In-Home & Virtual Eating Disorder Intensives

The families we support are not just “sort of” dealing with an eating disorder. They are dealing with an illness that hijacks their home, their routines, their confidence, and worst of all, their child’s health, happiness, and future.

Family-Based Treatment (FBT) is the most well-supported outpatient treatment for adolescents with eating disorders, and for many families, weekly treatment is exactly the right fit. But when a teen is actively restricting, purging, refusing meals, compulsively exercising, or rapidly deteriorating, time matters. Waiting a full week after an intake to learn how to respond at meals, establish structure, and protect your child’s health often doesn’t feel like an option.

That’s why we offer Adolescent Eating Disorder Intensives, to help families stabilize quickly, build early momentum, and start recovery on the right foot. In FBT, parents are the primary agents of change. For that reason, parents typically start intensives by meeting virtually with the clinician first, often for extended sessions and a structured orientation to FBT, before their child even meets the provider. This early parent-only work is designed to ensure parents begin the treatment with clarity, structure, and confidence. 

Once parents understand and have committed to the treatment approach, our team schedules a minimum three-hour, in-home visit with both parents and teen, often beginning early in the morning on a school day. Keeping a teen home from school and having our team enter the home is intentional and almost ceremonial. It is a clear signal that this is a turning point for parents. "We mean it". The eating disorder no longer sets the rules, and meaningful change begins immediately.

We begin the in-home intensive with a brief intake and assessment with the adolescent, along with psychoeducation about the psychological and physical impacts of semi-starvation and the rationale for our treatment approach. We discuss weighing, review historical growth charts, and predicted goal weight ranges while parents prepare food for the initial “family meal.” Having worked with parents beforehand, our goal is that they enter this phase equipped to take decisive action, hold the line, and avoid unintentionally reinforcing avoidance, restriction, or negotiation. Practical coaching throughout the intensive commonly includes:

• How to provide effective meal support, including coaching through the initial family meal
• How to take immediate and effective control of nutrition, including what “enough” looks like early in treatment
• Feedback on what to serve and how to structure meals and snacks (simple, consistent, non-negotiable)
• How to respond to refusal, stalling, bargaining, and escalation without reinforcing the eating disorder
• Ongoing guidance on evaluating whether intake is truly sufficient, including recognizing hypermetabolism, when even “a lot of food” may still not be enough
• What to expect early in treatment, including why distress often increases before it decreases, and why this does not mean treatment is failing
• Our approach to weighing in FBT (open, unblinded weighing), using transparency and real data to reduce avoidance and directly disconfirm fear-based predictions over time

Within the FBT-Anchored Modular (FAM) model, pioneered by Dr. Appenzeller during his tenure as Founding Director of the UTHealth Houston Center for Eating Disorders, additional evidence-based treatments are integrated as needed and at the appropriate time, based on the adolescent’s clinical presentation, developmental level, and readiness to engage. These approaches are never used in isolation and never replace parent-led nutritional rehabilitation. Instead, they are added thoughtfully to address mechanisms that commonly maintain eating disorder symptoms once medical and nutritional stability are improving. Depending on the adolescent’s needs, treatment may incorporate the following evidence-based approaches:

Enhanced Cognitive Behavioral Therapy (CBT-E) is used to target eating disorder-specific psychopathology, including rigid dietary rules, shape and weight concerns, fear of weight gain, dietary restraint, and compensatory behaviors. CBT-E interventions are introduced gradually and are most effective once nutritional intake is improving and the cognitive rigidity associated with undernourishment has begun to resolve.

Exposure and Response Prevention (ERP) is incorporated when anxiety, avoidance, or obsessive-compulsive symptoms are prominent contributors to eating disorder pathology. ERP may involve systematic exposure to feared foods, eating contexts, body-related stimuli, or uncertainty, while supporting the adolescent in reducing eating disorder-driven safety behaviors and avoidance patterns. ERP can also be provided to target comorbid anxiety disorders, such as OCD and social anxiety disorder that often times co-occur with eating disorders.

Dialectical Behavior Therapy (DBT) skills and interventions are introduced when emotional dysregulation, impulsivity, self-harm urges, or acute distress interfere with treatment engagement or increase risk. DBT skills are used in a targeted manner to support distress tolerance, emotion regulation, and behavioral stability without reinforcing eating disorder behaviors.

Radically Open Dialectical Behavior Therapy (RO DBT) skills and interventions are used when overcontrol is a central maintaining feature, including excessive rigidity, perfectionism, emotional inhibition, threat sensitivity, or extreme self-control. RO DBT targets maladaptive overcontrol by promoting flexibility, openness, emotional expression, and social signaling- processes that are often essential for sustained recovery and relapse prevention.

Across all modules, individual work is introduced only to the extent the adolescent is willing and developmentally able to engage, and always in close coordination with parents. The purpose of integrating these approaches is not to shift responsibility away from the family, but to support recovery by addressing mechanisms that interfere with progress while maintaining FBT as the organizing framework of care. The goal is not insight for insight’s sake, but skill-building that directly supports recovery and reduces risk for relapse. By anchoring treatment in FBT while integrating CBT-E, ERP, DBT and RO-DBT in a targeted and developmentally appropriate way, the FAM Model allows care to remain both structured and responsive, while maintaining a clear, clinically coherent path forward.

For some adults, weekly outpatient therapy is not enough to interrupt entrenched eating disorder patterns or create meaningful momentum. Adult in-home or virtual eating disorder intensives are designed for individuals who want or need a more concentrated, structured, and hands-on start to treatment.

These intensives provide a higher “dose” of evidence-based care over a short period of time, allowing us to move quickly from assessment to action. Treatment is anchored in CBT-E and when indicated, integrated with ERP, nutritional rehabilitation support, and skills and intervention from DBT or RO DBT based on temperament and comorbidity. We begin with a focused intake and formulation, clarifying the maintaining mechanisms of the eating disorder and identifying the most strategic points of intervention. From there, we move directly into the intensive so clients leave with a clear plan, concrete tools, and real-world practice already underway.

Depending on the individual’s needs, an adult intensive may include:

• Intensive psychoeducaiton and behavioral intervention around eating, restriction, binging, purging, or compensatory behaviors
• Real-time coaching before, during, and after meals or feared eating situations
• Exposure-based work targeting food fears, body image avoidance, and rituals
• Structured planning and accountability around meals, snacks, and behavioral change
• Skills for responding to urges, anxiety, perfectionism, and self-criticism without defaulting to eating disorder behaviors
• Coordination with dietitians, physicians, or psychiatrists as needed
• Clear expectations for the first several weeks of treatment, including how discomfort and uncertainty are part of meaningful change

Adult eating disorder intensives are not about taking control away, they are about helping clients regain it in "real life", in the comfort of their own home. The goal is to interrupt the disorder quickly, reduce suffering, and create a clear path forward so ongoing treatment can be effective, sustainable, and aligned with the client’s values. When we come into the home, it is intentional and almost ceremonial, a clear signal that this is a turning point. The eating disorder no longer sets the rules, and meaningful change and recovery begin today.