Hello hello m’fitties! *fist bump*
How’ve you been doing? August is here and GUHH IS IT EVER SO HOT!
Today I have in store for you one last article that I had to write for my course completion (it was a social work course; I needed to fulfill for an elective). You can find my previous research findings here:
- Overeating just makes you SAD!
- Eastern VS Western Values in Eating Disorder Development
- 13 REASONS WHY YOU’RE BINGEING
Okay, I admit, the last one wasn’t for a paper but I still did a lot of research and introspection from my own personal experiences and experiences of girls I work with (as a lifestyle coach!) and it’s SUPER INSIGHTFUL and can help you find the reasons why you’re addicted to food so you can find out how to stop it.
I’ve mentioned in the past that I’ve personally begun therapy for anxiety and depression, and there’s no shame in that!
I did some research on the different models of therapy. My hope is that you’ll expose yourself to a variety of approaches so you can find one that works for you. 🙂
Enjoy!
**this is a lot more formal than my usual writing style; I just wrote a paper for school on this topic after lots of research and thought it’d be insightful to share my findings!
Don’t suit the treatment model; let the treatment model suit you:
Among the numerous treatments offered for eating disorders, the unique needs of each individual allow for certain therapies to resonate more in some than in others. There are numerous approaches ranging from cognitive, group, family, spiritual, art, psychodynamic, even the new innovative equine therapy, and because there lie multiple intersections for the factors that contribute to the development of eating disorders (biological, socio-cultural, psychological, etc.), there are many treatments that could potentially suffice. No two cases of eating disorders are identical, and thus, no single therapy is a one-size-fits-all solution; certain approaches work better in certain cases for certain individuals. With so many possibilities, one solution is sure to exist to aid the recovery process.
The most common type of therapy for any mental illness is CBT, otherwise known as cognitive behavioral therapy. CBT is based on the principle that if one can change their thoughts, they can change their course of action (in other words, change the thought, and change the behavior). CBT promotes new adaptive ways of thinking instead of the maladaptive ones driving poor behavior. “[They]…are aimed at delineating and testing the patient’s specific misconceptions and maladaptive assumptions” (Beck, 2011). Its popularity could be attributed to the fact that mental illness occurs in one’s cognition—it is a psychological illness, so naturally, it makes sense to heal the brain. In the context of an eating disorder, it could alter destructive thought patterns and restrictive mindsets (such as black-and-white thinking) that feed into the eating disorder. CBT addresses underlying core values, like body image, low self esteem, unconscious beliefs and other limiting beliefs. Its practical, brain-based approach allows patients to learn to become aware of their unconscious, automatic thought patterns through exercises such as journaling, writing, and drawing. CBT generally lasts in segments of 8-12 sessions with 1 or 2 meetings a week (Rothbaum et al., 2000).
Similar to CBT, Diabolical Behavioral Therapy (DBT) lies on a similar principle but aims to regulate heightened, stressful emotions. This type of treatment was originally developed and intended to treat borderline personality disorder because those patients experience intense emotional highs and lows and often don’t feel a sense of control over their turbulent moods (which leads to irrational actions). DBT works by calming the sympathetic nervous system in order to better deal with stressors and obsessive emotions/thoughts. Through mindfulness and thought-acceptance exercises, DBT gets one to stop, think, and then respond rationally instead of reacting irrationally/immediately. In the context of eating disorders, DBT can be used to control impulsivity, such as battling urges to binge and purge in those with bulimia or binge eating disorder. DBT usually involves two sessions per week: one individual session done privately with a therapist, and another in a group setting with others who deal with the same problem. Private sessions are used to provide one-on-one support, address the unique individual circumstance of a patient and identify personal triggers, whereas group sessions provide social support. Members in the group are able to challenge each other, validate each other’s frustrations and experiences, and also sympathize and comprehend on a personal level with other members’ stories and struggles. Through peer support and community engagement, group therapy allows all to celebrate successes, share hardships, hold each other accountable, and ultimately, progress together.
