Non-biological treatmeng for anorexia: CBT

What is the type of CBT used for AN called?

Enhanced CBT (CBT-E)

How is CBT-E conducted?

On a one-to-one basis between patient and therapist. Most patients receive about 20 therapy sessions.

What happens before CBT-E officially starts?

A detailed interview takes place between the patient and therapist, allowing the therapist to assess patient symptoms and suitability for treatment using CBT-E.

What is the point of CBT-E?

To change the cognitive malfunctions thought, by cognitive psychologists, to cause AN

How many stages of CBT-E are there?

4

What happens in stage 1 of CBT-E?

The focus is on rapidly changing the patient’s eating behaviour. The patient is weighed on a weekly basis and regular eating is encouraged after the client and therapist devise an eating plan together. Patients are also given information about AN to ensure they understand the disorder and the serious medical dangers caused by self-starvation, such as a high risk of death.

What happens in stage 2 of CBT-E?

Stage 2 is usually a progress update for both the patient and the therapist. The therapist may need to look further into why progress isn’t being made if the patient hasn’t gained any weight, doing this by identifying if there are additional symptoms external to the core pathology, such as low self-esteem, which are maintaining their AN.

What happens in stage 3 of CBT-E?

The main treatment phase that aims to directly address the reasons behind patient eating behaviour, including any ‘triggers’ in their life for changes in their eating (eg- death of a loved one).

• Dietary rules are identified (eg- patient avoiding certain foods like carbohydrates) and the therapist helps the patient break these with behaviour experiments, such as sharing the importance of a balanced diet including carbohydrates and showing that breaking self-imposed rules doesn’t produce the negative co sequence the person is afraid of (eg- u controllable weight gain).

• The therapist may test the patients’ irrational beliefs (eg- ‘if i don’t weigh myself 3 times a day, my weight will go out of control) by introducing alternative beliefs.

• The client and therapist will also identify the many ways in which the client’s self-evaluation is dependent upon their body weight and shape. Behavioural experiments go to address body image disturbance may include full length mirror exposure for long periods of time.

What happens in stage 4 of CBT-E?

The patients agrees on a plan with their therapist including continuing weekly weigh-ins at home and strategies such as rule-breaking and avoiding body-checking to prevent AN relapse and manage eating behaviour at home. A post-treatment review around 20 weeks later will also be set up to see how the patient hasn’t been progressing and to check weight gain has been maintained by the patient.The patient is so encouraged to be realistic about the notion of relapses, seeing them as inevitable but also something that can be overcome.

Two strengths of CBT-E?

• Effectiveness: Pike et al (2003)

• The flexibility of treatment

Why is Pike et al (2003) a strength of CBT-E.

Provides evidence to highlight its effectiveness, especially n in comparison to other treatments. Pike et al (2003) found that the relapse rate for AN patients receiving CBT was lower (22%) than those receiving nutritional counselling (73%). Additionally, Faiburn et al (2015) found that after 20 weeks of treatment, 69.4% of the CBT-E groups were classes as ‘in remission’ compared to 33.3% of the group cling interpersonal psychotherapy treatment. Therefore, this demonstrates that CBT is a more effective treatment for the majority of people with AN than other established therapies.

Why is the flexibility of treatment a strength of CBT-E?

CHT can be adapted to suit the needs of each individual patient. For example, there is a version of CBT-E that is designed specifically for patients with extremely low body weight, most commonly used for patients whose eating disorder is not maintained by clinical perfectionism, low self-esteem or interpersonal issues. Therefore, the treatment process is personalised for these patients. Additionally, due to the collaborative nature of CBT, the therapist is able to target behavioural experiments and strategies to specifically change the beliefs of each patient. Therefore, the treatment can be made specific for each patient, presumably making it more affective.

Two weaknesses of CBT-E?

• Requires motivation: Carter et al (2012)

• Drug treatments may be better

Why is motivation a weakness of CBT-E?

CBT-E requires the patient to be motivated to change and hVe the time to dedicate to treatment. CBT-E is a demanding treatment that requires the patient to attend weekly session and complete homework - it is often unpleasant and mentally challenging, leading to patients dropping out. Carter et al (2012) found that in a CBT-E programme. there was a 45% attrition rate, again, proving that CBT-E may not be a universally effective treatment.

Why may drug treatments be better for treating AN?

They do not require as much of a time commitment or as much effort from patients, meaning that they are more likely to make it through the programme, However, CBT does look at factors that affect AN so it may be more effective than drug treatment which just aims to control the symptoms. Perhaps drug therapy and CBT should be used collaboratively to provide the most effective treatment for AN patients.