Mirasol has just received three-year accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF). The survey report commended Mirasol for its “dedication and commitment to improving the quality of the lives of the persons served” and its “established pattern of practice excellence”.

The CARF survey report described Mirasol’s residential eating disorder treatment program as follows:

• Mirasol has a seasoned staff that is capable of helping women deal effectively with eating disorders and return to a lifestyle free from these disorders.
• Mirasol CEO Jeanne Rust, PhD, is “a leader in the field in developing innovative interventions that will help individuals with eating disorders overcome their disorders”.
• The outcomes data have shown over the last three years a dramatic reduction in depressive characteristics, an increase in self-esteem, and a reduction in personal destructive traits….
• Mirasol has been fully licensed by the Arizona Board of Behavioral Health Examiners since 1999. The organization prides itself on its cutting-edge therapists such as cognitive-behavioral therapy, dialectical-behavioral therapy, Gestalt psychology, eye movement desensitization and reprocessing, and … experiential therapies. Adjunctive therapies are provided by professionals certified in their various fields, such as neurofeedback, art therapy, meditation, therapeutic recreation, and yoga. Additional therapies include exercise therapy, dance/movement therapy, art therapy, polarity therapy, acupuncture, and nutritional education. Each client participates for a minimum of six hours a week in these specialty modalities.
• The organization’s alternative approach to eating disorder recovery has a success rate that is twice the industry average. Services are holistic in nature and deeply spiritual, with emphasis on the mind, body, siprit and soul.
• Clients interviewed are very pleased with services and staff members. Several talked about how much they have learned and how their lives have changed through the unique therapies offered at Mirasol. One said she felt Mirasol was “magic,” and all agreed on how caring the staff members are.
• The enthusiasm and empathy of the management and staff members promote a healthy and caring setting for all persons served who report staff members are always available and work as a team.
• The commitment, dedication, compassion, enthusiasm, and skills of very professional staff members are impressive and infectious. Leadership strives to hire and retain individuals who clearly meet and exceed state-required qualifications.

The CARF survey contained surprisingly few recommendations, but included an admonition to do a better job of communicating Mirasol’s achievements to present and future clients, referring therapists and other stakeholders!

Mirasol is thrilled and humbled to be so recognized by CARF. We thank the members of the survey team for their thorough assessment, and we pledge to follow CARF’s guidelines and to do our best to continually exceed the expectations of CARF, our clients, their families and members of the community.

We celebrate the women who, over the course of the last two centuries, struggled tirelessly so that we, as women, could enjoy those basic rights. They set an example of courage and resilience that, even 90 years later, still inspire women all over the world.

Along with Clinical Director Diane Ryan, we are reviewing any new information available in regards to trauma and its treatment. And we are finding out complex trauma or DESNOS (extreme stress not otherwise specified) is much more common than a diagnosis of simple PTSD.

PTSD was originally developed as a diagnosis in the 1970s to explain the symptomology of Vietnam veterans. Research has shown that men are traumatized most frequently by accidents, war, assaults, and natural disasters, single event occurrences. Women, on the other hand, are most frequently traumatized by childhood sexual abuse. B.A. van der Kolk (2005) reported that between 17 and 33% of women in the general population had histories of sexual-physical abuse while women in psychiatric treatment reported 35 to 50%.

PTSD has captured only a partial snapshot of post-traumatic psychopathology. The PTSD diagnosis does not capture the facets of long-term, repeated trauma. People with a history of physical and sexual abuse over long periods of time report many psychological problems such as substance abuse, borderline and antisocial personality disorders, eating disorders, impulsivity, self-mutilation and suicidality. They will be chronically depressed with dissociative episodes of varying lengths of time. Extreme aggression and impulse control difficulties are also present.

PTSD clinically has referred to these other problems as co-morbid conditions, as if they have occurred apart from the PTSD symptoms. As a result, the authors of the DSM-IV began to separate these other symptoms under a category of extreme stress not otherwise specified (DESNOS). They found that the earlier the trauma, the more severe the symptoms of DESNOS. Studies also have shown that it is possible to experience DESNOS without having PTSD.

DESNOS represents a psychological injury from long-term social and/or interpersonal trauma that is characterized by lack or loss of control, disempowerment, and the victim is unable to escape.

As a result of our research, we evaluate all incoming clients for trauma and disassociation. If the client has a history of trauma, our clinicians immediately focus on stabilization techniques. The therapist must assume the role of teacher or guide for the client. Trauma survivors cannot teach themselves how to be safe and stable because they have no baseline, no meaningful experience of what the words “safe” or “stable” mean. Our therapists help the client learn to ground herself and to find a safe place where she can go and be protected under any circumstances.

