Behavioral Integrative Treatment and Evaluation (BITE) is the first comprehensive behavioral approach to the treatment of the most deadly psychiatric diagnosis: anorexia nervosa. Part of what makes BITE innovative is that it is integrative in three main respects: 1) it comprehensively integrates many behavioral approaches as well as novel interventions, 2) it integrates custom assessments of BITE-specific treatment targets into therapy, and 3) it is pragmatically designed for easy integration into a therapist's practice. When administered in full with adolescent patients, Comprehensive BITE includes family, group, and individual treatment modalities. Across these modalities, important clinical information and complex therapeutic concepts are clearly depicted in BITE handouts for patients, parents, and dispersed collaterals. Currently, BITE programs are being implemented in the inpatient and outpatient departments of the Weill Medical College of Cornell University / NY Presbyterian Hospital as well as at North Shore LIJ's eating disorders day treatment program.
Our mission is to optimize the treatment of anorexia nervosa in adolescents by not only integrating evidence-based interventions, but also: 1) making the BITE treatment manuals exceedingly user-friendly for clinicians, 2) creating handouts that clearly depict important clinical information to make communication with malnourished patients, distressed parents, and dispersed collaterals (e.g., medical doctors and school staff) more effective, and 3) actively encouraging the online eating disorder community to provide feedback and suggest ideas for future content. Further, the decision to self-publish BITE was made so that the developers may evolve the treatment - handout by handout - over time. In this way, we will strive to meet the needs of the community. We also chose to self-publish BITE so that, unlike traditionally published material, BITE handouts can be made both immediately accessible and printable from anywhere the internet works.
Dr. Deliberto is extremely committed to fostering the development and dissemination of effective treatments. Locally, she is the technology committee chairperson of the NYC CBT Association. Dr. Deliberto is also an active member of the international Academy for Eating Disorders' (AED) award-winning social media committee. Taken together, Dr. Deliberto co-runs social media accounts for AED, NYC CBT, and BITE. This year, she is also presenting on a panel at AED's conference on conducting internet-based research on BITE evaluations. Lastly, Dr. Deliberto volunteers for "EDParents2Pros," an online group that allows parents of children with eating disorders to contact professionals for resources. Through these organizational involvements, Dr. Deliberto has networked with field leaders as well as parents impacted by anorexia nervosa, all of whom have provided invaluable feedback on BITE. In short, Dr. Deliberto has a platform of organizational leadership and internet technology skills on which to scale and evolve evidence-based treatments.
BITE is particularly well poised for sustainability. The cost of developing, implementing, and disseminating this treatment is inherently low. Further, all revenue from the self-published manuals will be retained. But because BITE will not be available for purchase until April 2015, the current resources and support for BITE are as follows: 1) our own unpaid time, 2) our personal donations for the cost of graphics, the website, etc. and 3) a "volunteer squad" of mental health professionals who provide edits and feedback on BITE material. Once BITE is launched prior to the Academy of Eating Disorders' conference, a reasonable fee will be charged for the BITE material, discounts will be given to people who need financial assistance, and free BITE handouts packets will be given to families in need. Prior to receiving payments for the BITE content, however, there has not been any outside support.
BITE is inherently replicable because of its design. The developers went to great lengths to make BITE both comprehensible and structured so that it can readily be implemented anywhere adolescents with anorexia nervosa need treatment. Broadly, the creation of both BITE handouts and evaluations standardize the treatment and ensure that important behavioral treatment targets are being addressed. Further, the BITE material was created to be woven into existing treatments. BITE Group Therapy handouts, for instance, are meant to easily substitute general CBT group material that is often used. Unlike prior work, BITE Group Therapy handouts are tailored to the treatment of anorexia nervosa (e.g., topics include acceptance of adults having control over food and tolerating feelings of fullness). In short, BITE was designed to be easily incorporated into existing practice and measured over time.
True to its name, Behavioral Integrative Treatment & Evaluation, BITE incorporates the use tailored assessments to measure specific behavioral treatment targets for all three treatment modalities (i.e., family, group, and individual). For instance, Stage 1 BITE Family Therapy evaluations measure adaptive behaviors (e.g., eating all food served) and maladaptive behaviors (e.g., exact measurement of food). Across BITE modalities, incorporating the use of treatment-specific evaluations makes the targets of behavioral interventions clear not only for the clinician, but for the patient and parents as well. Additional reliable and valid assessments have been chosen from The Handbook of Assessment Methods of Eating Behaviors and Weight Related Problems to evaluate the progress of patients in BITE. The developers of BITE also actively encourage feedback about its usefulness and effectiveness from clinicians administering the treatment. As the number of patients enrolled in BITE grows, the developers intend to track their progress online.