biological stress vulnerability a model of eating disorders restriction of eating social cultural...

BiologicalStress vulnerability

A model of eating disorders

Restriction of eating

SocialCultural & family pressures

PsychologicalAnxiety about appearance

Anorexia

Continued restriction

Reduced anxiety

Excessive weight loss

Bulimia

Bingeing

Purging

Maintain weight

Based on Barlow & Durand (1995) psyc

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Treatments for EDs

Behaviour therapy Cognitive behaviour therapy Weight restoration (anorexia only)

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CBT

Treatment based around: Identifying dysfunctional thinking processes

that cause & maintain disordered eating Use of behavioural exercises to test and

modify maladaptive beliefs

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CBT with bulimia nervosa

Four stages (Fairburn, 1985):1. Education about effects of bingeing,

purging, dieting2. Modified eating patterns – small meals 5-6

times a day3. Altering dysfunctional attitudes about

food, eating & the body4. Teaching coping strategies to avoid

bingeing & purging

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CBT with bulimia nervosa

Fairburn et al (1993); comparison of three treatments:

1. CBT (all four parts)2. BT (just the eating habits part)3. IPT (interpersonal therapy)

Outcome measures: cessation of bingeing/purging; attitudes to body/eating

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CBT with bulimia nervosa

Start End 4mo 8mo 12Mo

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CBT

IPT

BT

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CBT with bulimia nervosa

CBT works fast & is more effective than BT Not a panacea – only 36% had no

symptoms at 1 year follow-up Early treatment gains may be lost; IPT more

effective long term Drugs may boost effectiveness (Agras

et al, 1992)

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CBT with anorexia nervosa

Anorexia involves several cognitive distortions: Irrational beliefs about food & weight gain Inaccurate perception of body

CBT aims to change these thinking patterns, which are assumed to maintain anorexia behaviour

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CBT with anorexia nervosa

Treatment goals (Yager, 1994): Educate & inform about anorexia Identify & focus on unhelpful thoughts &

beliefs Replace these with more adaptive ways of

thinking Identify problems & develop problem

solving strategies

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CBT with anorexia nervosa

Improved body image, eating habits at 7-year follow up (24 patients; Yager, 1994)

Can be effective in helping maintain weight but many continue to have distorted body image (Davison & Neale, 1994)

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CBT with anorexia nervosa

Highly structured treatments (BT, CBT) most effective during initial treatment (<1 year)

In longer term, patients may benefit more from psychotherapy/IP/family therapy Addressing underlying problems? Compare

bulimia treatment data.

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