NEDA TOOLKIT for Parents
Types of psychotherapy
Perhaps one of the most important considerations
when you and your loved one select a psychotherapist
is the type of therapy they provide. Different therapies
work differently for different people, and some may
be more helpful than others for where your loved one
currently is in their recovery. Reducing eating disorder
behaviors is generally considered to be the first goal of
treatment, and the following therapies currently have
the most evidence for effectiveness.
Acceptance and Commitment Therapy (ACT). The
goal of ACT is focusing on changing your actions rather
than your thoughts and feelings. Patients are taught to
identify core values and commit to creating goals that
fulfill these values. ACT also encourages patients to
detach themselves from emotions and learn that pain
and anxiety are a normal part of life. The goal isn’t to
feel good, but to live an authentic life. Through living a
good life, people often find they do start to feel better.
Family Based Therapy (FBT). Also known as the
Maudsley Method or Maudsley Approach, this is a
home-based treatment approach that has been shown
to be effective for adolescents with anorexia and
bulimia. FBT doesn’t focus on the cause of the eating
disorder but instead places initial focus on refeeding
and full weight restoration to promote recovery. All
family members are considered an essential part of
treatment, which consists of re-establishing healthy
eating, restoring weight and interrupting compensatory
behaviors; returning control of eating back to the
adolescent; and focusing on remaining issues.
Behavioral Systems Family Therapy (BSFT). Parents
are coached to help the sufferer restore adequate
nutrition and eat regular meals and snacks. BSFT also
broadens the focus of treatment to include cognitions
and problems in “family structure” while the parents
are still in charge of the re-feeding process.
Cognitive behavioral therapy (CBT) and Enhanced
Cognitive behavioral therapy (CBT-E). A relatively
short-term, symptom-oriented therapy focusing
on the beliefs, values, and cognitive processes that
maintain the eating disorder behavior. It aims to modify
distorted beliefs and attitudes about the meaning of
weight, shape and appearance, which are correlated
to the development and maintenance of the eating
disorder. Interpersonal Psychotherapy (IPT). This is a short-
term individual psychotherapy. It is premised on the
theory that interpersonal difficulties contribute to the
onset and maintenance of eating disorder symptoms,
and that their resolution will promote recovery. It has
predominately been applied to treatment of bulimia
nervosa and binge eating disorder, and focuses on
interpersonal difficulties rather than behavioral aspects
of disordered eating.
In addition to the above evidence-based treatments,
the following (listed in alphabetical order) are
commonly used to help eating disorder sufferers move
towards recovery.
Cognitive Remediation Therapy (CRT). CRT aims to
develop a person’s ability to focus on more than one
thing. CRT targets rigid thinking processes considered
to be a core component of anorexia nervosa through
simple exercises, reflection, and guided supervision.
CRT is currently being studied to test effectiveness in
improving treatment adherence in adults with anorexia;
it has not currently been tested in other eating
disorders. Conjoint Family Therapy (CFT). This is a therapeutic
approach that treats the entire family, including
the eating disordered member, simultaneously. The
premise of CFT is that the client exists within a family
and spends most of their time with them. Focus is on
improving family dynamics that may be contributing to
maintaining the eating disorder.
Dialectical Behavior Therapy (DBT). A behavioral
treatment supported by empirical evidence for treat
ment of binge eating disorder, bulimia nervosa and
anorexia nervosa. DBT assumes that the most effective
place to begin treatment is with changing behaviors.
Treatment focuses on developing skills to replace
maladaptive eating disorder behaviors. Skills focus on
building mindfulness skills, becoming more effective
in interpersonal relationships, emotion regulation,
and distress tolerance. Although DBT was initially
developed to treat borderline personality disorder, it is
currently being used to treat eating disorders as well as
substance abuse.
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