eating disorders treatment and prevention

Question 1

are clinicians a problem?

Answer 1

• 38% reported using strongest therapy
• 6% report using evidence-based treatment manuals
• many are untrained

Question 2

what do the most effective interventions focus on?

Answer 2

ones that focus on maintenance factors

Question 3

evidence that prevention isn’t always risk-free

Answer 3

-Carter et al 1977 + Baronowski & Heatherington 2001: psychoeducation to 11-14yrs –> level of pathology got worse (C–>LT) (B+H–>ST)

Question 4

what prevention approaches work?

Answer 4

• le et al 2017: review and meta-analysis - lots were weak
• media literacy approaches reduce shape/weight concerns for M+F in young pop
• cognitive dissonance approaches reduce eating behaviours+ attitudes in high risk groups
• CBT interventions reduce risk of dieting
• weight management interventions reduce some factors

Question 5

obesity prevention

Answer 5

NICE (2015): recommends school, local government, family interventions
-encouraging lifestyle changes

Question 6

effective treatments for anorexia nervosa

Answer 6

adults:
-CBT, maudsley (MANTRA), specialist supportive clinical management
children/adolescents:
-AN-focused family therapy, CBT

Question 7

effective treatments for bulimia nervosa + binge eating disorder

Answer 7

adults with BED:
-group/individual CBT
adults with BN:
- individual CBT
children/adolescents with BN:
-family therapy, CBT

Question 8

effective treatment for atypical (OSFED)

Answer 8

-use therapy for most similar full syndrome

Question 9

effective treatments for avoidant and restrictive food intake disorder

Answer 9

• not addressed by NICE (2017)

- early evidence for CBT

Question 10

common elements of what works

Answer 10

• briefer therapies can be as effective for non-underweight ED
• early change is critical
• no evidence that severity/duration reduces effectiveness
• start with food as key element
• single most important element is nutrition/exposure to food
• for non-underweight cases extra value in psychological element

Question 11

case/risk management

Answer 11

• medical monitoring and management address risks

- intensive treatments: risk of creating dependence, necessary for high-risk cases, useful for stage 1 anorexia

Question 12

weak evidence for intervention use

Answer 12

-NICE 2004 has therapies that aren’t mentioned in NICE 2017 bc overtaken by stronger evidence

Question 13

medications

Answer 13

• SSRI medications at high doses for BN - enhances functional serotonin but withdrawal effects
• novel antipsychotics for AN

Question 14

neuromodulation

Answer 14

transcranial stimulation methods reduce depression slightly but no evidence that it works

Question 15

leucotomy

Answer 15

used for chronic anorexia nervosa with extreme OCD, evidence poor

Question 16

dialetical behaviour therapy

Answer 16

reduces impulsive beh in BED/BN but little change in core pathology

Question 17

interpersonal psychotherapy

Answer 17

works for BN but slower+less effective than CBT

Question 18

focused psychodynamic approaches

Answer 18

effective for AN but needsd to be replicated in other countries

Question 19

integrative cognitive-affective therapy

Answer 19

less affective than CBT

Question 20

psychological therapies with little evidence

Answer 20

• mentalisation-based
• acceptance and commitment
• mindfulness-based
• family therapies that aren’t food focused

Question 21

how effective are evidence-based therapies?

Answer 21

• 50% recovery (lower for underweight 30%)
• 25% improvement
• 20% unchanged
• 5% deteriorate

Question 22

effects of addressing eating + nutrition

Answer 22

• reduced anxiety, depression, impulsivity
• reduces alcohol levels
• enhances cog flexibility, social skills
• normalises and stabilises weight
• enhances quality of life

Question 23

obesity (Jeffrey et al. 2000)

Cooper et al 2010

Answer 23

we are good at getting people to lose weight short term but terrible at keeping it down
-cooper devised new CBT - wasn’t effective

Question 24

how to treat obesity

Answer 24

• don’t blame
• political/social changes e.g. sugar tax
• lifestyle coaching
• longer therapy
• continuing care model works
• bariatric surgery: gastric band