eating disorders Flashcards

Question

# CBT for BED guided self help | Wilson (2018) ## Footnote Cognitive-Behavioral Therapy for Eating Disorders

Answer 1

Study: at 2-year follow-up, both CBTgsh and IPT not only successfully maintained their improvement, but were also significantly superior to BWL in producing remission from binge eating - Results provide further evidence that CBT is more effective than BWL in eliminating binge eating in overweight and obese patients

Answer 2

studies encourage the further development and application for CBT-E as a treatment for adults and adolescents with AN - adolescent CBT completers showed significant improvement in eating disorder psychopathology and weight gain - adult completers showed substantial improvement in weight and eating disorder psychopathology at post-treatment another study found disappointing results: on almost all other measures TAU did comparably well + CBT-E did not improve on TAU on any measure of efficacy

Answer 3

- efficacy: short & long term results - cost effective - clinical range/reach: transdiagnostic nature offers major advantages - brevity: breif treatment is advantageous - task sharing: currently minimal evidence on use of this in ED treatment - scalability: capacity of CBT to “scale up” treatment so as to provide greater access to treatment for large numbers of people

Answer 4

Hypothesizes that interpersonal functioning is a critical component of psychological adjustment and well-being IPT acknowledges a **two-way relationship between social functioning and psychopathology**: - Disturbances in social roles can serve as antecedents for psychopathology - And mental illness can produce impairments in the individual’s capacity to perform social roles **IPT makes no assumptions about the causes of psychiatric illness** - however, it assumes that the development and maintenance of some psychiatric illnesses occur in a social and interpersonal context + that the onset, response to treatment, and outcomes are influenced by the interpersonal relations

Answer 5

Suggests that **problems with social functioning cause difficulties with low self-esteem and negative affect, which then lead to binge eating behaviors** This is supported by data - EDs have been consistently associated with poor interpersonal functioning Interpersonal psychotherapy is designed to improve interpersonal functioning and self-esteem, reduce negative affect and, in turn, decrease ED symptoms

Answer 6

treatment focuses on the resolution of problems within four social domains that are associated with the onset and/or maintenance of the eating disorder: 1. **interpersonal deficits** - apply to those patients who are either socially isolated or who are involved in chronically unfulfilling relationships 2. **interpersonal role disputes** - refer to conflicts with a significant other that emerge from differences in expectations about the relationship 3. **role transitions** - include difficulties associated with a change in life status 4. **grief** - when the onset of the patient’s symptoms is associated with either the recent or past loss of a person or a relationship

Answer 7

sessions 1-5 - patient’s current ED symptoms are assessed, and a history of these symptoms is obtained - Formal diagnosis - Diagnosis and treatment expectations discussed - Assignment of ‘sick role’ - serves several functions (e.g. granting patient permission to recover) - Therapist explains IPT rationale + conducts an ‘interpersonal inventory → develops specific interpersonal formulation

Answer 8

8-10 sessions - constitutes the ‘work’ stage of the treatment Essential task: assist patient in understanding connections between difficulties in interpersonal functioning & the ED behavior & symptoms **Therapeutic strategies** and goals shaped by the primary problem area targeted in the treatment - strategies: - therapeutic stance = warmth, support & empathy - focusing on goals - making connections - redirecting issues related to ED symptoms - general therapeutic techniques

Answer 9

4-5 sessions - clinician should begin to discuss termination explicitly and address any anxiety the patient may be experiencing - Prepare patient for emotions that may arise with termination - Patient encouraged to reflect on progress - Outline goals for after end of treatment - Identify early warning signs of relapse + make POA

Answer 10

IPT shown to be effective for the treatment of BN + is the only psychological treatment for BN that has demonstrated long-term outcomes that are comparable to those of CBT Currently, IPT is considered an alternative to CBT for the treatment of BN

Answer 11

For the treatment of BED among adults, IPT has been demonstrated to be effective in randomized controlled studies In 2 randomized trials comparing IPT with CBT, IPT had similar effects to CBT in the treatment and management of BED IPT may be considered a first-line treatment for BED

Answer 12

In general, there are very few effective treatments for AN There is a relative lack of research examining IPT’s utility for AN - there have been no controlled studies yet that have demonstrated the efficacy of IPT for AN May be that for AN, IPT is optimally delivered in the context of other adjunctive treatments (e.g., pharmacological, nutritional), rather than as a “stand alone” treatment

Answer 13

Utility of medications in the treatment of BN has been well established **Antidepressant medication** - fluoxetine: most commonly prescribed for treatment of BN - found that 60 mg/day of fluoxetine was superior to placebo and 20 mg/ day in reducing binge-purge frequency **Antiepileptic medications** - topiramate: used to treat epilepsy - associated with effects on weight and appetite - mixed results for BN

