Non-Bio Treatment for AN - CBT-E Flashcards
What is CBT-E?
“Enhanced cognitive therapy” - refers to a “transdiagnostic” personalised psychological treatment for eating disorders
How does CBT-E work? (3 points)
It is a highly individualised treatment - designed to fit the patient’s difficulties and be modified based on their progress
Starts with an initial assessment appointment followed by 50-minute treatment sessions over 20 weeks
It is 40 sessions over 40 weeks for people who are significantly underweight
What are the 5 stages of CBT-E?
Starting Well
Taking Stock
Dietary Restraint
Setbacks and Mindset
Ending Well
How does “CBT-E Stage 1: Starting Well” work?
Involves gaining a mutual understanding of the patient’s eating disorder, including telling the patient facts about anorexia like the effects it has on their body
How does “CBT-E Stage 2: Taking Stock” work? (2 points)
Involves systematically reviewing treatment plans, including advising patients on what their treatment entails
This is so that they understand the process and feel part of the treatment
How does “CBT-E Stage 3: Dietary Restraint” work? (3 points)
Focuses particularly on the processes that are maintaining the patient’s eating problem
The therapist:
+ Looks at any ritualistic habits/negative eating patterns the client has about food and the thought processes involved
+ Focuses on the reasons why the client has anorexia, including assessing factors like body image dysmorphia
How does “CBT-E Stage 4: Setbacks and Mindset” work?
The client and patient create a plan for the future to prevent old eating habits from resurfacing
How does “CBT-E Stage 5: Ending Well” work?
Ensures progress is maintained and relapse is prevented through continuation of care planning
What impact does CBT-E have on AN patients? (4 points)
Raises awareness of:
+ Negative interpretations
+ Behavioural patterns which reinforce the distorted thinking about body dysmorphia and restrictive food patterns
Challenges:
+ Belief modification
+ Body dysmorphic thought
Tests them against reality
Shows them how their daily food habits are unhelpful and can be modified - patient writes them down as H/W
Normalises experiences, destigmatises body image, and teaches them relaxation techniques (mindfulness/breathing)
How can the ABC model be applied to AN patients? (5 points)
It can be used to identify irrational beliefs regarding their relationship with food and body image
The patient can be subsequently persuaded to challenge these false beliefs through analyses
Involves the client writing down the:
+ Activating event which has led to a high emotional response
+ Modifying negative Beliefs like ‘I must be thinner’
+ Realising Consequences, including dealing with the negative emotions and physical outcomes of their behaviour
What are the supporting and refuting arguments for CBT-E as a treatment for AN?
Supporting:
S - Grave (2014)
D - Autonomy + Holistic
Refuting:
C - Limitations to Grave + Freud
O - Risk of relapse + Olanzapine
A - Threat, mood and motivation
What are the strengths of CBT-E as a treatment for AN? (3 points)
CBT-E was part of the ‘Cognitive Revolution’ of moving away from harmful medicinal therapies like lobotomy
Compared to biological treatments, there are no adverse side effects like Tardive Dyskinesia as seen with antipsychotic medication
Supported by Grave (2014) - tells us there are major advantages when utilising CBT for AN treatment
How does Grave (2014) support CBT-E as a treatment for AN? (3 points)
Found that 96% of patients completed a 20-week CBT-E inpatient treatment
BMI changes were maintained at the 1-year follow-up
83% of patients still had normal weight 1 year later
Is CBT-E a credible treatment for AN? (4 points)
Critics argue there are limitations to Grave’s (2014) study:
+ Lacks a control group for comparison
+ Used non-typical methodologies like parental involvement in therapy which may be contributing to long-term positive outcomes
Therefore, it is difficult to establish cause and effect between CBT and positive therapy outcomes seen in AN patients
The fundamental principles of CBT are based on Freud’s ideas of talking therapy in psychological treatment - criticised for a lack of empiricism
Therefore, it is difficult to falsify and scientifically measure the outcomes of CBT-E due to extraneous variables
E.g. the patients’ rapport with the therapist influencing the Hawthorne Effect
Are there any other treatments for AN other than CBT-E? (4 points)
An additional limitation of CBT as a treatment for AN is the risk of relapse - supported by Berends (2016)
CBT-E’s positive effects can only be seen weeks or even months after treatment - difficult to use in critically ill AN patients who are at immediate risk of mortality by cardiac arrest or suicide
In such cases, it could be argued that biological treatments are better suited, which work almost immediately to alleviate symptoms and lift mood
Olanzapine:
+ Shown to significantly increase appetite and weight gain in AN patients because of antagonism at histamine receptors and acetylcholine receptors
+ Functions as a Dopamine D2 receptor and Serotonin 5HT2-A antagonist for mood-modulating effects
