eating disorder anorexia bulimia new approcheas

“ACT ON LIFE NOT ON WEIGHT ”

Nicolas Sahuc Nîmes/Montpellier [email protected]

www.nicolassahuc.fr

Fondateur et vice-Président de l’association “L’ACT, redonnons du sens au comportement alimentaire”www.sudtca.fr

mailto:[email protected]

mailto:[email protected]

http://www.nicolassahuc.fr

http://www.nicolassahuc.fr

http://www.suct

http://www.suct

Short presentationTrain as dietician and work in a private practice (Nîmes and Montpellier)

Train Eating Disorder St Anne hospital Paris

Train C.B.T. Med school of Montpellier

Train A.C.T. and C.R.T. for child and adolescent

H.A.S. first french guidelines

A.F.D.A.S. TCA member

Organisor of ED convention Nîmes and creator of the non-profit organization “ACT, way out of ED”

Losing one’s way of life

Diminished amount of normal activities

Focusing on weight loss and body image

Appearence of food obsessions

Intense fear of gaining weight.

significant increases in mood (depression) and important personality changes

most of the subjects experienced perdiods of severe emotional distress and depression

extreme reactions: self mutilation and binge eating during the rehabilitation phase

Participants exhibited a dramatic increase in food preoccupation while the both phase

sexual interest was drastically reduced

The volunteers showed signs of social withdrawal and isolation

the participants reported a decline in concentration, comprehension and jugement capabilities

Severe and prolonged dieatry restriction can lead to serious physical and pshycological complications.

Many of the symptoms once thought to be primary features of anorexia are actually symptoms of starvation.

The Minnesota semi-starvation experiment (Keys et al., 1950)

Lunch

10h

17h

Breakfast

in the evening Eat sweets

Dinner

Lunch

10h

17h

Breakfast not enough bread, butter and marmelade / 1 yaout / Thé


Dinner

Guilty

How I can lose weight if I eat

when I’m hungry

Low self-esteem

Lunch

10h

17h



Dinner

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

Lunch

10h

17h



Want to eat

Don’t think about food, drink Cola 0%, don’t look at food, do physical activity, work a lot,...

Strategy against the food thinking or feel hungrycola light, ...

Failed: thinking about a

great meal

I don’t want to gain weight

Dinner

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

Lunch

10h

17h


Lunch:Dietary meal


Want to eat




great meal

I don’t want to gain weightLunch:

