Eating Disorders and Obesity Flashcards
Non-pharmacological methods for the treatment of eating disorders
- Cognitive behaviour therapy (CBT-ED, CBT-BN, CBT-BE)
- Family therapy (FT-AN, FT-BN)
- Focal psychodynamic therapy
- MANTRA
- SSCM
- Bulimia-nervosa-focused guided self-help programmes
- Binge-eating-disorder-focused guided self-help programmes
Anorexia nervosa characterised by
- weight loss, induced or sustained.
- BMI atleast 15% below that expected
Bulimia nervosa characterised by
- repeated bouts of overeating and escessive preoccupation with control of body weight resulting in extreme measure to mitigate the fattening effects of ingested food
- self induced vomiting
- laxative abuse
Many prescription and over-the-counter products can cause weight loss, and may
be abused by a person with an eating disorder. These include:
- Anorectics
- Appetite suppressants
- Laxatives
- Diuretics
- Enemas
- CNS stimulants
- Anticonvulsants
- Antidepressants
- Antidiabetics
- Emetics
Treatment for bulimia and binge eating
SSRI (fluoxetine 60mg OD)
Cognitive behaviour therapy (CBT-ED, CBT-BN, CBT-BE):
- typically consist of up to 40 sessions over 40 weeks, with twice-weekly sessions in the first 2 or 3 weeks
- aim to reduce the risk to physical health and any other symptoms of the eating disorder
- encourage healthy eating and reaching a healthy body weight
- cover nutrition, cognitive restructuring, mood regulation, social skills, body image concern, self-esteem, and relapse prevention
- create a personalised treatment plan based on the processes that appear to be maintaining the eating problem
- explain the risks of malnutrition and being underweight
- enhance self-efficacy
- include self-monitoring of dietary intake and associated thoughts and feelings
- include homework, to help the person practice in their daily life what they have learned.
Family therapy (FT-AN, FT-BN):
FT-AN for children and young people with anorexia nervosa should:
- typically consist of 18–20 sessions over 1 year
- review the needs of the person 4 weeks after treatment begins and then every 3 months, to establish how regular sessions should be and how long treatment should last
- emphasise the role of the family in helping the person to recover
- not blame the person or their family members or carers
- include psychoeducation about nutrition and the effects of malnutrition
- early in treatment, support the parents or carers to take a central role in helping the person manage their eating, and emphasise that this is a temporary role
- in the first phase, aim to establish a good therapeutic alliance with the person, their parents or carers and other family members
- in the second phase, support the person (with help from their parents or carers) to establish a level of independence appropriate for their level of development
- in the final phase:
- focus on plans for when treatment ends (including any concerns the person and their family have) and on relapse prevention
- address how the person can get support if treatment is stopped.
FT-BN for children and young people with bulimia nervosa should:
- typically consist of 18–20 sessions over 6 months
- establish a good therapeutic relationship with the person and their family members or carers
- support and encourage the family to help the person recover
- not blame the person, their family members or carers
- include information about:
- regulating body weight
- dieting
- the adverse effects of attempting to control weight with self-induced vomiting, laxatives or other compensatory behaviours
- use a collaborative approach between the parents and the young person to establish regular eating patterns and minimise compensatory behaviours
- include regular meetings with the person on their own throughout the treatment
- include self-monitoring of bulimic behaviours and discussions with family members or carers
- in later phases of treatment, support the person and their family members or carers to establish a level of independence appropriate for their level of development
- in the final phase of treatment, focus on plans for when treatment ends (including any concerns the person and their family have) and on relapse prevention.
- Focal psychodynamic therapy:
- typically consist of up to 40 sessions over 40 weeks
- make a patient-centred focal hypothesis that is specific to the individual and addresses:
- what the symptoms mean to the person
- how the symptoms affect the person
- how the symptoms influence the person’s relationships with others and with the therapist
- in the first phase, focus on developing the therapeutic alliance between the therapist and person with anorexia nervosa, addressing pro-anorexic behaviour and ego-syntonic beliefs (beliefs, values and feelings consistent with the person’s sense of self) and building self-esteem
- in the second phase, focus on relevant relationships with other people and how these affect eating behaviour
- in the final phase, focus on transferring the therapy experience to situations in everyday life and address any concerns the person has about what will happen when treatment ends.
MANTRA:
- typically consist of 20 sessions, with: weekly sessions for the first 10 weeks, and a flexible schedule after this, up to 10 extra sessions for people with complex problems
- base treatment on the MANTRA workbook
- motivate the person and encourage them to work with the practitioner
- be flexible in how the modules of MANTRA are delivered and emphasised
- when the person is ready, cover nutrition, symptom management, and behaviour change
- encourage the person to develop a ‘non‑anorexic identity’
- involve family members or carers to help the person:
- understand their condition and the problems it causes and the link to the wider social context
- change their behaviour.
SSCM
- typically consist of 20 or more weekly sessions (depending on severity)
- assess, identify, and regularly review key problems
- aim to develop a positive relationship between the person and the practitioner
- aim to help people recognise the link between their symptoms and their abnormal eating behaviour
- aim to restore weight
- provide psychoeducation, and nutritional education and advice
- include physical health monitoring
- establish a weight range goal
- encourage reaching a healthy body weight and healthy eating
- allow the person to decide what else should be included as part of their therapy.
Binge-eating-disorder-focused guided self-help programmes:
- use cognitive behavioural self-help materials
- focus on adherence to the self-help programme
- supplement the self-help programme with brief supportive sessions (for example, 4 to 9 sessions lasting 20 minutes each over 16 weeks, running weekly at first)
- focus exclusively on helping the person follow the programme.
Bulimia-nervosa-focused guided self-help programmes:
- use cognitive behavioural self-help materials for eating disorders
- supplement the self-help programme with brief supportive sessions (for example 4 to 9 sessions lasting 20 minutes each over 16 weeks, running weekly at first).
What does cognitive behavioural therapy involve? CBT
If you have CBT you should be offered weekly therapy sessions for up to 40 weeks (9 to 10 months). For the first 2 or 3 weeks you should be offered 2 sessions a week. You will work with a practitioner (for example a therapist) to make a personal treatment plan and start making changes in your behaviour. This should involve:
coping with your feelings
understanding nutrition and starvation
helping you to make healthy food choices and manage what you eat.
You should be given simple ‘homework’ to help you put into practice what you have learned. You should also be taught how to monitor your own progress, and how to cope with times when you find it hard to stick to your new eating habits (this is called relapse prevention).
What does the Maudsley Anorexia Nervosa Treatment for Adults involve? MANTRA
You should be offered 20 sessions with a practitioner. The first 10 should run weekly, and the next 10 can be on a flexible schedule based on what works best for you. Some people will have extra sessions, depending on how severe their problems are.
MANTRA helps people to understand what causes their anorexia. It focuses on what is important to you personally, and on encouraging you to change your behaviour when you are ready. Your family and carers can be involved in the therapy too if you think it could help.
What does specialist supportive clinical management involve? SSCM
You should be offered 20 or more weekly sessions. At these sessions your practitioner will help you to explore the main problems that cause your anorexia. You will learn about nutrition and how your eating habits cause your symptoms. Your practitioner will help you set a target weight and encourage you to reach it.
You can also include other things as part of the therapy if you want to (such as improving relationships with other people, or getting back into work or education).
