The Naomi programme - Pathways to recovery
An innovative cognitive–behavioural therapy (CBT)-based approach for the in-patient treatment of people with eating disorders, including those with significant chronicity and comorbidity.
The model was developed in a regional specialist eating disorder in-patient unit for women aged 18 and over with complex eating disorders and comorbidities including personality disorders, substance misuse, and autistic spectrum disorders.
A CBT approach was adopted in response to evidence that CBT was the most effective treatment for bulimia nervosa and it had the potential to be effective transdiagnostically with other types of eating disorders and a wide range of comorbidities. The collaborative CBT approach was not compatible with the pre-existing framework of using BMI to inform treatment and evaluate progress (i.e. the BMI guidelines). The Pathways to Recovery model was developed as a solution by a multidisciplinary group of clinicians with a consultation with patients, their families/carers, and the wider staff team. Pathways to Recovery incorporated key CBT principles and enabled the whole staff team to work collaboratively and coherently in an integrated and holistic way with each patient.
Pathways to Recovery broadly defines recovery as learning to live with eating-disordered thoughts without using eating-disordered behaviours. Emphasis is thus placed on behavioural change while developing a repertoire of CBT skills to manage difficult thoughts and feelings. The programme consists of seven parallel pathways: physical monitoring, psychological, physical activity, meaningful living, meaningful eating, self-catering and leave. Progression up the pathways corresponds to the person’s stage of recovery, moving from medical stabilisation through to gaining skills and concluding with the transferring skills stage. Progression is discussed collaboratively at weekly multidisciplinary team meetings and regular care programme approach reviews, which are run transparently with the patient present throughout the meeting. CBT principles, methods, and techniques are central to each pathway.