Heavy meal

Dinner

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

or

Lunch

10h

17h


Lunch:Dietary meal


Want to eat


Thinking about a great meal


Frustrated


great meal


Heavy meal

Dinner

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

or

Hungry

Lunch

10h

17h


Lunch:Dietary meal


Want to eat




Frustrated


great meal


Heavy meal

Dinner

Sometimes: picky

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

or

Hungry

Lunch

10h

17h


Lunch:Dietary meal


Want to eat




Frustrated


great meal


Heavy meal

Dinner

Sometimes: picky

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

or

Hungry

Strategy against the food thinking or feel hungry

cola light,

How I can lose weight if I eat when I’m hungry

Low self-esteem

Lunch

10h

17h


Lunch:Dietary meal

Dinner:Dietary meal


Want to eat




Frustrated


great meal


Heavy meal

I want to EAT

Dinner

Dinner:Heavy Meal

Sometimes: picky

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

or

Hungry


cola light,

Hungry


Low self-esteem

I want to EATHungry

Lunch

10h

17h


Lunch:Dietary meal

Dinner:Dietary meal


Want to eat




Frustrated


great meal


FrustratedHungry Want sugar

Lunch:Heavy meal

I want to EAT

Dinner

Dinner:Heavy Meal

Sometimes: picky

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

or

Hungry


cola light,

Hungry


Low self-esteem

I want to EATHungry

Lunch

10h

17h


Lunch:Dietary meal

Dinner:Dietary meal


Want to eat

Want to eat sugar




Frustrated


great meal



Lunch:Heavy meal

I want to EAT

Dinner

Dinner:Heavy Meal

Sometimes: picky

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

Guilty

or

GuiltyHungry

Hungry

New strategies for the afternoon


cola light,

eaten too much

Hungry


Low self-esteem

I want to EATI EAT just before

the meal

Hungry

Lunch

10h

17h


Lunch:Dietary meal

Dinner:Dietary meal


Want to eat

Want to eat sugar




Frustrated


great meal



Lunch:Heavy meal

Eaten too much

I want to EAT

Dinner

Dinner:Heavy Meal

Sometimes: picky

Hungry

Hungry

Guilty


when I’m hungry

Low self-esteem

Guilty

or

GuiltyHungry

Hungry

New strategies for the afternoon


cola light,

eaten too much

Hungry


Low self-esteem

I want to EATI EAT just before

the meal

Hungry

Food intake

More I fight more I want to

eat

lunchBreakfast snackor back home

end of the day or back home

quan

tity

Fight against food obsession

Don’t eat too much for breakfast

Elis

a C

osso

nnet

Food Obsessions

Mind VS bodyBody Image: the mind perceives that body image becomes a source of danger

Separation between the horizontal and/or vertical axis

In the anorexic, two opposing ideas are seen: body and mind; good vs evil.

The strategies are the problem:

dieting, the fight against obesity

and the fight against body image

Weight objectivesThe goal is weight loss

Lose 11 pounds in a monthReduce caloriesSkip mealscook without fatNo meat...Don’t eat sugar, cheese...Play sports daily

Breakfast25% of Energy

1 32 4 5 6

Lunch 40% of energy

7 8 9 10 11 12

Snack 10% of energy

Dinner 35% of energy

Food Crisis zone

1 ounce bread

fat-free yagourth tea

without sugar

Omelette with a green salad and one fruit

150kCal 300kCal ? ?

600kCal 960kCal 240kCal 840kCal

I am not hungry

I am not hungry

Food intake and crisis

Effectivness of the behaviourshort term

I cannot diet more than 5 daysBut on the weekend, I eat more than normal since I am so starved.I don’t lose weight and am therefore frustrated.

long termIrritationI yell at everyoneAt the end I have new crisis

Lunch

10h

17h

breakfast

After

Dinner

End of the day ?

Lunch

10h

17h

breakfast

After

Dinner I crack and give in to my cravings

Guiilty

Binge eating

End of the day ?

Lunch

10h

17h

breakfast

After


Guiilty

Binge eating

“Tomorrow I restrictive day”

End of the day ?

Lunch

10h

17h

breakfast Breakfast control

After


Guiilty

Binge eating


End of the day

“Are you hungry in the morning?” “No”

?

Lunch

10h

17h


I eat a low-calorie meal

After

“I want to eat but eat=gaining weight”

I crack and give in to my craving


Hungry

Guiilty

or

Binge eating

Strategies to fight hunger and thoughts about food


End of the day


?

Lunch

10h

17h



After


Frustrated



Hungry

Guiilty

or

GuiltyHungry

Eaten too much

Binge eating



I must not crack

ECHECE.S.➘

End of the day


?

Lunch

10h

17h



After


I need suggarFrustrated



Hungry

Guiilty

or

GuiltyHungry

Eaten too much

Binge eating



I must not crack

I fight to not eat

ECHECE.S.➘

ECHECE.S.➘

End of the day


?

Lunch

10h

17h



Control my hungry

After


I need suggarFrustrated

Frustrated

Hungry



Hungry

Guiilty

or

GuiltyHungry

Eaten too much

Hungry I want to eatBinge eating



I must not crack

I fight to not eat

ECHECE.S.➘

ECHECE.S.➘

I fight to not eatECHEC

E.S.➘

End of the day


?

More and more obsession:

“white bear”

Binge eating

New strategies to loose weight

Binge eating and strategies

I loose

End of the day

tps

Evering getting better while the

first intake

“I continue because I eat food as I like”

Intensity

Want to eat

Strategy against “want to eat”

More and more obsession:

“white bear”

Binge eating

New strategies to loose weight

Binge eating and strategies

I loose

End of the day

tps

Evering getting better while the

first intake

“I continue because I eat food as I like”

Intensity

Want to eat

Emotionnal situation that effects our

value system

Strategy against “want to eat”

The triggers(“Vaincre l’anorexie” Ed. Dr. Vanderliden)

4 cases:

Emotions: qualify as negative (ex: feeling alone)

