10 - eating disorders II

Question 1

what maintenance factors do intervention focus on?

Answer 1

• safety behaviours
• cognitive patterns
• emotional patterns
• social maintenance
• family accommodation of symptoms
• nutrition

Question 2

what are types of prevention for eating disorders?

Answer 2

primary prevention - lower level of future development of Eds

secondary prevention - lowering eating and other concerns in present

Question 3

examples of prevention making things worse?

Answer 3

Carter et al., and Bronowski both tried psychoeduction about dieting and eating disorders

in both cases, level or pathology worsened
- Baronowski - short term
- Carter - long term

some reported as a problem, some as a success

Question 4

what prevention approaches are effective for reduction in risk factors and current pathology?

Answer 4

• media literacy approaches reduce shape and weight concerns in young population
• cognitive dissonance approaches reduce eating behaviours and attitudes ion high-risk groups
• CBT interventions reduce risk of dieting
• weight management interventions reduce some risk factors

Question 5

what are methods to prevent obesity?

Answer 5

• NICE recommends interventions involving schools, local government, families, taxation
• encouraging lifestyle changes, healthy eating and exercise
  these don’t work on they’re own, relatively unsuccessful

Question 6

what are effective treatments for adults with anorexia?

Answer 6

• individual CBT (40 sessions)
• Maudsley anorexia nervosa treatment for Adults (MANTRA) (20-30 sessions)
• specialist supportive clinical management (SSCM) (20-30 sessions)
• similar level of effectiveness to behaviour therapy

25-30% effectiveness

Question 7

what methods to prevent obesity are most effective?

Answer 7

NICE guidelines

primary differences between:
- adult vs children/adolescents
- underweight vs non-underweight

Question 8

what are effective treatments for children and adolescents with anorexia?

Answer 8

AN-focused family therapy
- non-blaming
- stop accommodating patterns
- family takes control of child’s eating
- then gives control back to child
- finishes with relapse prevention

CBT or adolescent focused psychotherapy as second option

Question 9

what are effective treatments for bing eating disorders?

Answer 9

group or individual CBT-ED (16-20 cases)
both adults and adolescents

Question 10

what are effective treatments for adults with bulimia nervosa?

Answer 10

individual CBT-ED (16-20 sessions)

Question 11

what are effective treatments for children and adolescents with bulimia nervosa?

Answer 11

• family therapy for BN
• CBT-ED as a second line therapy

Question 12

what are effective treatments for atypical cases (OSFED)?

Answer 12

use therapy recommended for the most similar full syndrome e.g. anorexia

Question 13

what are effective treatments for ARFID?

Answer 13

• not addressed by NICE
• some early evidence for CBT-AR

Question 14

what is a common element of effective treatment?

Answer 14

nutrition/exposure to foods
- physical, cognitive, emotional and social benefits

particularly valuable for underweight cases

Question 15

what are other effective approaches not included in NICE?

Answer 15

medical monitoring and management

intensive treatments (in- and day- patients)
- necessary for management of high-risk cases
- good for weight restoration
- no evidence of establishing recovery
- very expensive
- risk of creating dependence
- best use is stage 1 in anorexia

Question 16

what medications can be used to address the biology of eating disorders?

Answer 16

SSRI medications at high doses for bulimia
- enhances serotonin
- reduces binges for some while taking it but no longer

novel antipsychotics for anorexia
- potentially reduce anxiety

WEAKER EVIDENCE

Question 17

what are physical interventions that have weak evidence for use?

Answer 17

neuromodulation - transcranial stimulation methods slightly reduce depression

leukotomy - used for anorexia with extreme OCD, evidence is anecdotal

Question 18

what are psychological therapies that have some evidence for use?

Answer 18

dialectical behaviour therapy (DBT)
- reduces impulsive behaviours in BED/BN but little change in core pathology

interpersonal psychotherapy (IPT)
- works for BN but slower and less effective than CBT

focused psychodynamic approaches (FIT)
- effective for anorexia but no replication

integrative cognitive-affective therapy
- less effective than CBT

Question 19

what are psychological therapies with little evidence for use?

Answer 19

• metallisation-based therapy
• acceptance and commitment therapy
• mindfulness-based approaches
• family therapies not food/eating focused

Question 20

what is the mean effectiveness of evidence-based therapies for adult psychological disorders?

Answer 20

50% recovery
25% improvement
20% unchanged
5% deteriorate

Question 21

what is the mean effectiveness of therapies for eating disorders?

Answer 21

50% recovery for non-underweight cases

30% recovery for underweight cases

Question 22

how is the hunger/satiety balance used to treat eating disorders?

Answer 22

gets the person to overcome their reasons for not eating healthily

teaching them to eat in response to biological need, not toxic environment of inner psychological concerns

Question 23

what are the effects of addressing eating and nutrition?

Answer 23

• reduces anxiety, depression, impulsivity
• reduces alcohol level
• enhances cognitive flexibility, social skills
• normalises and stabilises weight
• enhances quality of life

Question 24

what are the effects of psychological therapies for treating obesity?

Answer 24

• help to lose weight in the short term
• bad at keeping weight down long term

Question 25

what can be done to treat obesity?

Answer 25

• not blame and abandon individual
• political/social changes
• lifestyle coaching
• longer therapy
• continuing care model most likely to work
• bariatric surgery