non-biological treatment

• what is CBT & what has it been developed for

  CBT has been developed for AN - called an enhanced CBT (CBT-E) which is conducted on a 1-1 basis between AN patient & therapist - most patients have 20 sessions - hard time limit encourages fast recovery in time frame
• what takes place over 2 sessions

  an interview takes place over 2 sessions to allow the therapist to assess patients symptoms (e.g: fear, distorted body image) and suitability for CBT-E - interview aims to adjust thoughts and behaviours of AN patients
• stage 1

  • focuses on changing patients eating behaviours
  • patient is weighed regularly and eating is encouraged over 3-4 week period (e.g: praise when keeping a meal down over 1000kcal)
  • given info about AN - patients understand that AN is fatal
• stage 2

  • progress update for patient and therapist in terms of weight gain and eating behaviour, if no progress is made = therapist discovers why
  • core beliefs are identified
• core beliefs such as:

  • i will become disgusting
  • i will be a failure
  • i will instantly become fat
• stage 3

  • main treatment phase that directly addresses the reasons behind eating behaviours including any triggers in their life for changes in their eating such as starting a new school
  • therapist tests clients irrational belief by introducing an alternative belief
  • client and therapist identify ways in which the clients self evaluation is dependent on their body weight & shape
• what behavioural experiment happens in stage 3

  behavioural experiments to address body image disturbance may include full length mirror exposure for 40 minutes which is scary at first but leads to rapid drop in distress over time, reducing body avoidance if that's an AN symptom client experiences
• stage 4

  • involves 3 appointments around 2 weeks apart
  • patient is encouraged to look to the future and think about how to manage their own eating behaviour & thought patterns which includes: an agreed plan on how to prevent relapse
  • post treatment interview review 5-6 months later set up to see how patient has been
• strength

  • pike (2003) compared effectiveness of CBT-E against nutritional counselling
  • in 33 patients observed, relapse rate of those in CBT-E condition was 22% compared to 73% in counselling
  • demonstrates the success of CBT-E in lowering relapse rate
• strength

  • fairburn (2015) compared effectiveness of CBTE against interpersonal psychotherapy (IPT)
  • randomly allocated 130 ppts with EDs to CBT-E or IPT. after 20 weeks, 65.5% of CBT-E and 33.3% of IPT ppts - independently judged to be in remission. after a 60 week follow up, 65% and 49% for IPT
  • shows CBT-E is more effective treatment for majority of people with AN than alternative therapy
• weakness

  • CBT targets cognitive aspects of AN but other treatments seem more effective
  • sodersten (2017) compared CBT and a normalisation of eating procedure which involved providing the client with feedback at mealtimes to encourage normal eating behaviour. remission rate was 75% over 5 years compared to remission rate of 45% for CBT
  • implies there are more effective alternative treatments for AN
• weakness

  • CBT-E has a high drop out rate
  • carter (2012) found there was a 45% dropout rate for CBT-E programme factors like: waitlist times & initial low body weight make patients want to drop out
  • other studies may only improve on improvements of patients that complete the treatment