Enhanced Cognitive Behavioural Therapy for those experiencing Eating Disorders (CBT-e) Mirin Craig Clinical Nurse Specialist Connect-ED, NHS GG&C
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1 Enhanced Cognitive Behavioural Therapy for those experiencing Eating Disorders (CBT-e) Mirin Craig Clinical Nurse Specialist Connect-ED, NHS GG&C
2 Agenda Overview of CBT Development of CBT-e My role within the team Summary of CBT-e Team outcomes & data Overview of mirror exposure work group activity Discussion & Questions
3 Cognitive Behavioural Therapy Early experiences & relevant information, development of core beliefs, rules for living and assumptions Trigger/event Thoughts/images Physical sensations Feelings Behaviours/ response
4 Key principles Collaborative therapy Shared goals Working to become their own therapist Agenda setting Role of homework Regular review and outcome measures Ideally weekly sessions, reducing frequency when working towards ending Ongoing monitoring of mental health & safety
5 CBT-e Enhanced form of CBT for people experiencing eating disorders Manualised by Chris Fairburn (2008) Work by Glenn Waller & colleagues (2007)
6 Role summary Developed to support the key functions of the team, thus supporting the mission: Connect-eating disorders team will support and provide the most effective interventions for full recovery from eating disorders for all children and young people in Greater Glasgow and Clyde area.
7
8 Why individual work? When barriers to FBT present and efforts have been made to alleviate these barriers, or when the young person and their family do not wish to engage in FBT, CBT-e can be considered as an alternative therapy. Additionally, CBT-e may be indicated as an adjunct to Phase 3 of FBT (estimated in 20% of cases).
9 CBT-e (adapted from Fairburn & colleagues at credooxford.com) Stage 1 Starting well & engagement Assessment & formulation. Goals Stage 2 Review & plan Stage 3 Maintaining factors Stage 3 Dietary restraint Stage 3 Maintaining factors Stage 3 Planning for the future and maintaining wellness Stage 4 Ending well & being your own therapist
10 CBT-e Can be in its focused form of 20 sessions or broad form of sessions. Dependant on individual needs Planning therapy and time allocation to work through maintaining factors Assessment tools and outcome measures
11 Formulation example Predisposing Factors - Anxiety -Perfectionism - Perceptive child Maintaining Factors -Over-evaluation of weight and shape -Over-evaluation of striving and achievement (clinical perfectionism) - Negative body image - Difficulty tolerating negative emotions Precipitating Factors -Number of changes within short space of time - Body changes (puberty) - Negative comments from others about appearance -Academic stressors Presenting Problems -Restricted eating -Low body weight - Heightened Anxiety -Negative body image Protective Factors -Friends and family - Inner strength & determination - Problem solving skills -School -Hobbies (dancing, drawing, listening to music) -Pets
12 Transdiagnostic CBT-e formulation Over-evaluation of shape and weight and their control Strict dieting; non-compensatory weight control behaviour Events & associated mood changes Binge eating Compensatory vomiting/laxative misuse Significantly low weight
13 Team Outcomes & Data Therapy modality P3 FBT Post FBT CBT only Other
14 Primary maintaining factors *Note all have core maintaining factor of overevaluation of weight and shape C. Exercise Anxiety C.Perfect. Distress Int. Low Self-esteem Neg. Body Image Int.Pers.Rx
15 Co-morbid Diagnoses Depression Drug misuse Trauma OCD Pot. ASD
16 Average length of time engaged in CBT-e (of those completed) Ax only <6 months >6 months >1 year
17 EDE-Q Outcomes EDE-Q non-clinical EDE-Q clinical
18 CIA Outcomes CIA non-clinical CIA clinical
19 Example of a piece of work body Body image work image Always last piece of work, to allow natural time to adjust to healthy weight Working towards acceptance or more neutral thoughts and feelings about body Body image development Mirror exposure Behavioural experiments and cbt surveys
20 Mirror exposure work
21 Mirror exposure practice We will do together as a group Volunteers? What might be helpful? What might be unhelpful? Dispelling myths Selective attention Exposure
22 Example of a session Preparatory work Rate anxiety throughout the session Talk about mirrors accurate representation? What do you see? (notice selective attention) Talking through body parts & functions Notice and discuss where focus is, practice redirecting Any neutral feelings? Stay with exposure work until anxiety reduces
23 Discussion & Questions
24 References Lock, J. & Le Grange, D. (2013) Treatment Manual for Anorexia Nervosa: A Family-based Approach (2 nd ed.) New York: The Guilford Press Beck, J.S. (2011) Cognitive Behavioural Therapy: Basics and Beyond. New York: The Guilford Press Padesky, C. A. & Greenberger, D. (1995) Mind Over Mood: Change How You Feel by Changing the Way You Think. New York: The Guilford Press Fairburn, C. G. (2008) Cognitive Behaviour Therapy and Eating Disorders. New York: The Guilford Press Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V. & Russell, K. (2007) Cognitive Behavioural Therapy for Eating Disorders: A Comprehensive Treatment Guide. Cambridge University Press
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