eating disorders treatment and prevention Flashcards
are clinicians a problem?
- 38% reported using strongest therapy
- 6% report using evidence-based treatment manuals
- many are untrained
what do the most effective interventions focus on?
ones that focus on maintenance factors
evidence that prevention isn’t always risk-free
-Carter et al 1977 + Baronowski & Heatherington 2001: psychoeducation to 11-14yrs –> level of pathology got worse (C–>LT) (B+H–>ST)
what prevention approaches work?
- 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
obesity prevention
NICE (2015): recommends school, local government, family interventions
-encouraging lifestyle changes
effective treatments for anorexia nervosa
adults:
-CBT, maudsley (MANTRA), specialist supportive clinical management
children/adolescents:
-AN-focused family therapy, CBT
effective treatments for bulimia nervosa + binge eating disorder
adults with BED: -group/individual CBT adults with BN: - individual CBT children/adolescents with BN: -family therapy, CBT
effective treatment for atypical (OSFED)
-use therapy for most similar full syndrome
effective treatments for avoidant and restrictive food intake disorder
- not addressed by NICE (2017)
- early evidence for CBT
common elements of what works
- 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
case/risk management
- medical monitoring and management address risks
- intensive treatments: risk of creating dependence, necessary for high-risk cases, useful for stage 1 anorexia
weak evidence for intervention use
-NICE 2004 has therapies that aren’t mentioned in NICE 2017 bc overtaken by stronger evidence
medications
- SSRI medications at high doses for BN - enhances functional serotonin but withdrawal effects
- novel antipsychotics for AN
neuromodulation
transcranial stimulation methods reduce depression slightly but no evidence that it works
leucotomy
used for chronic anorexia nervosa with extreme OCD, evidence poor
dialetical behaviour therapy
reduces impulsive beh in BED/BN but little change in core pathology
interpersonal psychotherapy
works for BN but slower+less effective than CBT
focused psychodynamic approaches
effective for AN but needsd to be replicated in other countries
integrative cognitive-affective therapy
less affective than CBT
psychological therapies with little evidence
- mentalisation-based
- acceptance and commitment
- mindfulness-based
- family therapies that aren’t food focused
how effective are evidence-based therapies?
- 50% recovery (lower for underweight 30%)
- 25% improvement
- 20% unchanged
- 5% deteriorate
effects of addressing eating + nutrition
- reduced anxiety, depression, impulsivity
- reduces alcohol levels
- enhances cog flexibility, social skills
- normalises and stabilises weight
- enhances quality of life
obesity (Jeffrey et al. 2000)
Cooper et al 2010
we are good at getting people to lose weight short term but terrible at keeping it down
-cooper devised new CBT - wasn’t effective
how to treat obesity
- don’t blame
- political/social changes e.g. sugar tax
- lifestyle coaching
- longer therapy
- continuing care model works
- bariatric surgery: gastric band
