Temperament Based Therapy with Supports (TBT-S): Assessing the feasibility, acceptability and efficacy in Victorian tertiary eating disorder services

Organisation / Service

Victorian Centre of Excellence in Eating Disorders (CEED)

Neurobiological research has shifted our understanding of anorexia nervosa (AN) from primarily an outside-in, to now include an inside-out, brain-based illness that can be severe, enduring, and fatal. Brain imaging research has increased our understanding on the aetiology and neurobiological mechanisms underlying EDs symptoms and has highlighted that there are neurobiological contributions to EDs. Accumulating behavioural and neuroimaging evidence supports a neurobiologically-based temperament that impacts the development and maintenance of AN. In addition to predating AN, mild to modest amounts of these traits often persist after recovery, suggesting those who recover might do so by effectively managing these traits. This personality and behaviour profile establishes a framework to guide development of therapies designed to directly target trait-related symptoms specific to AN. In order to make advances in adult AN treatment, a paradigm shift is needed that includes consideration of both the biological and the familial dimensions for anorexia nervosa treatment. Treatment needs to reflect, integrate, and synthesise neurobiological underpinnings into ongoing, evidence-based approaches. Targeting underlying neurobiological mechanisms, that are core expressions of AN traits, will complement current treatments and create a more meaningful, rich and holistic understanding of a person's functioning.

Temperament Based Therapy with Support (TBT-S) is an innovative treatment approach that incorporates the genetic and neurobiological vulnerabilities that influence eating disorder development over the lifespan. TBT-S combines psychoeducation and experiential activities that emphasise the key role of neurobiological factors in the development and maintenance of AN to increase insight and recognize temperament patterns. Skills-based training is used to teach consumers and supports age-appropriate strategies to manage these neurobiological factors to reduce problem thoughts and behaviours. TBT-S treatment targets include common AN temperament traits (e.g., anxiety, cognitive inflexibility, harm avoidance) and related brain processes such as altered reward and punishment sensitivity, interoception, inhibitory control, and decision-making. The focus of TBT-S is to work with clients who have AN and their Support persons to acknowledge, understand, and utilize their own temperament as a primary source for strength and change. Supports can include members of one’s family of origin (such as parents, siblings, grandparents, adult children) and of one’s “family” of choice (such as spouses, partners, friends, housemates, or colleagues).

The TBT-S program can be offered in a range of formats, with the intensive community based 5-day model being most researched to date. This project will be the first Australian study investigating the use of TBT-S in Australia, thus playing a crucial role in the understanding of the new and novel eating disorder treatment approaches yet to be trialled in Australia. Four Victorian mental health services will pilot the 5 day intensive TBT-S program. Clinicians will receive training in the TBT-S model and supervision throughout the program.

National Strategy Standards and Actions

Treatment

Standard 3: Treatment is person-centred and inclusive of families/supports and communities.

Action 3.3: Treatment services to engage families/supports as early as possible in treatment and provide them with specific psychoeducation and support for their own needs.

Standard 4: Treatment models and practices are effective and evidence-based.

Action 4.4: Researchers, in conjunction with service providers and people with lived experience, to conduct research into existing as well as innovative treatment models to improve outcomes.

Standard 9: Treatment providers are trained and skilled for the level of treatment they provide in line with national training standards.

Action 9.1: Mental health and health services to ensure treatment providers meet minimum training standards in line with the National Framework for Eating Disorders Training and relevant professional guidelines.

Action 9.6: Services to promote opportunities for staff to learn and enhance skills through activities such as secondments, exchange programs, coaching, mentoring and peer reflective practices, and communities of practice.

TBT-S offers two separate program formats that are tailored to the unique needs of each age group. Young Adult TBT-S (YA TBT-S) is designed for those 17-27 years of age and highlights the unique stage of developmental this group are at. The SEAN TBT-S program is suited to those 18 years or older with a long-standing eating disorder. This program prioritises client as expert and allows for collaboration and consideration of the clients’ own goals. The research project involves hearing from the clients, supports and clinicians experience of the TBT-S program. It is hoped these results will contribute to the further development of the TBT-S approach in Victoria. 

Community-based intensive treatment

Standard 1: People can access a community-based intensive treatment option delivered close to home or virtually (e.g., day programs, intensive outpatient programs, outreach support).

Action 1.1: Commonwealth, state/territory governments and regional planners to support additional community-based intensive treatment options, due to significant gaps for step-up and step-down treatment.

TBT-S is a collaboration between Victoria’s state-wide eating disorder organisation (CEED) and four mental health services. CEED’s role includes the upskilling and training of the clinicians involved in TBT-S as well as completing a research project to evaluate this new treatment approach. It is important to note, that three of the four services involved in the TBT-S project provide the state's specialised treatment options for people living with eating disorders. 

Workforce

CEED is working alongside the mental health services, providing ongoing supervision and annual training in the TBT-S model.