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IPTforEatingDisorders
Friday10th November20172-4pm
IPTUKEDUCATIONFORUM
DebbieWhightNicolaBrewin
ZoeThistlewoodBarbaraThompson
PROGRAMME
• BriefintroductiontoEatingDisorders• IPTforED• IPTBN(m)- forbulimianervosaorbingeeatingdisorders
• IPTBN10- brieftreatmentformildtomoderateseveritybingeeatingdisorders
• IPTBNmA – IPTforadolescentswithbulimianervosaorbingeeatingdisorder
• IPTAN- foranorexianervosa• Plenary
TheEatingDisorders
AnorexiaNervosaBulimiaNervosa
BingeEatingDisorder
Anorexianervosa(NIMH)
Anorexianervosaischaracterizedby:
• Extremethinness(BMI17.5orlessICD10)• Arelentlesspursuitofthinnessandunwillingnesstomaintainanormalorhealthyweight• Intensefearofgainingweight• Distortedbodyimage,aself-esteemthatisheavilyinfluencedbyperceptionsofbodyweightand
shape,oradenialoftheseriousnessoflowbodyweight• Extremelyrestrictedeating.• Otherformsofweightcontrol(ICD10)(e.g.exercise)• Manypeoplewithanorexianervosaseethemselvesasoverweight,evenwhentheyareclearly
underweight.Eating,food,andweightcontrolbecomeobsessions.Peoplewithanorexianervosatypicallyweighthemselvesrepeatedly,portionfoodcarefully,andeatverysmallquantitiesofonlycertainfoods.Somepeoplewithanorexianervosamayalsoengageinbinge-eatingfollowedbyextremedieting,excessiveexercise,self-inducedvomiting,and/ormisuseoflaxatives,diuretics,orenemas.
• Somewhohaveanorexianervosarecoverwithtreatmentafteronlyoneepisode.Othersgetwellbuthaverelapses.Stillothershaveamorechronic,orlong-lasting,formofanorexianervosa,inwhichtheirhealthdeclinesastheybattletheillness.
• Purgingandnon-purging(DSM)
BulimiaNervosaDSM-V•Recurrent episodes of binge-eating
• Recurrent inappropriate compensatory behaviour (such as self-induced vomiting, misuse of laxatives, diuretics, enemas or other medications, fasting, excessive exercise) in order to prevent weight gain
• Binge-eating and compensatory behaviours occur on average at leastonce per week for 3 months
• Self-evaluation is unduly influenced by body shape or weight
• The disturbance does not occur exclusively during episodes of anorexia nervosa
BingeEatingDisorder(BED)DSMV• Recurrent episodes of binge eating.
• Bingeing episodes are associated with three or more of the following:
– Eating more rapidly than normal – Eating until uncomfortably full – Eating large amounts of food when not hungry – Eating alone because of being embarrassed by how much one is eating– Feeling, disgusted, depressed or very guilty after overeating
• Binge eating occurs on average at least 1 day per week for 3 months
• Marked distress regarding binge eating
• Absence of regular compensatory behaviours (e.g. purging)
WhyIPTforEatingDisorders?
References• Agras,W.S.,Walsh,B.T.,Fairburn,C.G.,Wilson,G.T.Kraemer,H.C.(2000);Amulticenter comparison
ofcognitive-behaviouraltherapyandinterpersonalpsychotherapyforbulimianervosa:ArchGenPsych.;57:459-466
• Arcelus,J.,Whight,D.,Langham,C.,Baggott,J.,McGrain,L.,Meadows,L,,Meyer,C.(2009);AcaseseriesEvaluationofamodifiedversionofinterpersonalpsychotherapy(IPT)forthetreatmentofbulimiceatingdisorders:Apilotstudy;Eur.Eat.DisordersRev.;17;260-268
• Fairburn,C.G.,Kirk,J.,O'Connor,M.,&Cooper,P.J.(1986).Acomparisonoftwopsychologicaltreatmentsforbulimianervosa. Behav ResTher,24, 629-643.
• Fairburn,C.G.,Jones,R.,Peveler,R.C.,Carr,S.J.,Solomon,R.A.,O'Connor,M.E.,Burton,J.,&Hope,R.A.(1991).Threepsychologicaltreatmentsforbulimianervosa:Acomparativetrial. ArchGenPsychiatry,48, 463-469.
• Fairburn,C.G.(1992).Interpersonalpsychotherapyforbulimianervosa.InG.L.Klerman &M.W.Weissman (Eds.), Newapplicationsofinterpersonalpsychotherapy (pp.353-378).Washington,D.C.:AmericanPsychiatricPress.
• Fairburn,C.G.,Jones,R.,Peveler,R.C.,Hope,R.A.,&O'Connor,M.(1993).Psychotherapyandbulimianervosa:Thelonger-termeffectsofinterpersonalpsychotherapy,behaviourtherapyandcognitivebehaviourtherapy. ArchGenPsychiatry,50, 419-428.
