in person or online), filling out a weekly report after each meeting, and completing several questionnaires once every few months.