CBT-E: Possible Treatment for Eating Disorders
CBT-E or "enhanced" cognitive behavior therapy is the brainchild of Christopher G. Fairburn. The concept started in the late 1970’s as a theory-driven, outpatient-based treatment for adults with bulimia nervosa. At that time bulimia nervosa was just being recognized around the world. With the help of Zafra Cooper and Roz Shafran, Fairburn finetuned the treatment through periods of trial and error. "The theory that underpins CBT-E is concerned with the process that maintain eating disorder psychopathology rather than those responsible for its initial development although the two may overlap," says Fairburn. CBT-E was intended for adults with eating disorders. However, the treatment can also be use with younger patients. It is both suitable for male and female patients.
CBT-E involves formulation of the processes that maintains the patient’s psychopathology and utilize it to identify the features that need to be treated. Fairburn says that CBT-E is "generally of fixed length, with the great majority of patients receiving 20 treatment sessions over 20 weeks. It also uses certain well-specified strategies and procedures to address the targeted psychopathology. And it has four relatively well-defined stages." (Cognitive Behavior Therapy and Eating Disorders, 24).
There are various forms of treatment. There is the core treatment which is the "focused" version. This the default version, suitable for the majority of eating disordered patients. Then, the "broad" version which is with modules that address clinical perfectionism, core low self-esteem and interpersonal difficulties. Fairburn, Cooper and Shafran also created versions for younger patients (under 18 years), intensive and intensive outpatients, and group treatments.
CBT-E is a time-limited eating disorders treatment and often misinterpreted as inconsistent being individualized. However, this kind of treatment enables the patient to focus the mind of both patient and the therapist. "It encourages the establishment of the therapeutic momentum that is needed early on to make inroads into the eating disorder, and it helps ensure that the therapist and patient keep working hard at achieving change, (26)." It also give way for a more definite and formal ended treatment.
Being another form of CBT treatment, CBT-E requires CBT training. The patient and therapist is aimed at working together as a team to achieve the goal of eliminating the eating problem. This is a very important factor as being in control is the key for the patients gain trust and confidence in themselves as they go through the process.
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Design Challenge: A Word with Our CDE Judge, Gary Scheiner
As you all hopefully know, the 2010 DiabetesMine Design Challenge is ON. We opened for entries last Monday. I’m excited about community voting this year (y’all get to choose the competition finalists).
Excerpt from:
Design Challenge: A Word with Our CDE Judge, Gary Scheiner
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Causes of Eating Disorders
Fashion and culture perpetuate the concept of thinness as beauty but causes of "eating disorders are much more than the fallout of fashion opportunism," says Trisha Gura, Ph.D., author of the book Lying in Weight. Experts say that one of the factors that lead to eating disorders is the intention to assert power in time of helplessness or powerlessness. Eating disorder can be a voice against insufferable struggle like oppressive authority or a "lifeboat in a storm of transition."
There are also cases when having eating disorder is biological – a matter of genes craving for thinness. Recent research in the field of genetics reveals that genetic tendencies contribute to eating disorders. However, this does not mean that environmental factors (fashion and culture) cannot anymore be blamed as reason for a person to develop eating disorder. Genetic predisposition is the unloaded gun and environmental and cultural are the factors that load the gun and pull the trigger. Genetic trait may have always been around but it takes environmental encouragement to activate the disorder.
Researchers are also looking on certain brain chemistry that affects the urge the person to binge, purge, starve and do compulsive exercises. Carolyn Costin, in her book The Eating Disorder Sourcebook mentions that "the neurotransmitter serotonin (a mood-and-appetite-regulating chemical in the brain) is reduced in anorexia nervosa [while] reduced serotonin activity persists even after recovery. Symptoms improve in approximately 50 percent of bulimia nervosa cases through the use of selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil and Zoloft.
Eating disorder usually happens in adolescent years. Teens are the most susceptible to having weight problems as they undergo rapid physical and emotional changes in their lives. Trisha Gura cited a typical pattern for development of eating disorders:
"Stress mounts as new issues come up. The old ways, the ways of a child, cannot solve the new problem. A girl takes the problems out on her body. She reduces the problem to something she can manage – dieting. And for most girls this is where the cycle stops."
Professor Christopher G. Fairburn, explains the same pattern in his book Cognitive Behavior Therapy and Eating Disorders:
"A woman hates herself; her low self-esteem causes extreme concern about her shape and weight; this in turn, prompts strict dieting. With anorexia it stops here. With binge eating disorder, the strict dieting leads to binge eating; with bulimia, the binge eating leads to such guilt that it triggers the urge to vomit or purge in some other way."
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