Non-bio Treatments for AN

AO1 - CBT-E

• The cognitive approach suggests that behaviour is a result of information processing and mental processes, and that all information we receive from the environment is processed by the brain, leading to our beliefs, feelings and behaviours.

• According to the cognitive approach, anorexia nervosa develops due to faulty cognitive processes, meaning individuals form disordered and dysfunctional beliefs about food, weight and body image, which then lead to restrictive eating behaviours.

• Enhanced cognitive behavioural therapy (CBT-E) is used as a main form of treatment for anorexia nervosa and aims to rectify the thoughts and behaviours associated with disordered eating and body dysmorphia.

• CBT-E follows four stages, beginning with “starting well”, where patients are introduced to regular eating, weekly weighing and psychoeducation to encourage motivation and behavioural change.

• The second stage, “taking stock”, involves reviewing progress and identifying any barriers to improvement, allowing the therapist and patient to adjust the treatment accordingly.

• The third stage focuses on body image and involves addressing dietary restraint, body checking behaviours, emotional triggers such as mood and events, and rigid rules around food, in order to challenge the maintenance of the disorder.

• The final stage, “ending well”, focuses on relapse prevention by helping the patient develop long-term strategies and reframing relapse as a manageable lapse rather than a failure.

AO1 - FBT

• Family-Based Therapy (FBT) is another non-biological treatment for anorexia nervosa that involves the family, particularly parents, taking an active role in recovery by supervising eating and ensuring weight restoration.

• The Maudsley approach to FBT involves three stages, starting with weight restoration where parents take control of the patient’s eating, followed by gradually returning control to the individual, and finally establishing a healthy identity to prevent relapse.

AO3 - Support (CBT-E)

• Pike et al. found that relapse rates were significantly lower for patients receiving CBT (22%) compared to those receiving nutritional counselling (73%), demonstrating that CBT is effective at reducing relapse in anorexia nervosa.

• This increases the validity of CBT-E as a treatment because it shows a clear improvement in long-term outcomes, which is essential when treating chronic disorders such as anorexia.

• Byrne et al. found that approximately two thirds of patients showed significant improvement in eating behaviours and general psychopathology, suggesting that CBT-E is effective across a wide range of eating disorders.

• This supports the reliability of CBT-E because similar positive outcomes are found across different samples and settings, indicating consistent effectiveness.

AO3 - Critique

• One limitation of CBT-E is that it relies heavily on patient engagement and motivation, however individuals with anorexia nervosa often have a strong fear of weight gain, which can lead to resistance, poor adherence or dropout from treatment.

• This reduces the ecological validity of CBT-E because its effectiveness in controlled clinical settings may not reflect real-world outcomes where patients are less compliant.

• Additionally, there is limited evidence for the effectiveness of CBT-E in adults, with research suggesting it is more effective for adolescents, which reduces the generalisability of the treatment across different age groups.

AO3 - Support (FBT)

• Lock et al. found that family-based therapy was more effective than individual therapy for adolescents with anorexia nervosa, leading to higher rates of weight restoration and recovery.

• This supports the effectiveness of non-biological treatments more broadly, as it shows that involving the family can significantly improve outcomes.

• Le Grange also found improvements in eating behaviour and weight gain in patients receiving FBT, further supporting its reliability due to consistent findings across studies.

• Russell et al. also found that family therapy was more effective for younger patients, suggesting that FBT is particularly effective for adolescents.

AO3 - Other explanation (bio treatments)

• Biological treatments such as SSRIs and antipsychotics focus on neurotransmitters like serotonin and dopamine, suggesting that anorexia nervosa may have a biological basis rather than being purely cognitive or behavioural.

• Kaye et al. found that patients taking SSRIs had lower relapse rates, indicating that targeting biological factors can also be effective in treatment.

• This challenges non-biological treatments because it suggests that CBT-E and FBT may only address surface-level symptoms, such as thoughts and behaviours, rather than underlying biological causes, reducing their overall validity as standalone treatments.

AO3 - Application

• CBT-E and FBT have strong real-world application as they are widely used in clinical settings and recommended by organisations such as NICE for the treatment of anorexia nervosa.

• These treatments help patients develop long-term coping strategies and reduce relapse rates, making them highly useful for improving patient outcomes and quality of life.

AO3 - Reductionism

• Non-biological treatments are reductionist because they focus mainly on cognitive processes and environmental influences while ignoring biological factors such as genetics and neurotransmitters.

• This means they may oversimplify anorexia nervosa, which is a complex disorder with multiple interacting causes, reducing the overall validity of these explanations.

AO3 - Psychological knowledge in society

• Non-biological treatments are valuable in society because they provide non-invasive and effective ways to treat anorexia nervosa, improving mental health outcomes and reducing long-term healthcare costs.

• However, these treatments can be resource intensive, requiring trained therapists and structured programmes, which may limit accessibility and create inequalities in treatment availability.