Cognitive behavioral therapy and diabolical behavioral therapy are identical in that they work to alter the attitude from a thought. Both are very similar and often overlap, however the main difference between the two is their approach. DBT involves the acceptance of a negative thought; neutralizing it, and puts more emphasis on controlling the emotion derived from the thought, whereas CBT emphasizes controlling, manipulating, or modifying the thought itself.
An alternate treatment that involves pills is the pharmacological treatment. Eating disordered patients are often low on neurotransmitters such as serotonin (the feel-good hormone, and when depleted causes cravings for sugar) and dopamine (the hormone for motivation and pleasure, and when depleted causes depression and lethargy). Antidepressants such as Zoloft, Prozac, Lexapro and other selective serotonin reuptake inhibitors (SSRI’s) are commonly prescribed to elevate mood. These medications can be beneficial in controlling urges to make irrational, impulsive decisions in patients. The hope of pharmacological treatment is to restore neurotransmitter balance to the brain—in essence, cure the imbalance and cure the patient. While prescribed under a wide variety of circumstances, unfortunately, there lie numerous side effects to the administration of these drugs such as weight gain, loss of sex drive, dizziness, insomnia, and diarrhea. Patients may also start to rely on the medication in order to properly maintain physiological function and may experience negative withdrawal symptoms with discontinued use.
The pharmacological approach is rarely used as a treatment on its own. “Usually these involve a combination of one-to-one cognitive behaviour therapy and some form of family therapy” (Fairburn, 2001) to address the psychological components of the eating disorder.
Based on the same principle as pharmacological therapy, there is also nutrition therapy, which uses food to treat nutritional imbalances in hopes of curing the disorder. Similarly, it is also rarely used on its own for recovery because eating disorders are conditions of the mind, and not exclusively physiological. Nutrition therapy is often paired with psychotherapy as well.
In this treatment, nutritionists ensure patients are getting adequate nutrients for the body to maintain functionality; often patients suffer from medical complications such as low blood pressure, impaired digestion, weak organs and impaired cognitive function as a result of their eating disorder. Usually, a nutritionist or dietitian devises a meal plan and meets regularly with the patient to check up on how their bodies are responding to the treatment. If things progress in the right direction, the meal plan is adjusted to accommodate the physiological adaptations; more calories are added. Slowly, their bodies recover from malnutrition through strategic caloric increase. Patients that are severely anorexic may commence with less calories than what is generally recommended for their weight and height because a sudden increase in calories to their starved bodies could induce refeeding syndrome, a condition that occurs when there is a fatal shift in fluids and electrolytes that cause hormone and metabolism damage (Mehanna et al., 2008). In addition to healing the physical body, nutritionists may challenge a “food fear” (Steinglass et al., 2012): a belief around a certain food by asking them to eat it. It fosters a healthier relationship between the patient and food itself by viewing the food as neither good nor bad.
The product of nutrition therapy eventually gets patients to a heathy weight, incorporate food varieties (since most disordered eating revolves restriction on certain foods), and no more fear around “scary” foods like chocolate or cake.
Spiritual therapy is a very abstract concept used in psychotherapy. It heals the root cause of the eating disorder so patients learn from their past mistakes. There is unconditional positive regard from the therapist for the patient’s current state and their life going forward. Eating disorders are very self-focused, self-adsorbed habits and so this approach aims to inspire the patient to serve a higher purpose instead of placing the focus on themselves. Spirituality connects a holistic view of the patient and views them not for their illness, but as a human being in the greater context of the universe. It gets patients to focus on how they feel, and how they can give back to the greater good of the world as a way to add to their self-value instead of measuring self-worth in appearances. Where CBT focuses on the mind-body connection, spiritual therapy adds the missing component of spirit to the mix (mind-body-spirit). By combining all aspects from mind, body, and spirit, it forms a bigger picture.