Answer 14

**Antidepressants** - generally been shown to reduce binge eating in BED - but little impact on weight loss **Weight management medication** - differing results for different medications - Some help with weight loss but not binging, others help w binging but have neg side effects, etc **Stimulant medications** - generally have appetite suppressing effects - LDX: first medication to receive indication from FDA for treatment of BED - found to results in sig reductions in binge eating frequency + decreased weight **Chromium** = an essential mineral - has recently been examined for treatment of BED - limited conclusions

Answer 15

Many medications have been considered for the treatment of AN with generally disappointing results = pharmacotherapy is not typically the primary means of treatment for AN **Antidepressants** - have consistently been no better than placebo at achieving changes to weight or any associated psychological symptoms **Antipsychotics** - first-generation antipsychotics did not demonstrate significant clinical benefits - BUT development of second-generation antipsychotics has shown more promise - Olanzapine most notable - associated with a small but significant difference in rate of weight gain

Answer 16

**Medications are clinically useful in the treatment of BN and BED** - Although they are often utilized in combination with targeted psychotherapy and other behavioral management strategies SSRIs and other antidepressants are particularly useful in BN For BED, medications associated with appetite and weight reduction, such as the stimulant LDX, have demonstrated success AN poses a greater treatment challenge as the medications useful for other eating disorders offer no significant benefit in AN

Answer 17

5 studies - found that patients in the compulsory group have more severe symptoms regarding both the AN as well as more severe comorbidity Weight at discharge was similar for both the voluntarily treated and the compulsorily detained groups No worsening of therapeutic relationship when compulsorily detained + patients remained in treatment voluntarily

Answer 18

only studied in 1 study - found that the risk factors were: - Prior AN admissions - More comorbidity - Lower BMI **= a higher illness severity or complexity results in a higher likelihood of compulsory treatment**

Answer 19

Study: nearly half of the patients who denied (the need for) treatment at admission converted to acknowledging the need for admittance within 2 weeks of hospitalization - **Adherence to treatment does not seem to be worsened by the use of compulsion** in general psychiatry Study: most interviewed patients reported that compulsory treatment was “self evidently” the right thing to do - Many patients who themselves had experienced compulsory treatment were grateful in hindsight

Answer 20

Outcome (main conclusion): short term outcome of detained patients is similar to that of patients that are voluntarily treated - Important bc otherwise these patients would not have been treated if not for legal measures (i.e., the fact that compulsory treatment is legal) - Outcome at discharge is similar to those of voluntarily - important bc those compulsorily detained have higher levels of psychopathology Patients views: AN patients’ views on compulsory treatment appear to be similar to those of other psychiatric patients,

Answer 21

Validation of the client's experience is crucial to engagement/success, however, accurate empathy is unusually difficult to sustain with anorexic clients Principles for sensitizing therapist to the anorexic population: - Appreciate the fully ego syntonic nature of thinness and self-control - Recognize the desperation that drives symptom 'choice’ - Do not attach surplus meaning to resistance - it is professionally irresponsible to be offended when anorexic clients act anorexic - Acknowledge the difficulty of change

Answer 22

**socratic style** = the style of using a series of questions to help clients synthesize info and reach conclusions on their own principles derived from the socratic model: - speak the client's language - respect client's individuality - be collaborative: client's thoughts and feelings are viewed as hypotheses that both the therapist and the client work on together to test and evaluate - be honest - be curious - be focused - be systematic: socratic style uses a series of questions to help clients draw conclusions - be patient

Answer 23

Anorexic/bulimic individuals have a lot of knowledge on dieting → therapists must know more than their clients and the general public to help disentangle truth and falsehood about eating and dieting

Answer 24

‘objective, fact-finding approach', where clients are 'true collaborators in the search for unknown factors' Personal disconfirmatory evidence as the most powerful way to provoke change Each step is undertaken w/an attitude of 'let's test this out and see what happens' → the results will be evaluated on the basis of the client's experience rather than the therapist's opinions

Answer 25

A focus on functionality is indicated when clients' beliefs are highly valued, culturally shared, or delusional, so that evidence about their validity is unavailable or irrelevant The most explicit application is a review of advantages and disadvantages

Answer 26

“In our experience, clinicians who practice the principles we have summarized rarely fail to engage the most reluctant eating-disordered individuals in the therapeutic process” The desire to recover in no sense guarantees the successful achievement of that objective - it is simply a beginning step that most other (non-ed) clients accomplish before their first session As recognized within the substance abuse field (to which ED bares many similarities), change is likely to occur in a spiral rather than linear pattern, with frequent oscillations between the tendencies to advance and retreat