VCU clinic expands eating disorder treatment and training in Virginia

By Madeline Reinsel

At a nondescript concrete building along Broad Street, two Virginia Commonwealth University researchers have created a rare resource for a common health condition. Established this spring, the eating disorder clinic, located on VCU's Monroe Park Campus, is now serving patients in Richmond and statewide while providing a training ground to address a notable gap in mental health care.

The clinic is the brainchild of associate professor Ann Haynos, Ph.D., and postdoctoral scholar Bek Urban, Ph.D. Haynos, who previously served as the director for research operations at a large eating disorder research center at the University of Minnesota, joined the VCU faculty in 2022. She then noticed that Richmond, and all of Virginia, generally lacked accessible eating disorder treatment.

That led her to establish the clinic this year within VCU's Center for Psychological Services and Development, which also treats conditions like anxiety, depression and trauma.

The clinic, which operates on a sliding scale payment system and is staffed by supervised graduate students from VCU's psychology Ph.D. program, accepts patients from across Virginia ages 12 years and older. The students treat disorders including anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant restrictive food intake disorder using research-backed therapy techniques, both in person and virtually.

"I quickly realized that not only would opening a clinic for eating disorders be a good training opportunity for our students, but it would also fill a major gap in the mental health care available in Richmond and in Virginia more broadly," said Haynos, an associate professor of psychology in the College of Humanities and Sciences.

For Haynos and Urban, the aim of the clinic - and their research - is to help patients access care.

"What we have is a giant gap in clinical care and training for these disorders," Haynos said. "We have to not only get this care in the hands of more people, but also spread the ability for people to be treated by clinicians trained in these approaches."

From the brain to the clinic

Eating disorders are difficult to treat, and anorexia has one of the highest mortality rates of any psychiatric disorder. The clinic, which uses evidence-based treatments for anorexia and other eating disorders, also draws on Haynos' research.

That research starts where eating disorders start: the brain.

Most people with an eating disorder, Haynos said, have deeply ingrained, rigid thought processes, but researchers still don't know exactly how or why people get stuck in those thought patterns. That's different from someone who goes on a diet and then stops dieting when they reach their preferred weight.

"It's incredibly hard to break out of these restrictive eating patterns once they're entrenched, and we have limited insight into why," Haynos said.

Bek Urban, Ph.D., (left) and Ann Haynos, Ph.D., (right) lead the clinic and conduct research on eating disorder neuroscience and treatment. (Dean Hoffmeyer, Enterprise Marketing and Communications)

But she and other researchers noticed that other psychiatric disorders, including obsessive-compulsive disorder and obsessive-compulsive personality disorder, are also characterized by rigid thinking. Now, Haynos is using MRI technology to scan the brains of people with OCD or OCPD and people with eating disorders, to find out how different brain processes can all lead to rigid thinking.

Haynos is also analyzing the decision-making processes of both groups through surveys, including surveys delivered in real time during participants' everyday lives, to see how those processes lead to them getting "stuck" in their symptoms.

"Just like the way you could have a fever for a lot of different reasons, you could also have rigidity for a lot of different reasons that might follow different patterns in the brain," she said. "Why does somebody go down one path toward one mental health problem and another person goes down another path?"

New research brings new treatments

One of the researchers' other studies is focused on shifting how patients with anorexia feel fulfillment in their lives. People with the disorder typically have difficulty experiencing fulfillment from everyday things - like being with friends and family, or enjoying meals - and instead feel rewarded by restrictive eating habits and exercise.

Haynos hopes to change those patterns by using a newer therapy technique called positive affect treatment, which works by identifying what drives the patient's behavior and helping to shift their mindset. Currently, Haynos is working with two sets of anorexia patients who have recently moved to outpatient therapy after more intensive treatments, like residential or partial hospitalization care.

One set of virtual trial participants is receiving the standard evidence-backed treatment informed by an eating disorder-specific variation of cognitive behavioral therapy. This form of CBT focuses on making behavioral changes by tracking food intake and weight changes, addressing body image concerns and figuring out what mental blocks are preventing a patient from getting better.

But that treatment, Haynos said, works better for people with bulimia nervosa and binge eating disorder than it does for people with anorexia. And while other therapeutic techniques are also frequently used for anorexia, they don't always work.

"The state of treatment for eating disorders is not optimal," she said. "We have some treatments that work, but they don't work for everyone."

The other group in the study is receiving positive affect treatment. So far, Haynos said, her team has found that positive affect treatment can be helpful for those with eating disorders, and it can also reduce depression and anxiety symptoms. Eventually, she plans to bring those treatments to the new clinic.

"I see the clinic as an even further extension. We have the mechanistic research, we have the clinical research," she said. "Now, what does it look like when we're actually implementing some of these principles in real-world clinical settings?"

Coordinated, community-based care

Urban, who supervises clinical graduate students working alongside Haynos, sees the clinic as a unique way to fill in a major gap in both psychological training and in the Richmond community.

"Eating disorders are really difficult to treat because there aren't a lot of resources in the community, and not a lot of people get training in graduate programs in order to know how to work with people with eating disorders," they said.

Graduate students Amanda Makara (left), Grace Lee (center) and Whitney Redeemer (right) see patients at the clinic as a part of their clinical psychology training. (Dean Hoffmeyer, Enterprise Marketing and Communications)

The graduate students, who will each work with approximately 15 to 20 clients over the course of a year or more, mostly hope to focus on eating disorder treatment in their future clinical careers.

"It's not only a unique opportunity to be trained in evidence-based treatment, but also a great opportunity to provide that to clients," said psychology Ph.D. student Grace Lee, who has worked at the clinic since it opened in April.

The clinic also coordinates with patients' other medical providers and with the families of minor patients, and it is available to those who may not technically meet all of the criteria for an eating disorder.

"So often people either are missed for various reasons, or are made to feel as if their eating disorder is shameful," said psychology Ph.D. student Amanda Makara, who also joined the clinic in the spring. "And we're not here to do that."