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Treatments for Anorexia - Coggle Diagram
Treatments for Anorexia
Biological Treatment: Drug Therapy
National institute for health and social care excellence states that drugs shouldn’t be used as primary or only treatment for patients with anorexia nervosa and there’s very little (If any) evidence that states that drugs are useful treatment for anorexia. However, many patients with anorexia may suffer from comorbid conditions which occur at same time as eating disorder, for which drug therapy may be effective. Comorbid conditions may include depression and anxiety, including obsessive-compulsive behaviours. Currently, the two types of drugs most used in treatment of anorexia nervosa are selective serotonin reuptake inhibitors (SSRI’s) and olanzapine. SSRIs are a form of antidepressant that work by blocking reuptake of serotonin in presynaptic neuron, making it more available in synapse to be passes to postsynaptic neuron and increase levels of serotonin.
Olanzapine is an atypical antipsychotic drug which is also used to treat anxiety and is thought to block serotonin and dopamine absorption in certain pathways of the brain. It’s felt that, in patients with comorbid conditions like depression and anxiety, the use of medication to treat these symptoms may enable patient to benefit more readily from psychological therapies that are effective in treating anorexia. For example, a patient who is anxious about weight gain necessary to treat eating disorder is less likely to drop out of therapy programme if anxiety can be treated with drugs.
Evaluations
Kaye et al (2001) found that people who took fluoxetine were more likely to stay on medication up to a year after outpatient treatment and had lower relapse rates.
Jensen and Mejinede (2000) found positive effects for 3 patients treated with 5mg of olanzapine a day (effects on body image) suggests antipsychotic makes body image more realistic but first 2 months difficult due to hunger and weight gain side effects-
Small Sample, case study of 3
Some Anorexia suffers may have serious problems so drugs can be risky or have cardiac side effects.
Patients taking SSRI’s and olanzapine find that they gain weight which can be difficult to cope with and causes difficulty in maintaining medication.
Ferguson et al (1999) found no significant difference in terms of clinical symptoms and anxiety reports between those taking SSRI’s and those not.
Issues and Debates Psychology As a Science
Drug therapies are scientifically developed treatments for mental health disorders based on good, scientific research including large-scale, double-blind randomised control trials before they become passed for use. This means that the drug had performed better than a placebo in reducing symptoms, and that possible side effects are well recognised, and risk of development can be assessed for everyone who is given treatment
Psychological Treatment: Cognitive Behavioural Therapy
A form of cognitive behavioural therapy has been developed for specific use with eating disorders. Enhanced cognitive behaviour therapy (CBT-E) is used in anorexia nervosa treatment as well as other eating disorders as it’s aimed specifically at tackling the thoughts and behaviours associated with disordered eating behaviour. The advantage of CBT-E over other modified forms of cognitive behavioural therapy used in patients with eating disorders is that the mechanisms in enhanced cognitive behavioural therapy are comprehensive enough to be used to treat the changing patterns of disordered eating that are common In patients with eating disorders over time. The therapy is conducted on one-to-one basis between the client and therapist, and courses of about 20 sessions will be advised for most people initially. Clients who are significantly underweight will be advised to complete 40 sessions.
Initially, a detailed interview occurs, normally over 2 separate sessions to allow therapist to assess the patient’s suitability for CBT-E at current time. The therapist will also explain the treatment process to the client and allow them to ask questions if necessary. For the therapy to be effective, any possible barriers to treatment must be removed at the outset and this means, if there’s other factors in client’s life that can affect treatment success, they’re dealt with before therapy begins.
The therapy works in 4 stages:
Stage 1- 4 weeks with 2 sessions per week, to encourage rapid change in client behaviour. Two important procedures are implemented in this phase ‘Weekly weighing’ with therapist and ‘regular eating’. Clients are educated about disorder and will learn about treatment programme, so they know what to expect. It’s important during this first stage that the patient is positive about the treatment and are motivated to progress because the therapy will only be effective if they’re willing to make necessary changes.
Stage 2- The stage is quite brief consisting usually of two appointments one week apart. The therapist and client will meet to discuss the progress being made in one and taking stock of how the patient is currently. Good progress can be praised to boost motivation, while poor progress can be discussed to uncover possible reasons for why things are not going well.
Stage 3- This is the main stage of the treatment phase where clients will usually have eight appointments once a week to tackle factors that are involved in maintenance of the eating disorder. This will involve dealing with the client’s body image, their dietary rules, and any event-related changes in eating. Dealing with body image will usually look at certain behaviours that are likely to lead to body dissatisfaction such as constant body checking, as well as triggers that make them ‘feel fat’. Dietary rules are explored to consider the impact that rigid and restrictive rules are having on client’s quality of life and any foods they currently avoid that are gradually introduced to the diet. It is also important that external events that impact on major changes in eating are considered and tackled at this stage in treatment.
Stage 4- Clients are encouraged to look to the future and consider factors that need to be managed to prevent relapse. Usually, clients will have three appointments about two weeks apart at this stage. The therapist and patient will draw up an agreed plan that is personalised for specific circumstances. Clients are also encouraged to consider their own mindset so that they don’t see any relapse as ‘failure’ and instead think of it as ‘lapse’ that they can address. A post-treatment review appointment will then be made about five months latter where the client will be available to discuss any setbacks or issues.
Evaluation
The benefit of any form of CBT is that it’s flexible and can be adapted to suit the needs of the patient, like version of CBT-E designed specifically for patients with extremely low body weight.
Most used form of enhanced CBT is only effective for patients with anorexia nervosa whose eating disorder isn’t maintained by clinical perfectionism, low self-esteem, or interpersonal problems. However, there’s other forms of CBT that can be used with these patient groups and this can be identified early on in treatment process.
Pike et al (2003) found relapse rates for CBT were significantly lower (22%) than nutritional counselling (73%).
Byme et al (2011) found 2/3 significant improvement in symptoms of all Eps after CBT-E.
More suited to those with independent access to treatment + living away from family (It’s about taking control and monitoring own thoughts and behaviour). For patients who still live at home, family therapy may be more effective as it deals with effects on family, not just the individual.
It is flexible so that can be adapted to participants needs.
Client must be motivated or not effective.
Does allow for client not spend time learning about this disorder before they enter the treatment, it will be important for therapist to recognise signs that client isn’t fully ready.
Most common form only effective when disorder not maintained by clinical perfectionism, self-esteem or interpersonal probs but there are other forms for these groups.