The conventional way of thinking is to treat the substance abuse first, then address the eating disorder. At Mirasol, we have long believed that co-occurring conditions need to be treated simultaneously. If all the conditions are not treated at the same time, treatment outcomes are usually poor, and what would ordinarily be considered a small slip can turn into a cascading event, almost like a house of cards, with one slip triggering another one rapidly.

A strong connection between eating disorders and substance abuse has been long evident with a majority of women reporting binge eating and/or bulimia nervosa along with the substance abuse. Some 40-50% of all women who have an eating disorder will have a problem with alcohol and drugs either currently or at some time in their lives. The eating disorder and substance abuse are frequently accompanied with PTSD.

In a recent survey of eating disorder symptoms among women in treatment for substance abuse, researchers found that among women with co-occurring substance abuse disorders and PTSD, a little more than one-third of the women were binge eaters as well. The women who were binge eaters had higher eating disorder, PTSD, and depressive symptomology than those women in the non- eating disordered group. Researchers also found that progress in the binge-eating group was much slower. It stands to reason that the relapse rate would also be higher with the binge eaters.

Substantial new research in eating disorders, substance abuse, and PTSD, indicates that the greater the severity of childhood trauma and PTSD or Disorder of Extreme Stress Not Otherwise Specified (DESNOS), the earlier the onset of alcoholism and related problems. Consequently, Mirasol is now evaluating all new patients with dual-or multiple diagnoses for PTSD and trauma, and we have developed specific protocols for treating these patients.

However, I promised a team of surveyors from The Commission on Accreditation of Rehabilitation Facilities (CARF) that I would share some of our numbers with our stakeholders, and that includes you!

When a new client enters treatment, we do quite a lot of psychological testing. Two of the most important psychological instruments we administer are the Eating Disorder Inventory-III and the Beck Depression Inventory.

The Eating Disorder Inventory 3 (EDI-III) is the third edition of a test that reports in multiple scales. The test consists of 91 questions answered in terms of frequency of behaviors from “always” to “never”. Reports consist of 21 separate scales; three are validity scales, four are eating disorder risk and composite scales, nine are psychological scales, and five are psychological composite scales. Results are presented as percentiles for all, anorexia, bulimia, and EDNOS diagnoses.

For simplicity of reporting, percentiles of two risk scales/composite scores are used, each chosen for broad-based relevancy to Mirasol’s program, the Eating Disorder Risk Composite (ERDC) and the Global Psychological Maladjustment Composite (GPMC). In addition, the 9 psychological scales, including Low Self-Esteem (LSE), Personal Alienation (PA), Interpersonal Insecurity (II), Interpersonal Alienation (IA), Interoceptive Deficits (ID), Emotional Dysregulation (ED), Perfectionism (P), Ascetism (A), and Maturity Fears (MF).

These will all be compared for pre- and post-treamtnent scores for the total, anorexic, bulimic, and EDNOS populations.

The information presented in the following chart is based on residents who completed the program during the years of 2007, 2008, 2009, and through June 2010.

You can readily see the differences between the pre-scores and the post-scores. But look at the post scores for EDRC for 2007, then 2008, 2009, and finally 2010. You’ll see that the scores progressively get lower – meaning that our patients are getting a lot better!

I also wanted to share the pre- and post- test scores for the Beck Depression Inventory. The Beck is one of my favorite tests. It’s short and very informative.

The decrease in the levels of depression as evidenced by these scores is dramatic. They display a general trend of improvement of feelings of well-being.

I am happy to send anyone the full EDI-III report who is interested. I invite anyone to phone me with any comments or suggestions. I’m proud of the work our staff is doing – they are truly incredible as is our treatment model!

“Our new licensure will allow us to provide level 1 sub-acute care, which is a just a step below the level of care provided by psychiatric hospital,” says Jeanne Rust, PhD, founder and CEO of Mirasol. “This will enable us to serve clients whose insurance policies cover inpatient treatment as well as those who have residential benefits.”

Mirasol pioneered the mind-body-spirit approach to the treatment of eating disorders, combining traditional individual and group psychotherapy with proven alternative therapies including neurofeedback, acupuncture and EMDR. Since its founding in 1999, Mirasol has helped more than 700 women recover from eating disorders. Its residential treatment programs are licensed by the Arizona Department of Health Services Office of Behavioral Health and certified by the Commission on Accreditation of Rehabilitation Facilities (CARF).

Rust hopes that the new license will make Mirasol’s unique integrative treatment program available to a much larger population. “We get calls every day from women all over the country who want to come to Mirasol, but whose insurance doesn’t cover residential care,” says Rust. “By broadening our scope of services, we hope to be able to meet the needs of many more women for effective alternative treatment.”

The results of Polarity Therapy can include profound relaxation, relief from hypertension and anxiety attacks and a new appreciation of the importance of energy flow to optimal health and well-being.

Polarity therapy is an integral part of Mirasol’s mind-body-spirit approach to the treatment of eating disorders.

