Compulsive Exercise & The Safe Return to Movement and Sport
Sarah Archer, LMFT, Clinical Director
Align Residential Treatment Center
www.aligneatingdisorder.com
Sarah Archer, LMFT, �Clinical Director, �Align Residential Treatment Center
Sarah Archer LMFT, has been working with adolescents, teens and their families for over 15 years as a behavioral coach, individual and family therapist. Transitioning from Rady Children’s Hospital, Sarah has served as the Program Manager to the UCSD Adolescent Eating Disorder Program for over 10 years. While in addition to providing clinical services, she managed all program admissions, served as the San Diego Unified School District Liaison, trained and supervised staff in Evidence Based Practices and served as Lead of Adolescent Athletic Programming.
Sarah Archer received her Master’s in Marriage and Family Therapy from University of San Diego in 2005. She has served as an Adjunct Professor at USD teaching Family Counseling to Graduate Students in 2019 and 2020 and for the past 6 years has been a guest lecturer at UCSD for the undergraduate eating disorder seminar. In 2019 she Co-Founded CounSEL, an animated video-based program teaching adolescents and teens evidence-based coping skills and has served over 30,000 students throughout California.
�Why is this important for Caregivers to know?��
DEX post Tx 2nd Highest Predictor of Relapse
Youth Sports
Movement encouraged medical / mental health
PE / Mandated Movement in School
Family Culture / Joyful Movement
Peer Culture
RED-S
Motivation & Vulnerability for Recovery
athletes_web.pdf (nationaleatingdisorders.org)
(Galli, Petrie, Reel, & Chatterton, 2014)
Hop
Dysfunctional Exercise (DEX)
Quantity of Exercise
Compulsivity / Rigidity
Incidental Movement
Exercise Motivation
Compulsive Exercise Affects up to 4 out of 5 individuals with Eating Disorders
Hopkins et al., 2023
Addressing DEX in Treatment
Hopkins et al., 2023
The Compulsive Exercise Test (CET)
RTC Group Curriculum
Psychoeducation of Female Athlete Triad
Effects of ED on Sport
Good Athlete and ED patient
Personality traits of athletes and Athlete Myths
Stress management, PMR, visualization & Performance Anxiety
Nutrition: Caloric Needs
Returning to Sport: Challenges and Goal Setting
Stress Management, Thought distortions and reframing
Self-Monitoring: Exercise and intake
Self Esteem: Realistic vs Unrealististic expectations
Interpersonal Effectiveness: With Coaches, Teammates, and Support
Relapse Prevention
Safe Exercise at Every Stage (SEES) Principles
Nonabstinence
Safety
Taking a holistic perspective to understand one's relationship with activity
Promoting intuitive and mindful movement
Collaboration among the treatment team, patient, and their loved ones
Hopkins et al., 2023
How do I know if it’s the eating the disorder or joyful/competitive movement?
First Things First: Is my child ready for movement?
Medical
85% IBW
Stable Vitals
Heart and Bones
ED behaviors
Motivation
Is it a priority
Safety issues
Willingness
Supervision
Refuel
How do we create a safe movement plan with our treatment team?
Phases of Movement Introduction
Phase | Focus | Examples | Frequency | Duration | Refuel | Considerations |
1 | Medical & Behavioral Stabalization | No movement due to critical need to stabalize mdically and behaviorally | N/a | N/a | N/a | N/a |
2 | Physical Stabalization | Casual walks�Yin yoga | 1-2x/wk | up to 30m | N/a | N/a |
3 | Strength | Body Weight �Resistance Bands �Weight Training (dumbbells / KBs / BB)�Flow Yoga | 1-3x/wk | up to 30m | Refuel required at all of these stages pre or post workout as prescribed by your dietician. ��During movement some clients may use Gatorade as a mid-workout refuel | If ED behaviors return or weight drops below IBW, movement will be halted and return to a former phase will be required. |
4 | Endurance | Dance�Swim�Skill training/technique work �Increasing pace - body weight movement �Increasing weight/resistance with strength | 1-4x/wk | up to 45 m | ||
5 | Performance | Running�Tumbling passes�Full Out Sports Practice �Competition | 1-5x/wk | varies by pt |
Exercise Exposure Example (Baseball player)
Check-In
10 min warmup
20 min strength
10 min cool down
Refuel + Process
“My eating disorder is strong, but as an athlete I feel stronger.”
Compulsive Exercise | National Eating Disorders Association
Eating Disorders & Athletes | National Eating Disorders Association
A reason to recover
The Pros of returning to sport
Skills coaching athletes
ED and Good Athlete Parallel
What vulnerabilities will your child face?
How does your family system talk about exercise?
How can I prevent exercise from being my child’s only coping skill?
Setbacks and Solutions
Weight loss
Refusing Refuel/Supervision
Decision to leave sport, change sports, add additional hobbies/joyful activities
Questions?
sarah@aligneatingdisorder.com