biological stress vulnerability a model of eating disorders restriction of eating social cultural...
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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)
psyc
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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
psyc
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ron.
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uk
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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
psyc
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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
psyc
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CBT with bulimia nervosa
Start End 4mo 8mo 12Mo
Ces
satio
n ra
te
020
4060
CBT
IPT
BT
psyc
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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)
psyc
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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
psyc
hlot
ron.
org.
uk
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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
psyc
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org.
uk
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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)
psyc
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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.
psyc
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org.
uk