Transcript A model of eating disorders

A model of eating disorders
Biological
Psychological
Stress vulnerability
Anxiety about appearance
Social
Cultural & family pressures
Anorexia
Bulimia
Continued restriction
Bingeing
Reduced anxiety
Purging
Excessive weight loss
Maintain weight
Based on Barlow & Durand (1995)
psychlotron.org.uk
Restriction
of eating
Treatments for EDs


Behaviour therapy
Cognitive behaviour therapy
Weight restoration (anorexia only)
psychlotron.org.uk

CBT
Treatment based around:


Identifying dysfunctional thinking processes that
cause & maintain disordered eating
Use of behavioural exercises to test and modify
maladaptive beliefs
psychlotron.org.uk

CBT with bulimia nervosa
1.
2.
3.
4.
Education about effects of bingeing, purging,
dieting
Modified eating patterns – small meals 5-6 times
a day
Altering dysfunctional attitudes about food,
eating & the body
Teaching coping strategies to avoid bingeing &
purging
psychlotron.org.uk
Four stages (Fairburn, 1985):

CBT with bulimia nervosa
Fairburn et al (1993); comparison of three
treatments:
1.
2.
3.

CBT (all four parts)
BT (just the eating habits part)
IPT (interpersonal therapy)
Outcome measures: cessation of
bingeing/purging; attitudes to body/eating
psychlotron.org.uk

40
IPT
CBT
Start
End
4mo
8mo
12Mo
psychlotron.org.uk
20
BT
0
Cessation rate
60
CBT with bulimia nervosa
CBT with bulimia nervosa
CBT works fast & is more effective than BT



Not a panacea – only 36% had no symptoms at 1
year follow-up
Early treatment gains may be lost; IPT more
effective long term
Drugs may boost effectiveness (Agras et al,
1992)
psychlotron.org.uk

CBT with anorexia nervosa
Anorexia involves several cognitive
distortions:



Irrational beliefs about food & weight gain
Inaccurate perception of body
CBT aims to change these thinking patterns,
which are assumed to maintain anorexia
behaviour
psychlotron.org.uk

CBT with anorexia nervosa




Educate & inform about anorexia
Identify & focus on unhelpful thoughts & beliefs
Replace these with more adaptive ways of
thinking
Identify problems & develop problem solving
strategies
psychlotron.org.uk
Treatment goals (Yager, 1994):

CBT with anorexia nervosa

Improved body image, eating habits at 7-year
follow up (24 patients; Yager, 1994)
Can be effective in helping maintain weight
but many continue to have distorted body
image (Davison & Neale, 1994)
psychlotron.org.uk

CBT with anorexia nervosa

Highly structured treatments (BT, CBT) most
effective during initial treatment (<1 year)
In longer term, patients may benefit more
from psychotherapy/IP/family therapy

Addressing underlying problems? Compare
bulimia treatment data.
psychlotron.org.uk
