This chapter provides dietitians with a TBT-S strategic approach when working with adult clients with AN. Structure is central strategically. Dietitians enhance empathy when aligning with clients’ AN traits. Meal planning for adults with AN needs to be practical, consistent, and structured regarding how to obtain and prepare foods. Support persons are treatment team members who need to learn the meal plan and strategies to provide assistance at home or work/school. After the meal plan is identified, the dietitian is a central agent in coaching, practicing pre-, post, and mealtime fuel intake with both the client and their Support(s) virtually or face-to-face.

The YA Behavioral Agreement is collaboratively written by the YA and parents addressing criteria that meet their unique concerns.

TBT-S has been studied in a 40-hour, 1-week group format that consists of novel interventions that integrate temperament and Supports in structured interactive treatment approaches for YA and SE-AN. TBT-S neurobiological information and temperament approach could be “seasoned” into segments in multiple levels of ED treatment. The clinician schedules members of the ED treatment team, like dietitians and medical professions and Supports to participate with the adult client in various combinations of ways to address key aspects of treatment planning and skill/tool development. This ensures consistency inside and outside of treatment. Clinicians and programs could flexibly apply TBT-S core principles and components into ongoing ED treatment.

There is a biological basis for why eating is not easy in that food is not intrinsically rewarding, contributing to why the brain may code food as harmful. Lack of motivation for treatment may reflect a deficit in biologically induced reward/motivation system rather than willfulness. Clinicians can help clients to turn to Supports and others to identify external motivators since they are unable to experience intrinsic motivation. Providing structure around meals is temperament congruent because it is unlikely that individuals with active AN can eat intuitively given altered brain reward signaling to hunger.

Approaching AN from a temperament-based neurobiological perspective provides a biological foundation and conceptual framework from which to view symptoms and the underlying mechanisms that drive behavior. Temperament informs targeted interventions directed at the cause of the behavior, rather than the behavior itself. This is a paradigm shift for many. TBT-S has five core principles derived from neurobiological research. (1) Eating disorders are brain and biologically based illnesses. (2) Treat to the trait or the temperament underpinnings. (3) Food is medicine. (4) Supports are needed and a necessary part of the treatment process. d (5) Action or movement is fundamental to change.

TBT-S helps parents and other Supports to be aware of unique YA developmental needs and conflicts to offer appropriate assistance toward AN recovery. An experiential activity on guided reflections can enhance empathy for YA development along with skill development and the Young Adult Behavioral Agreement.