Prayer and meditation are common practices in spiritual therapy; approaches may take on a religious route but is not necessary. The downside to this treatment is that not everyone will connect with its abstract, unpractical concepts and may close their minds from the idea. It is also hard to measure progress because results are not tangible, but for those open to new experiences or are religious themselves, the recovery chances are promising.
Like spiritual therapy, another similar approach is art therapy. The unique aspect of art therapy is that it expresses feelings in way that words cannot. Often mediums for communication involve dancing, painting, singing, and sculpting. It is cathartic and purges negative feelings away instead of using food to; fostering an adaptive behavior change instead of keeping maladaptive ones (binging, restricting, etc.). Art is an adaptive way of coping with stress whereas dieting is not. Art therapy is about finding an alternative outlet for distress. Art therapists may prompt patients with instructions such as, “Illustrate the illness,” (in which the patient may respond by producing a picture of a black hole, for example) then ask them to describe their creative process. The difference between performative and illustrative arts is that the latter produces a tangible product. One art form may be more satisfying than another, but it all depends on the individual.
Again, there may lie some resistance to art therapy because patients may believe they are “not creative enough” or it is “too abstract” and “not practical enough” for recovery. Again, it takes an open mind to do this, like spiritual therapy.
Family therapy is another group-type therapy different from DBT that integrates relationships among close family members of the patient; sessions take place once a week with the patient, their family, and therapist all present. Often, family values and past are discussed, like childhood memories; sessions delve deep to solve unresolved issues, taking a psychodynamic approach. Shame, guilt, and angst are exposed to relieve bottled up tension (for example, loved ones may take it upon themselves to blame for and feel responsible for the patient’s eating disorder, and this therapy helps clarify and alleviate some of the guilt and regret). There is a chance to talk issues out and come to clear terms, set boundaries and discuss how to foster a healthy, supportive family dynamic. The family is educated on eating disorders and supplied with the tools necessary to support the recovery process. Family therapy is very beneficial for the patient especially if they are a minor because they live in the same household, and will require familial love and support in order to start or maintain a successful recovery. In fact, family therapy was proven to be more effective than individual therapy in patients whose illness was not chronic and had begun before the age of 19 years (Russell et al., 1987). Also, the structure of a family is crucial because it provides a hierarchy of power and structure integral for the recovery process; families establish the necessary environment to nourish a healthy recovery.
On the contrary, dysfunctional families can foster a poor recovery and even agitate or prolong the process. Patients have a higher chance of relapse into their disorder if they are placed in a negative, triggering household. Families at risk include those that place an emphasis on appearance or a family member with a history of dieting or disordered eating. A critical, forceful, or unsupportive member hinders the recovery process and even causes relapse. Ultimately, the goal of family therapy is to help each member come to a mutual understanding, and relieve conflict before they might happen at home where the patient continues their recovery. Families leave with strengthened relationships, and effective communication skills.
Equine therapy involves the unique interaction of a horse in hopes that being a nurturer to the animal will bring out the healer in the patient themselves to heal from their eating disorder. This type of therapy is not just popular among eating disorders, but also among depression, PTSD, grief, and substance abuse. Patients are asked to groom, talk to, and walk with a horse. Other activities performed include trust exercises and obstacle courses—exercises are based on metaphors for similar issues the patient is going through in life and recovery. Often, an equine therapist will also be present to facilitate bonding between the two. They may prompt the patient to grow emotionally and physically more intimate with the horse and open up their feelings by prodding questions. Other times, private space is given exclusively for the patient and horse to bond.
Horses also offer a variety of opportunities for projection and transference. A horse walking away, ignoring, being distracted by other horses, sleeping, wanting to eat at the wrong time, biting, urinating, and neighing are common horse behaviors to which clients respond. Clients can also often relate to a horse’s natural hypervigilance and impulse to escape when the horse feels frightened or threatened. A client’s interpretation of a horse’s movements, behaviors, and reactions determines the meaning of the metaphor and, as such, provides a portal for the resolution of unfinished business by bringing forth—and addressing—transference reactions in the here-and-now of therapy. (Klontz et al., 2007).
