10 - eating disorders II Flashcards
what maintenance factors do intervention focus on?
- safety behaviours
- cognitive patterns
- emotional patterns
- social maintenance
- family accommodation of symptoms
- nutrition
what are types of prevention for eating disorders?
primary prevention - lower level of future development of Eds
secondary prevention - lowering eating and other concerns in present
examples of prevention making things worse?
Carter et al., and Bronowski both tried psychoeduction about dieting and eating disorders
in both cases, level or pathology worsened
- Baronowski - short term
- Carter - long term
some reported as a problem, some as a success
what prevention approaches are effective for reduction in risk factors and current pathology?
- media literacy approaches reduce shape and weight concerns in young population
- cognitive dissonance approaches reduce eating behaviours and attitudes ion high-risk groups
- CBT interventions reduce risk of dieting
- weight management interventions reduce some risk factors
what are methods to prevent obesity?
- NICE recommends interventions involving schools, local government, families, taxation
- encouraging lifestyle changes, healthy eating and exercise
these don’t work on they’re own, relatively unsuccessful
what are effective treatments for adults with anorexia?
- individual CBT (40 sessions)
- Maudsley anorexia nervosa treatment for Adults (MANTRA) (20-30 sessions)
- specialist supportive clinical management (SSCM) (20-30 sessions)
- similar level of effectiveness to behaviour therapy
25-30% effectiveness
what methods to prevent obesity are most effective?
NICE guidelines
primary differences between:
- adult vs children/adolescents
- underweight vs non-underweight
what are effective treatments for children and adolescents with anorexia?
AN-focused family therapy
- non-blaming
- stop accommodating patterns
- family takes control of child’s eating
- then gives control back to child
- finishes with relapse prevention
CBT or adolescent focused psychotherapy as second option
what are effective treatments for bing eating disorders?
group or individual CBT-ED (16-20 cases)
both adults and adolescents
what are effective treatments for adults with bulimia nervosa?
individual CBT-ED (16-20 sessions)
what are effective treatments for children and adolescents with bulimia nervosa?
- family therapy for BN
- CBT-ED as a second line therapy
what are effective treatments for atypical cases (OSFED)?
use therapy recommended for the most similar full syndrome e.g. anorexia
what are effective treatments for ARFID?
- not addressed by NICE
- some early evidence for CBT-AR
what is a common element of effective treatment?
nutrition/exposure to foods
- physical, cognitive, emotional and social benefits
particularly valuable for underweight cases
what are other effective approaches not included in NICE?
medical monitoring and management
intensive treatments (in- and day- patients)
- necessary for management of high-risk cases
- good for weight restoration
- no evidence of establishing recovery
- very expensive
- risk of creating dependence
- best use is stage 1 in anorexia
what medications can be used to address the biology of eating disorders?
SSRI medications at high doses for bulimia
- enhances serotonin
- reduces binges for some while taking it but no longer
novel antipsychotics for anorexia
- potentially reduce anxiety
WEAKER EVIDENCE
what are physical interventions that have weak evidence for use?
neuromodulation - transcranial stimulation methods slightly reduce depression
leukotomy - used for anorexia with extreme OCD, evidence is anecdotal
what are psychological therapies that have some evidence for use?
dialectical behaviour therapy (DBT)
- reduces impulsive behaviours in BED/BN but little change in core pathology
interpersonal psychotherapy (IPT)
- works for BN but slower and less effective than CBT
focused psychodynamic approaches (FIT)
- effective for anorexia but no replication
integrative cognitive-affective therapy
- less effective than CBT
what are psychological therapies with little evidence for use?
- metallisation-based therapy
- acceptance and commitment therapy
- mindfulness-based approaches
- family therapies not food/eating focused
what is the mean effectiveness of evidence-based therapies for adult psychological disorders?
50% recovery
25% improvement
20% unchanged
5% deteriorate
what is the mean effectiveness of therapies for eating disorders?
50% recovery for non-underweight cases
30% recovery for underweight cases
how is the hunger/satiety balance used to treat eating disorders?
gets the person to overcome their reasons for not eating healthily
teaching them to eat in response to biological need, not toxic environment of inner psychological concerns
what are the effects of addressing eating and nutrition?
- reduces anxiety, depression, impulsivity
- reduces alcohol level
- enhances cognitive flexibility, social skills
- normalises and stabilises weight
- enhances quality of life
what are the effects of psychological therapies for treating obesity?
- help to lose weight in the short term
- bad at keeping weight down long term
