Treatments for AN - CBT

Question 1

Non-biological way of treating AN patients

Answer 1

enhanced cognitive behavioural therapy

Question 2

Study on enhanced cbt

Answer 2

Fairburn (2008)

Question 3

Two types of enhanced cbt

Answer 3

-Broad type (CBT-Eb)
-Focused type (CBT-Ef)

Question 4

What does the broad type treat

Answer 4

Treats core pathology of AN and symptoms external (overevaluation of body shape/weight)

Question 5

Who is the broad type of CBT suitable for

Answer 5

Suitable for clients with low self-esteem or perfectionism

Question 6

What does the focused type do differently to the broad type

Answer 6

Does not tackle external symptoms

Question 7

Two types of intensities

Answer 7

-40 sessions over 40 weeks for BMI <17.5
-20 sessions over 20 weeks for BMI >17.5

Question 8

How many stages of CBT-E

Answer 8

4

Question 9

Who made stages of CBT-E

Answer 9

Murphy et al (2010)

Question 10

Stage 1 of CBT-E

Answer 10

‘Start well’ – intensive
-Client and therapist together identify main AN related cognitions and behaviours
-Introduces ‘weekly weighing’ (recorded on graph) and ‘regular eating’ (devise specific eating times)

Question 11

Stage 2 of CBT-E

Answer 11

Brief stage – client and therapist review progress
-Identify barriers to change and plan stage 3
-Switch to broad CBT-E if external symptoms appear

Question 12

Stage 3 of CBT-E

Answer 12

How self evaluation depends on body weight/shape
-Client learns to focus instead on other areas of their lives
-Dietary rules identified (avoiding certain foods)
-Therapist helps client break rules using behavioural experiments (and then learn that breaking rules doesn’t have to lead to weight gain)

Question 13

Stage 4 of CBT-E

Answer 13

‘End well’ – maintain progress and prevent relapse
-weekly weighing continues at home
-Client and therapist plan next 20 weeks before a follow-up session
-Client continues with rule-breaking and avoiding body checking, realistic about relapse

Question 14

Strength of therapy

Answer 14

-Fairburn et al (2015)
Randomly allocated, 130 participants with eating disorders to CBT-E or interpersonal psychotherapy (IPT)
After 20 weeks, 65.5% of CBT-E and 33.3% of IPT participants were ‘in remission’
After 60 weeks, 69.4% for CBT-E and 49% for IPT
CBT-E more effective (and quicker) for most people with AN than IPT

Question 15

Counter-argument of strength

Answer 15

-All participant’s BMI was >17.5 = not seriously underweight
-Unclear whether CBT-E is as effective for severely underweight people
BUT
UK’s National Institute for Clinical Excellence (NICE 2017) considers CBT-E effective enough to recommend it for adults with AN

Question 16

Weakness of therapy

Answer 16

-Sodersten et al (2017)
Compared CBT and ‘normalisation of eating’ procedure giving clients feedback at mealtimes to encourage normal eating behaviour
Remission rate = 75%
Relapse rate = 10% -> over 5 years for normalisation (compared with remission rate of 45% and relapse of 30% for CBT)
Behavioural elements of therapy are sufficient and cognitive element is not necessary to improve AN symptoms

Question 17

Another weakness of therapy - dropout rates

Answer 17

because it is a demanding therapy, especially the intensive form of CBT-E (in terms of attendance and homework)
Clients must make difficult changes to their behaviour and thought processes
Carter et al (2012) found 45% dropout for a CBT-E programme
Effectiveness of therapy is enhanced in research as only completers are included in any research sample

Question 18

Application

Answer 18

People with AN experience intense fear of becoming fat and perception of fat is distorted
Improvement of gaining weight creates anxiety of them – successful therapy shows steps towards something are frightened of
Understanding experience of AN helps researchers to support vulnerable participants taking part in research