Treatments of Anorexia

Biomedical Approach

if a neurochemical imbalance causes a disorder like anorexia, drugs can be used to alleviate the symptoms.

Holtcamp et al. study

A study to measure effectiveness of SSRI’s.

Showed SSRi’s had no clear effect

Evaluating Olanzapine

Dennis Et Al found Olanzapine helped patients dealing with anorexia with major difference however some minor side effects

Norris et al found that Olanzapine didn’t really do much with barely any substancial difference but found many side effects to the drug

Spettigue et al found that Olanzapine helped with patients because their was a much greater number of weight gain however side effects led to stoppage

What kind of studies to test effectiveness of drug treatments?

randomized, double-blind and placebo controlled design

Randomized- randomly assigned to a treatment group or control

Double blind- neither the researcher nor participants know who’s recieving treatment or placebo, limiting researcher bias and demand characteristics

Drug treatments for Anorexia

Selective Serotonin Reputake Inhibors (SSRI’s) (anti-depressants)- used in hope to reduce obsessive compulsory symptoms and depression associated with anorexia. However, studies have shown are not as effective and are better with anxiety or depression

Olanzapine (anti-psychotic meds) - may help reduce anxiety around food and weight gain, some studies indicate it can help with weight gain. However, Olanzapine does come with side effects and doesn’t have a big effect, and is more used as antipsychotic medications

Repetitive Transcranial Magnetic Stimulation (rTMS)

non-invasive procedure that uses magnetic fields to stimulate brain areas. For anorexia it is applied to dorsolateral prefrontal cortext, which helps with control, emotions and desicion making.

Deep Brain Stimulation (DBS)

A more invasive treatment that involves surgically implanting electrodes into specific brain regions. The electrodes deliver electrical impulses to alter neural activity. In severe cases, DBS has shown some positive effects however it is very experimental and used for specfic cases.

Evaluation of Drug Therapy

Stength- it alleviates the symptoms that make day-to-day living difficult

Limitations- many side effects such as nausea, bluerred vision, insomnia, etc.

Researchers don’t know why the drug alleviates symptoms as studies proved to fluctuate it.

Reductionist approach- because it may alleviate symptoms but it may not address the actual cause of the disorder

Strengths and Limitations of biomedical treatments

medications have allowed more people to manage their conditions while living at home instead of staying in a hospital or care facility.

Drug therapy shows results more quickly than psychological therapies

Neglects important social and cognitive factors

Drug therapy- has side effects, which can cause a misinterpretation as a symptom of the disorder, known as an iatrogenic effect

Could lead to addiction and withdrawl symptoms

Cognitive Behavioral Therapy (CBT)

Used to treat anorexia specfically in adults. Focuses on addressing and modifying distorted thought patterns related to body image, weight and self-esteem.

Broken down into 3 phases

behavioral phase- patient and therapist work together to set goals for stabilization

cognitive phase- therapist helps patient recognize the problem and change problematic thinking patterns

maintenance and relapse prevention phase- providing coping strategies for strssors and conflict to prevent relapse.

Token Economies

A behavioral approach used as part of treatment programs particularly in inpatient setting. Approach applies operant conditioning to reinforce desired behaviours through tokens and rewards.

Techniques of CBT for Anorexia

Cognitive Reconstructing- patients with anorexia hold irrational beliefs about food, weight and body image, so, CBT helps challenege and replace them with more balanced views

Graded exposure- CBT may incorporate exposure to feared foods or situations (eating out), helping patients reduce the anxiety that drives restrictive behaviours

Goal Setting- Patients work with therapists to set achievable and specifc goals for weight gain, eating patter and improving body image.

Effectiveness of CBT

demonstrated some effectiveness but is better with other disorders like depression. Pike et al. found that groups without CBT relapsed earlier and at a higher rate than those in CBT group.

Placebo effects

often, clients improve partly because they believe that therapy will help

Therapeutic alliance

supportive relationship with a therapist can enhance motivation and self-belief contributing to improvements

Spontaneous Remission

Some mental health conditions can improve naturally over time. Natural recovery complicates assesment because its hard to know if improvements would have happened regardless of the therapy.

Extraneous variables

Positive or negative life changes can effect mental health. Family support or lifestyle chances can improve mental health. Seperating the effects from the changes are challenging.

Ecelctic Therapy

Therapists blend techniques from different therapeutic approaches. Blending makes it difficult to assess which specific elements of therapy contribute to improvement.

Evaluation of CBT

Strengths: Patients don’t experience any side effects.

CBT provides skills that may be used to prevent relapse after therapy is done

Limitations: Anorexia has high relapse rate, so patients experience setbacks after treatment

CBT for anorexia is intensive and requires commitment

Patients often need medical treatment and nutritional support, particularly in early stages of recovery

Family-Based Therapy (FBT)

Used only for adolescents. Considered the most effective evidence based treatment for adolescents. Actively involves family members, particularly parents, in the recovery process. Parents supervise meals, weight restoration and gradually give control back to adolescents as progressing.

The Maudsley Method

A specific form of family therapy in which parents assume resposibility for feeding their anorexic teen to help them gain weight and improve eating habits. Goal is to lower anxiety and distress in the family as well as give parents some communication tools to help their child build self-efficacy

Evaluation of Family Based Therapy

Strengths: Research shows that FBT is particularly effective for adolescents, with many studies reporting high success rates

FBT takes a hollistic approach, addresing family dynamics that contribute to disorder

FBT can be adapted to meet the family’s and patients needs allowing for personalized strategies

Limitations: Success relies heavily on supportive family dynamics

FBT does not fully explore the underlying psychological issues or trauma that contribute to the disorder

FBT requires significant commitment from family memebers

Open Label Trials

Open label trials are when the researcher and participants know exactly which group took the drug and which didn’t, as well as are very transparent so their isn’t really any deception. However, their are some issues like bias, demand characteristics, etc. could influence the study

Monteleon Findings

• FBT was the only intervention with evidence supporting weight gain in younger patients.

• Few treatments produced lasting improvements in adolescents’ eating behaviors, and relapse rates were high.

• Psychological therapies generally showed little advantage over control groups.

• No medication showed effectiveness for reducing disordered eating or improving weight gain in the evidence reviewed.