“We’ve been doing the challenge course for several years now, and it has become a really important part of our program,” says Mirasol Clinical Director Diane Ryan. “It’s a great metaphor for what the clients are going through in treatment. Recovery from an eating disorder is a huge challenge, but clients learn that they’re stronger than they think they are, that they can access different resources, learn to ask for support, and know that they’re not in this all by themselves.”

Since the challenge course was so powerful in the normal course of treatment, Ryan decided to incorporate it into Mirasol’s three-day family program.

“The exercises help women and their families see how they relate to one another,” says Ryan. “We talk a lot about things like enmeshment and enabling. But it’s one thing to talk about it, and it’s another to get up 40 feet in the air and be leaning on each for support and seeing that one of you is holding back and unwilling to trust. Or seeing how they can push through it by encouraging each other and being clear about communicating what they need.”

In the “High V”, two people clasp hands and traverse a set of cables in a “V” shape, each walking on one of the cables. The farther they traverse, the more they have to lean on one another. The only way for them to succeed is to put their total trust in each other.

“Adding the challenge course has created a whole different dimension. Families often tell us that it was the highlight of the program. It helps them feel connected and learn to communicate in a different way. So it really does what we want family program to do, which is put them in a place where they will have a whole different relationship going forward.”

One subject of great interest was the topic of nervine herbs. These are herbs that help nourish the nervous system. Many clients discover Kava Kava while in treatment at Mirasol. It’s an herb native to the South Pacific and is very effective in treatment of anxiety. It’s a nice alternative to the highly addictive anxiety medications like Valium and Xanax. You can take it as needed or throughout the day (up three times/day). However, if you’re going to take Kava Kava for more than a few months, it’s a good idea to have your liver enzymes checked.

I’m also a fan of herbal combinations that include passionflower, skullcap and milky oats. These can relieve anxiety and are may help us to better adapt to stress. I also like to include Valerian for clients who have trouble falling asleep or staying asleep.

I have found that there is no “one-size-fits-all” treatment for insomnia. I encourage clients to try different combinations and to practice good sleep hygiene. Cutting back on caffeine intake is a must also for those dealing with insomnia and/or anxiety.

For faster results, I suggest taking the herbs in a tincture form to ensure rapid absorption into the bloodstream. Otherwise, capsules and teas are fine too.

There have been big changes in Mirasol’s kitchen, thanks to our new chef, Robert Kuzyk. Kuzyk, who joined Mirasol’s kitchen staff after working in four-star restaurants at country clubs in Kansas and Arizona, believes in maintaining an “open kitchen”, encouraging clients to repair their relationships with food by becoming more involved in the process of creating it.

“What I like to do is help the clients overcome their fears of certain foods by actually cooking those foods with them,” says Kuzyk. “Learning how to cook those foods makes them more comfortable with them when they leave Mirasol and return to the
real world.”

Robert describes his work with Mirasol clients as a ‘building process.’ “The first step is getting them to trust me, and then walking them through the process of preparing the food, so that they realize that what they’re getting is nutritional, healthy food that also fits into their meal plans. I have prepared beef for women who haven’t eaten beef in six years. Even some women who are strict vegetarians have been persuaded to try fish, or shrimp or crabcakes.”

“Robert is very good at encouraging women to come into the kitchen little-by-little and maybe coaxing them to try something they haven’t tried before,” says Mirasol Clinical
Director Diane Ryan. “He’s also really great about teaching them to prepare foods they really like — maybe something they remember from childhood, like a special dessert or even just macaroni and cheese. And they can develop recipes and recreate those foods when they return home, and we find that’s really good for aftercare and for the recovery process in general.”

“A lot of the clients are hungry to learn how to cook,” according to Kuzyk. “They have never spent any time in the kitchen. As a chef — and a teacher — I try to teach them not only how to work their way around in the kitchen, but also to look at food as a palette.”

Kuzyk’s kitchen artistry has made him a big hit with both clients and staff. According to Ryan,

“Robert’s food is phenomenal! There isn’t a restaurant in the country that wouldn’t be proud to serve his food. But it isn’t just the food, it’s how he infuses the food with so much care and consideration and respect for the clients and what they’re going through. He is really able to see how what he cooks translates into an actual foundation for recovery. And that’s where the genius of the food really lies. It give the clients the feeling of being loved and supported and listened to, and it makes a huge difference.”

Kuzyk derives a great deal of personal satisfaction from helping Mirasol clients discover the joy of preparing and eating healthy meals.

“I used to think it was all about money and prestige,” says Kuzyk, reflecting on his years at the country clubs. “But I find more gratification being here at Mirasol and teaching these women what they need to know to be able to return home and live a normal life. I don’t think I could ever go back. My heart is in a different place, and I think that helping these women get where they need to be is more important than any executive chef’s job in the world.”