The most attractive and distinguishable aspect of this kind of treatment compared to other therapy types is that horses are non-judgemental and nonverbal; providing a therapeutic, quiet company. Patients can thus fearlessly disclose any information and be completely honest with their thoughts and feelings and receive no judgement, whereas in other talk-therapies when another human is present, it brings resistance and anxiety and a reluctance to share for the fear of being judged. This is inevitable in other therapies, and where equine therapy is unique. Animals are shown to help reduce anxiety and feelings of isolation. Patients grow nonverbal communication skills, reduce stress, anger and hostility, and instead grow responsibility, forgiveness, care and love. These nurturing skills towards the horse could translate into themselves and their own bodies. The bond between humans and animals has the potential to become strong enough to foster self-healing for the patient, and as a bonus, there is a caregiver for the horse—a mutual exists benefit for both parties. Unfortunately, equine therapy is not the most practical therapy because there is not always easy access to a horse; branches are often remote so they’re not conveniently accessible. Ultimately, equine therapy develops respect for other animals in the hopes that this quality translates into their own minds.
Inpatient treatment requires the patient to stay at a hospital or resort for weeks at a time where there is unlimited access to a team of medical experts ranging from nutritionists, psychiatrists, nurses and social workers, all readily available at a moment’s notice. Food, accommodation, medicine, and treatment are easily accessible and provided right on site. The goal of inpatient treatment especially in a hospital setting, is to get the patient medically stable (blood pressure, heart beats, electrolytes, weight restoration) to restore them back to health where they are able to function in the social world. Once stable, they are discharged into the outpatient program to continue their recovery (by still visiting a counsellor and getting weighed regularly). Because of this, there is generally given to those highest in need of priority. Spots are limited and there is a long wait list; usually only the most severe cases are admitted since their case is more life-threatening (the protocol is to make sure they are well enough for their bodies to sustain them without medical supervision); as soon as they reach medical stability they are discharged. Unfortunately, this is an expensive treatment because patients are paying for the most intense treatment including accommodation and 24/7 support and monitoring. This is a limited option for lower class families who cannot afford the treatment.
With so many possibilities for treatment, there is sure to be an approach that suits any case of an eating disorder. The bottom line is, all therapies work to set goals, identity problematic thinking, facilitate change and inspire recovery. No one particular approach is necessarily better than the other; it is critical to find a therapy (or a combination) that suits the patient. While this usually involves a lot of trial and error, there is hope and one should not give up. It is important to note that an individual should not tailor themselves to the specific protocol of a treatment but instead make the treatment, or a combination of; tailored to the individual. In this way, each recovery is unique.
REFERENCES
Beck, J. S. (2011). Cognitive-behavioral therapy. Clinical textbook of addictive disorders, 474-501.
Dokter, D. (Ed.). (1994). Arts therapies and clients with eating disorders: Fragile board. Jessica Kingsley Publishers.
Fairburn, C. G. (2001). Eating disorders. John Wiley & Sons, Ltd.
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. http://doi.org/10.1007/s10608-012-9476-1
Klontz, B. T., Bivens, A., Leinart, D., & Klontz, T. (2007). The effectiveness of equine-assisted experiential therapy: Results of an open clinical trial. Society & Animals, 15(3), 257-267.
Mehanna, H. M., Moledina, J., & Travis, J. (2008). Refeeding syndrome: what it is, and how to prevent and treat it. BMJ : British Medical Journal, 336(7659), 1495–1498. http://doi.org/10.1136/bmj.a301
Rothbaum, B. O., Meadows, E. A., Resick, P., & Foy, D. W. (2000). Cognitive-behavioral therapy.
Steinglass, J., Albano, A. M., Simpson, H. B., Carpenter, K., Schebendach, J., & Attia, E. (2012). Fear of food as a treatment target: exposure and response prevention for anorexia nervosa in an open series. International Journal of Eating Disorders, 45(4), 615-621.
Do you go to therapy? If so, what for and what type of therapy? How about coaching?
