Krista Crotty and her team are bringing groundbreaking eating disorder treatments to the Spokane community, becoming the first practice in the nation to offer Temperament-Based Treatment with Supports (TBT-S) in a private, five-day intensive program.
Brain Based Therapy NW is a new therapy practice based in Spokane that focuses on the treatment of anorexia nervosa using TBT-S. Crotty, TBT-S program director and professor of psychology at Gonzaga University, is one of the pioneers of this type of care in the U.S. As the second-most deadly mental health diagnosis, according to Crotty, anorexia is a serious condition that requires innovative treatment approaches.
“Every 52 minutes, someone in the United States dies as the result of a complication associated with an eating disorder,” Crotty said. “We’re not talking about a disorder that’s just a little bit of a hassle, this is a life-threatening illness we’re talking about here.”
TBT-S is a new therapeutic practice that is based on studies of neurobiology, where the focus is on the biological causes of eating disorders. TBT-S also has a large focus on temperament, the expression of traits in an individual.
“Temperament is a biological construct,” Crotty said. “Like the old saying: ‘the apple doesn’t fall far from the tree.’ We’re a lot like our parents in some ways. Those are all traits that are passed down.”
These traits are neither good nor bad on their own, but they can be expressed in helpful or unhelpful ways when dealing with a condition like anorexia. Providers like Crotty aim to educate the client and their supports on how their traits can impact the presentation of their eating disorder and how these traits can be used in positive ways throughout recovery.
“We treat the trait instead of treating the symptom,” Crotty said. “That is one of the biggest differences between TBT-S and current, traditional therapy.”
Brain Based Therapy NW offers a five-day, intensive program designed to get clients on the track toward recovery. Each client would ideally have a care team at home with doctors, dieticians and therapists. The clients and their support individuals come to Spokane for this program, and the hope is that it will help to educate the care that is being received at home.
“TBT-S will help inform your treatment and care, unlocking maybe some of the things that weren’t working in your other treatment, or enhance what you’re doing in your other treatment,” Crotty said.
During this program, patients and their supports receive extensive psychoeducation on the neurobiology behind eating disorders and even take an assessment to determine what specific traits the client may have that could be contributing to their diagnosis. Clients also go through exercises to help them explain their eating disorder to their supports. These supports can be a parent, partner, friend, coworker or anyone that the patient would like to be present during the recovery process.
“Yes, I am an expert in eating disorders,” Crotty said. “I actually only know so much. The person who is suffering knows everything about their illness.”
This type of novel therapy is common in other countries like Australia, Greece and Norway, but Crotty is one of the first to bring this treatment to the U.S. Crotty cites these countries’ willingness to change their approach to eating disorder treatment as a reason that they have embraced TBT-S.
“[Australia and New Zealand’s] governments have actually said, ‘we just can’t keep doing what we’re doing,’” Crotty said. “It’s not working. Less than 50% go on to recover in current traditional models in those countries, respectively. It’s not much different here in the U.S.; we’re about 50%. We haven’t really changed our program in a long time.”
One of the biggest differences between TBT-S and traditional therapy is the presence of support individuals for those who are undergoing treatment. During the program, these supports are present for the psychoeducation that clients are receiving. The goal is to provide support systems with information they need to be effective at aiding their loved one through the process of recovery.
“Eating disorders are interesting because they are so pervasive into your life,”Crotty said. “The support actually gets to learn and understand what it’s like to be in the brain of someone who has an eating disorder so that they’re more empathetic and more caring, so that they say the right things.”
Currently, Brain Based Therapy NW has three undergraduate students who are interning with Crotty to gain clinical experience in the field. Crotty said clinical psychology is a notoriously hard field to find experience in, especially at the undergraduate level, so she is happy to be able to offer this opportunity to GU students.
One of the interns working with Crotty is senior Anna Sofianek, a former student of Crotty. As a family support specialist, Sofianek works to ensure that clients with Brain Based Therapy NW have everything that they need to successfully participate in TBT-S sessions.
“Dr. Crotty created my role so that there could be an undergraduate presence at this program,” Sofianek said. “Myself and my two peers are each partnered with a specific client, and we are responsible for their paperwork, making sure they get their labs done and starting to create a relationship with them, so if they have any questions, there’s that open line of communication.”
Interns at Brain Based Therapy NW are also present during the treatment sessions, gaining exposure to the actual practice of TBT-S and what it looks like in a clinical setting.
“During treatment, we support the support people who come with the patients,” Sofianek said. “We make sure that the experience is going well for them.”
After working with Crotty’s practice, Sofianek is excited to pursue a career in the field of eating disorder treatment, despite the challenges.
“There’s not very good retention in the eating disorder field,” said Sofianek. “It’s tiring, and you’re not really seeing quick fixes. You really have to commit to your patients, but I’m learning that I really admire that commitment.”
More information about TBT-S and Brain Based Therapy NW is available online. Weekly information sessions are held via Zoom where Crotty and her associates are available to answer questions about the care that they provide and other inquiries.
