Laurie Zandberg recognized by Association for Behavioral and Cognitive Therapies for her research
Rutgers University's counseling center has begun offering a treatment that employs a "guided self-help" approach to help students overcome problem eating after a graduate student's award-winning research showed promising results for the therapy.
In a two-year study conducted by Laurie Zandberg (Psy.D. '13), a student in the Graduate School of Applied and Professional Psychology, the therapy – in which clients use workbooks to track their own progress, only consulting with a mental health practitioner occasionally – was administered to Rutgers students diagnosed with either bulimia nervosa or binge-eating disorders. Among the 38 students who participated in the 12-week program, 42 percent experienced no binge episodes and 63 percent no longer met criteria for an eating disorder after the sessions ended.
"That happens to be about as good a result as anything reported in the literature," said G. Terence Wilson, the Oscar K. Buros Professor of Psychology, an expert in the treatment of eating disorders who is Zandberg's mentor.
Zandberg received the 2012 Graduate Student Research Award from the Obesity and Eating Disorders Special Interest Group, which is part of the Association for Behavioral and Cognitive Therapies, in recognition of her study.
Bulimia nervosa, a condition primarily affecting adolescent girls and young women, is characterized by loss of control over eating, followed by attempts to purge the food through forced vomiting, excessive exercise or use of laxatives. Binge eating disorder does not involve purging.
Zandberg, who is from Roxbury Township, N.J., became interested in eating disorders when she was an undergraduate majoring in psychology at Cornell University. She recalls being struck by how many young women were pursuing weight loss.
"There is tremendous pressure in our culture to maintain a certain body ideal for women, and increasingly for men," Zandberg said. "It's gotten to the point where it is considered normal to feel dissatisfied with one's body. While we don’t fully understand why some people go on to develop eating disorders and others do not, research has taught us a lot about what keeps eating problems going over time.”
While researchers estimate eating disorders affect 1 to 2 percent of the general population, studies show that more than 30 percent of college students experience eating disorder symptoms during their college years.
Once someone is diagnosed with an eating disorder, Zandberg said it can be difficult to stop the behavior patterns that fuel it. In guided self-help treatment, patients use a self-help workbook to become educated about their disorder, learn what factors make them vulnerable to binge eating and experiment with new ways of responding to those triggers.
"The difference between guided self-help and most other therapies is that the client is really in the driver's seat," Zandberg said. "The therapist is there as a coach and supporter to help the client stay motivated and to troubleshoot challenges that come up along the way. But ultimately the gains are the client's to make and to keep."
The technique was pioneered by Christopher Fairburn, a world-renowned psychiatrist at Oxford University who wrote the book, Overcoming Eating Disorders (Guilford Press, 1995). In her study, Zandberg used Fairburn's book to train a group of seven graduate psychology students, who provided treatment to 35 women and 3 men referred by Rutgers’ Counseling, Alcohol and Drug Assistance, and Psychiatry Services, or CAPS. The therapy, based on behavioral cognitive therapy principles, was offered in 10 sessions, most lasting no more than 25 minutes.
In her work with the students, Zandberg said she found many were understandably wary of changing their behavior and were concerned about whether treatment would affect their weight. “It takes a lot of courage to face a problem head on," she said. "In guided self-help, people learn to take small risks, one at a time, and as they do, they begin to see the impact these changes have on their binge eating, preoccupation with food, and life satisfaction."
Not only is the treatment shorter and less costly than other types of therapy, but it also has the potential to become more accessible because professionals can be easily trained in delivering it. "This treatment we think can be used by a relatively wide range of providers if they are trained well, and that's what Laurie did in the study," Wilson said.
Last fall, Rutgers’ CAPS began offering the guided self-help model as part of its ongoing treatment to students with eating disorders.
"Our experience was that it was a very powerful treatment – so much so that we have moved to the next level as a result of our participation with the study," said Patricia Woodin-Weaver, a staff psychologist with CAPS and chairperson of the interdisciplinary team for students with eating disorders. To promote the long-term sustainability of guided self-help at Rutgers, Woodin-Weaver has been trained by Wilson and Zandberg both to provide the treatment and to train other CAPS staff members.
Zandberg, who is now completing an internship at the Montefiore Medical Center in the Bronx, plans to finish her training in a post-doctoral fellowship at the University of Pennsylvania's Center for the Treatment and Study of Anxiety. As part of her fellowship, she will be contributing to a study disseminating prolonged exposure therapy for the treatment of Post-Traumatic Stress Disorder to military bases across the country.
Zandberg hopes to pursue a career in research that improves psychological treatments and increases their accessibility to the public. "We have a big issue of supply and demand in clinical psychology," she said. "If you take a global view in particular, the majority of people with mental disorders do not receive any treatment at all, let alone treatment that is evidence-based."
For more information on connecting to services related to eating disorders, contact the CAPS office at 848-932-7884.