Primary Treatment Components

1
Primary Treatment Components

• Medical stabilization
• Establishment of therapeutic alliance
• Weight restoration
• Promotion of healthy eating attitudes, behaviors,
  and activity levels
• Psychotherapeutic treatment
• Family and community interventions

2
Cognitive Distortions

• Overgeneralization- extracting a rule based on
  one event and applying it to dissimilar
  situations
• Personalization- egocentric interpretations of
  impersonal events or over interpretation of
  events relating to the self.

3
Cognitive Distortions

• Magnification- overestimation of significance of
  undesirable consequences.
• Superstitious thinking- believing in the
  cause-effect relationship of noncontingent events.

4
Cognitive Distortions

• Selective abstraction- basing a conclusion on
  isolated details while ignoring contradictory and
  more salient evidence.
• Dichotomous reasoning- thinking in extreme and
  absolute terms. Events can only be black or
  white, right or wrong, good or bad.

5
Psychological Therapy

• 1. Ego psychology (Bruch)
• a. anorexia based on ego structural deficits
  which interfere with separation, individuation
  autonomous functioning
• b. a fact-finding trust building approach
• c. attention given to identity issues, changing
  faulty self-perceptions improving interpersonal
  relationships

6
Psychological Therapy

• 2. Nurturant-authoritative approach
• (Levenkron)
• a. supportive
• b. build trust
• c. identify purpose of disorder
• d. develop other coping strategies

7
Psychological Therapy

• 3. Cognitive Behavioral Therapy (CBT)
• a. increase self-esteem confidence
• b. develop autonomy
• c. challenge irrational or "anorexic" thinking
• d. teach coping skills

8
The ABCs of RET
A (activating event)
B (belief)
C (consequence)
E (new effect)
D (disputing intervention)
9
Psychological Therapy-Individual

• 4. Classical psychoanalytic approach (Freud)
• a. no attention to weight
• b. emphasis on interpretation by patient
• c. therapist plays a passive role
• d. ineffective for anorexia nervosa

10
Psychological Therapy

• 5. Behavior modification
• a. focuses on wt. gain, not psychological issues
• b. emotional family issues not addressed
• c. temporary and dangerous

11
Psychological Therapy-Family

• B. Family therapy (Minuchin)
• 1. primary mode if pt living at home
• 2. challenges enmeshment
• 3. care taken to avoid placing blame
• 4. individuality stressed
• 5. Aim- to increase parent effectiveness

12
Psychological Therapy-Group

• Not used with below viable weight anorexics
  should be considered for "well-recovering"
  anorexics

13
Psychological Therapy-Group

• 1. Goals
• a. increase weight
• b. increase self-confidence
• assertiveness
• c. increase ability to identify
• express emotion
• d. decrease depression

14
Psychological Therapy-Group

• 2. Advantages
• a. challenges their uniqueness
• b. challenges their misconceptions
• c. decreases feelings of isolation
• d. recreates some dynamics of primary family
• e. helps in correction of body image distortions

15
Diet Therapy

• Considerations
• 1. G.I. problems
• 2. ? levels of enzymes, bile, etc.
• 3. ? BMR ? will gain weight quickly
• 4. lack of complete knowledge of nutrition

16
Diet Therapy

• 1. emphasize nutrients nutritional status
  rather than weight and kcalories
• 2. computer analysis of diet
• 3. work on one nutrient at a time
• 4. stress nutrient density

17
Diet Therapy

• 5. stress visible results of good nutrition
• 6. cut down on caffeine so hunger fatigue are
  experienced
• 7. cut down on fluids so hunger will be
  experienced
• 8. zinc and protein are important nutrients to
  stress

18
Changing Dietary Behaviors

• 1. cognitive restructuring - challenge nutrition
  myths
• 2. model normal eating through eating with non
  dieters and use of food models
• 3. role play eating situations