Rebecca Willman, OTD '23, published her research paper "The potential role of occupational therapy in the treatment of avoidant/restrictive food intake disorder" earlier this year. Willman’s research on how occupational therapy could help patients with avoidant/restrictive food intake disorder (ARFID) was the culmination of her yearlong independent study with Dr. Jennifer Thomas, the co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital. 

A new lab instructor for the Occupational Therapy in Mental Health course, Willman recently won the OT Department's Alumni Professional Achievement Award for her work at The Home for Little Wanderers and McLean Hospital, where she has taken a role as the first dedicated occupational therapist treating patients at McLean’s Klarman Eating Disorders Center. In this month's IHP Interview, Strategic Communications Intern Sophie Hauck spoke with Willman about how occupational therapists play a unique role in eating disorder treatment, and why treating ARFID could be a gateway for OTs to work with people with eating disorders.

Why did you decide to specialize in eating disorder treatment as an occupational therapist?

I studied psychology and minored in nutrition in undergrad, and I saw this gap in how these two disciplines approach eating disorders. That's what occupational therapy is — the bridge between all the different aspects of eating disorder treatment. From then on, I became committed to research and advocacy for eating disorder treatment.

When you have an eating disorder, a lot of times, you're one circle, and the eating disorder is another, and you're overlapped. A lot of treatment is about separating yourself from the eating disorder, and then working through it with cognitive coping skills and different types of psychotherapy and psychoeducation. Occupational therapy is uniquely positioned to work through applying those skills in realistic context for patients in their daily life.

I take a lifestyle redesign approach, which is a framework that we use in occupational therapy where we go through every part of your day in a systematic way, and we determine, where are the problems? What are the challenges? What are some habits that are not aligned with what you want for recovery? Then we collaboratively problem-solve those things.

You spent a year conducting research with Dr. Jennifer Thomas at Mass General Hospital about how occupational therapy could help patients with avoidant/restrictive food intake disorder (ARFID). What is ARFID, and what were your findings?

Avoidant Restrictive Food Intake Disorder (ARFID) is a newer diagnosis in the DSM-5, characterized by a disturbance in eating or feeding that is not driven by body image concerns. There are three subtypes including a lack of interest in eating or food, avoidance based on the sensory characteristics of food, and fear of aversive consequences of eating — all of which have unique clinical presentations and functional implications. 

I didn't know much about ARFID before I started my research. I've always been drawn to more well-known eating disorders, like anorexia nervosa, bulimia nervosa, or binge eating disorder. Dr. Jennifer Thomas specializes in ARFID, so she pitched the idea to me to learn more about what occupational therapy can do in ARFID treatment. 

In the paper, I write about how OT has a long history of being involved in pediatric feeding disorders and feeding disorders in general. Oral motor differences often cause functional differences and physical impairments in eating and feeding. These experiences can impact someone's relationship with food psychologically or cognitively, which is where ARFID is maintained. ARFID can then persist even if those physical oral motor differences are remediated. 

With OT intervention to address oral motor differences early, an individual may have less aversive experiences with food and therefore a lower risk of developing ARFID. OTs can help prevent those issues through rehab of the muscles, and we have different tools that can promote more effective use of the mouth in eating and feeding, as well as and oral sensory function. 

There's also the sensory approach, where you can do whole-body sensory input to get somebody into a space where they're able to access higher levels of cognition. If their fight-or-flight response is on all the time because they have experienced trauma related to eating or feeding, and that's a perpetuator of their ARFID, then using those whole-body sensory inputs can help them regulate and come into a less distressed state, so they can try foods and have an appetite. 

Then there’s the component of overall occupational balance. A lot of times, when you have ARFID, it can isolate you, or your treatment might interfere with your social participation or your leisure. You can't do the things that you want to do all the time, and OT can help reshape those routines and roles and habits to promote recovery from ARFID.

Content creators are raising ARFID awareness through social media. Have you seen public knowledge of this eating disorder increase since you began researching it?

ARFID is a newer DSM diagnosis. Once there’s a diagnosis, more people are bound to receive that diagnosis, and with more people receiving a diagnosis, more people will naturally know about ARFID.

I did a guest lecture for the Occupational Therapy in Mental Health course at the IHP in June, and when I was a student here, ARFID wasn't even mentioned. I added it into my presentation, and I asked, ‘Has anyone heard of ARFID?’ and almost everyone raised their hands. I was very shocked to see that progression because I know that none of my friends in grad school knew about it, but almost everybody knew about it in the current cohort in the OT program. That was cool. 

How did your background in research shape your clinical experience at the MGH Institute, as well as the client-facing work you do now?

Throughout grad school, all my field work and clinical experiences were such foundational components because I was drawn more to analysis, research, and theory.

I still want to be doing research, so I'm actively applying to PhD programs to try to teach eventually. Clinical experience is so important to have as a researcher and as a professor because, especially with clinical research, you can understand the barriers to implementing research in clinical practice, and you can understand what clinical practice needs. 

I gain a lot of perspective from working with my clients and hearing their stories, and it keeps you out of that, one-size-fits-all, monotonous, robotic approach because you have to individualize to make a difference in the daily life of a person, versus just taking a protocol and applying it to their case.