Treatments for AN - CBT Flashcards
(18 cards)
Non-biological way of treating AN patients
enhanced cognitive behavioural therapy
Study on enhanced cbt
Fairburn (2008)
Two types of enhanced cbt
-Broad type (CBT-Eb)
-Focused type (CBT-Ef)
What does the broad type treat
Treats core pathology of AN and symptoms external (overevaluation of body shape/weight)
Who is the broad type of CBT suitable for
Suitable for clients with low self-esteem or perfectionism
What does the focused type do differently to the broad type
Does not tackle external symptoms
Two types of intensities
-40 sessions over 40 weeks for BMI <17.5
-20 sessions over 20 weeks for BMI >17.5
How many stages of CBT-E
4
Who made stages of CBT-E
Murphy et al (2010)
Stage 1 of CBT-E
‘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)
Stage 2 of CBT-E
Brief stage – client and therapist review progress
-Identify barriers to change and plan stage 3
-Switch to broad CBT-E if external symptoms appear
Stage 3 of CBT-E
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)
Stage 4 of CBT-E
‘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
Strength of therapy
-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
Counter-argument of strength
-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
Weakness of therapy
-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
Another weakness of therapy - dropout rates
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
Application
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