Not eating

Negative thinking

Seeing food

A are nutrition-related

Seeing food

Not eating

C.R.T. and A.C.T. Approaches

Les substrats cérébraux de la vulnérabilité aux TCA

Volkow et al Neuropharmacology 2004, Volkow et al Arch Neurol 2007, Wagner et al AJP 2007

Altération des processus de récompense dans la vulnérabilité à l’anorexie

Cognitive and Remediation Therapy

(K. Tchanturia, PHD, Maudsley hospital, London)(Pr B. Lask, Ellern , London)

From the ravelo profile (www.ravelloprofile.org)

Further refeeding, some part of brain don’t remove

Visual spacial processing and memory

Central coherence

Cognitive inhibition

Cognitive flexibility

http://www.raveloprofile.org

http://www.raveloprofile.org

The How rather than the what

What strategy did you use ?

Did it work?

Can you think of real life situations in wich you use such a strategy?

Did you try alternative strategies?

Can you think of real life situations to wich the alternatives apply?

What are the pros and cons of each strategy?Pr B. Lask, CRT training

Could we use it for others?

AN, ravello profile best for

Acceptance and Commitment Therapy (Stevens Hayes, PHD, University of Nevada)

“Acceptance and Commitment Therapy (ACT) has developed as a behavioral intervention to help people learn strategies to live life more in the present, more focused on important values and goals, and less focused on painful thoughts, feelings and experiences. ACT teaches people how to engage with and overcome painful thoughts and feelings through acceptance and mindfulness techniques, to develop self-compassion and flexibility, and to build life-enhancing patterns of behavior. ACT is not about overcoming pain or fighting emotions; it's about embracing life and feeling everything it has to offer. It offers a way out of suffering by choosing to live a life based on what matters most.” (http://www.contextualpsychology.org/act_for_the_public)

Emotions are not the problem

http://www.contextualpsychology.org/act

http://www.contextualpsychology.org/act

http://www.contextualpsychology.org/act_for_the_public

http://www.contextualpsychology.org/act_for_the_public

Connect the 9 points with only 4 straight line. You could not up the stylo of the paper.

Game

TRY

Need to take care with people who wants to loose weight

Elis

a C

osso

nnet

They try to control hungry but every time they loose and sometimes binge eating.

Focus on emotions = loose psuchological flexibility“the more I try to control my weight, more I loose energy, more I cannot

use it for the essential of my life”

Goal VS food identityFor loose weight Food identity

I eat vegetables without oilI eat yaougourht without lipidsI eat only one fruits, for suggarEvery morning it’s hard, I don’t know what I can eat.I eat protein more and moreSometimes after the meal I feel hungry

I love bread and cheeseI like grilled meat

I like well cookingI like fruits and vegetables

I love chocolate

Eavluation of the strategiesShort term Short term

“After 5 days I can’t cope with restriction.”“Every wek-end, back at my parents home’s and eat more, my mum cook very well, so hard to resist”.

“I loose weight quickly”

Feeling guilty to eat food forbiden

Long term Long termI feel angry/hungry (play on word)I shout on every peopleI had more and more compulsive behavior and binge eating

May be no weight looseFeeling better in my mind

More happyWorried beacause I stay like this

then ACT on life not on weight

Find our food identity

Going in the right way of my life

then ACT on life not on weight

thank you

BibliographieHelp-self:

“Faire face à l’anorexie” Ed. Retz (Dr A. Perroud)

“Faire face à la boulimie” Ed. Retz (Dr A. Perroud)

“Vaincre l’anorexie mentale” Ed. De Boek (Dr J. Vanderlinden)

“Faire face à la souffrance” Ed. Retz (Mr B. Schoendorff)

“S’en sortir rePAS après rePas” (Miss R. Shakland, traduction Dr T. Léonard)

Professionel thérapeutique:

“C.B.T. for Eating Disorder” Ed. Hardcover (C. Fairburn, PhD, Oxford)

“Eating disorder in Childhood and Adolescence” Ed. Paperback (Pr B. Lask, Ellern London)

eating disorder anorexia bulimia new approcheas

Documents

food thinking

food preoccupation

great meali dont

hungrycola light

im hungrylow selfesteemi

weight loss

great mealstrategy

yaout thlunch