Cognitive behavioral therepy in Eating Disorders – Anorexia Nervosa Katarzyna Kościcka Structure of presentation 1.Short Brain Storm about your knowledge about eating disorders 2.Some facts about anorexia nervosa (AN): and eating disorders generally (prevelance, types) 3.Criteria ICD-10 4.Cognitive Behavioral Therapy 5.Practical excercises Brain storm burza-mózgów-300x286.jpg What do you know about eating disorders? Type of eating disorders Prevalence of eating disorders •0,3 – 1 % of •population suffer from anorexia nervosa • •(Russel i Keel, 2002). • • •Age of onset of AN is typically early to late •adolescence (10-20 years old) • •(Keel, 2010). Common Definition of eating disorders • Include extreme emotions, attitudes, and behaviors surrounding weight and food issues. • • Eating disorders are serious emotional and physical problems that can have life-threatening consequences for females and males. • •www.nationaleatingdisorders.org ICD-10 •F50-F59 • • Behavioral syndromes associated with physiological disturbances and physical factors F50- F50.9 Eating disorders •F50.0 Anorexia nervosa •F50.1 Atypical anorexia nervosa •F50.2 Bulimia nervosa •F50.3 Atypical bulimia nervosa •F50.4 Overeating associated with other psychological disturbances •F50.5 Vomiting associated with other psychological disturbances •F50.8 Other eating disorders •F50.9 Eating disorder, unspecified • F50.0 - Anorexia Nervosa • Deliberate weight loss, induced and sustained by the patient. • • The disorder is associated with a specific psychopathology whereby a dread of fatness and flabbiness of body contour persists as an intrusive overvalued idea, and the patients impost a low weight threshold on themselves. • • There is usually undernutrition of varying severity with secondary endocrine and metabolic changes and disturbances of bodily function. • F50.0 - Anorexia Nervosa • The symptoms include restricted dietary choice, excessive exercise, induced vomiting and purgation, and use of appetite suppressants and diuretics. • •Criteria: •extreme weight loss, fasting or restriction of food intake, body image disturbance, and loss of female’s menstrual cykle. Body weight be at 85 % what is expected for one’s hight, and the fear of fitness or gaining weight despite being Neverly underveight. Obsessed with the body shape, size and appearance • • • Personality characteristic: •-perfectionism •-ego-oriented (showing strong fokus on autcome rather process) •-low self-esteem •-overemphesize weight and size •-alexithymia (inability to identyfy and Express feelings) •-a strong need for control •-extreem behavior to take underweight •-individuals: (OCD) or narcisism •(Encyclopedia of eating disorders) • What do you see? •Brige or sail? http://adonai.pl/relaks/zludzenia/graph/i6.jpg Cognitive Behavioral Therapy • Cognitive-behavioral aproches – which view many behaviours, including those which fall within the realm of personality, as being acquiared throught learning. They also emphasize the effect the mental processes, such as beliefs, thoughts and perceptions, have on behaviour • •(„Psychology in counselling and therapeutic practice” Wilkinson D.J. Campbell E. A.) Aim of therapy • To help clients to change the way in which they tink as well as they behave. • • CBT adentify and monitors thoughts, assumption, beliefs, and behaviours that are related to and accompanied by debiltating negative emotions. • • The therapist give the client to replace or transcend inaccurate or unhelpful emotions with realistic and usful cognitive and behavioral tools. • Rules of CBT •-Focusing on goals, restrict by time •-Focusing on particular problem •-Strong relationship between patient-terapist •-Focusing on what is now •-Using techniques •-Education •-Every session has a structure • • CBT (four stages) •Excercise 1: • •In the group try to (using prepar pices of paper) create the four stages of treatment. • •Stage one •- •- •- •Stege two (passing) •- •- •Stage three (main) •- •Stage four •- •- CBT (four stages) - answers •Stage one: -To engage the patient in treatment and changes - -To derive a personalized formulation (case conceptualization) with the patient - -To provide education about treatment and the disorder, and to introduce and implement 2 important procedures: collaborative “weekly weighing” and “regular eating.” - • CBT (four stages) - answers •Stage two: • •- Analysys of Progress/not progress. – encouragment/ the explanation needs to be understood and addressed. • •- Next steps of therapy - individual aproach. • CBT (four stages) - answers •Stage three: •- Its aim is to address the key processes that are maintaining the patient's eating disorder. The mechanisms addressed, and the order in which these are tackled, depend upon their role and relative importance in maintaining the patient's psychopathology • •Stage four: •- Is concerned with ending treatment well • Spectrum of eating disorders include: • •- waight control practices •- psychisical activity behaviours •- body image •- eating behaviours -weight status • How do I see myself? – body image •https://www.youtube.com/watch?v=QN4wF_kHtLI Techniques using in CBT •- keeping a diary of significant events associated feelings, thoughts, and behaviour •- questioning and testing cognitions, assumption, evaluations, and beliefs might be unhelpful an unrealistic •- gradually, facing activiteis which may have been avoided •- trying out new ways of behaving and reacting, Relaxation, mindfulness and distraction techniques are also common uses. • Techniques using in AN treatment •-What do you see in the mirror? •-How are you feeling? •- Perfect me -Excercise for the body -End of the sentance -Draw your body shape -Pantomima •Thank you for your atention! •