• FairburnCG,NormanPA,WelchSL,O’ConnorME,DollHA,Peveler RC(1995):AProspectiveStudyofOutcomeinBulimiaNervosaandtheLong-termeffectsofThreePsychologicalTreatments. ArchGenPsychiatry, 52,304– 312,April
• McIntosh,V.V.,Jordan,J.,Carter,F.A.,etal.(2005):Threepsychotherapiesforanorexianervosa:arandomized,controlledtrial. AmJPsychiatry;162:741–747.
• Whight,D.J.,Meadows,L.,McGrain,L.A.,Langham,C.L.,Baggott J.N.,Arcelus,J.A.(2011):IPT-BN(m):InterpersonalPsychotherapyforBulimicSpectrumDisorders:ATreatmentGuide; TroubadorPress
WhyuseIPTinEatingDisorders?
ChristopherG.Fairburn;RosemaryJones;RobertC.Peveler;R.A.Hope;MarianneO'Connor
PsychotherapyandBulimiaNervosa:Longer-termEffectsofInterpersonalPsychotherapy,BehaviorTherapy,andCognitiveBehaviorTherapyArchGenPsychiatry,Jun1993;50:419- 428
Outcomedatafor1993study
AMulticentreComparisonofCognitive-BehaviouralTherapyandInterpersonalPsychotherapyforBulimiaNervosaW.StewartAgras,MD;B.TimothyWalsh,MD;ChristopherG.Fairburn,MD;G.TerenceWilson,PhD;HelenaC.Kraemer,PhD
ArchGenPsychiatry.2000;57:459-466
Westartedthinking……
• HowtointroduceIPTintoourclinicalpractice• LearntIPTfordepression• Begantomakeadaptationstomodel• IPTusedinFairburn’sresearchandintheAgras research– notthesameasourpractice
CaseSeriesStudyIPTBNm
• TheLeicesterEatingDisorderServicehasbeenusinganadaptedmodelofIPTsuccessfullyforover20years
• Therewassomedatafromanunpublishedcaseseriesstudyof15patientsusingthismodel.
• Theaimofthisstudywastoevaluatethistherapyinabiggernumberofpatients.
StudyDesign
• 2yearperiod
• BNspectrumdisorder(1st Presentation)– EDNOS– 32– BN– 27
• n=59,females
Assessment&outcomestools
Timeline– assessments&outcomes
T1–assessmentatservice
T2– session8ofIPT-BNm
T4– 3monthsaftercompletionofIPT-BNm
T3– session16/endofIPT-BNm
5945
34
Findings– completers(n=45)
o inEDsymptomatology(exceptSIV)T1–T3
o inBDI&IIP-32scoreT1-T3
o Nodiffinweightandshapeconcerns,GlobalEDE-Q,binges,SIV&IIP-32T2-T3
o inallmeasures(exceptexercise)T1-T4
Findings– IntentiontoTreatanalysis(n=59)
0
2
4
T1 t2 T3 T4
EDE-QGlobal
0
5
10
15
20
T1 T2 T3 T4
Binges
SIV
1.4
1.6
1.8
2
T1 T2 T3 T4
IIP-32
0
20
40
T1 T2 T3 T4
BDI
Conclusions• IPT-BNmwaseffectiveforthetreatmentofpatientswithBulimicEatingDisorders.
• Changeineatingdisordersymptomatologycanoccurfast,withinthefirst8sessions
Published
• European Eating Disorders Review 17 (2009) 260-268
IPTBN(m)
Fortreatmentof:BulimiaNervosa
AtypicalBulimiaNervosaBingeEatingDisorderEDU(bulimicspectrum)
IPTforDepression IPTBN(m)
Noofsessions 12- 20 12- 20
Frequencyofsessions
Weekly Weekly
Earlysessions 1- 4 0- 4
Middlesession
5– 14 5– 14
Midtherapyreview
Yes Yes
Termination 15– 16 15- 16
Focusareas InterpersonalRoleTransitionsComplicatedGrief
InterpersonalRoleDisputesInterpersonalDeficits
InterpersonalRoleTransitionsComplicatedGrief
InterpersonalRoleDisputesInterpersonalDeficits
Session0tasks
• Assesscurrenteatingdifficulties• Namedisorder– psychoeducationasappropriate• Riskassessment• Introducefooddiaries• Discussweighing• Nodieting• DiscussIPTmodel• Goalsoftreatment• Timing/frequencyofsessions
Day&Date
Time Food&Drinkconsumed Where/withwhom
* V/L/E Context,thoughtsfeelings
Session1
• Reviewfooddiaries• Introducestructuredeating• Assessmood&diagnosedepression(Ham-D)ifpresent
• Sickrole• Starttolinkmoodwitheatingproblems
Day&DateThursday9th May
Time Food&Drinkconsumed Where/withwhom
* V/L/E Context/thoughts/feelings
6.45
101112
2.30
5.15
6.30
8.00-10
Oneslicetoast&marmalade
CoffeeCoffeeSmall salad
Tea
Bagofcrisps,largebarofchocolate,marshmallows,packetofcookies
Pastaandsaucewithroastedvegetables
LeftoverpastaCake,cereal,toast,icecream,cookies
HomealoneOfficeOfficeCanteen
Office
Car
Homewithhusband
Kitchen
*
*
V
V
I'mgoingtotryhardertodayanddietbetter.FeelinghungryStillhungryAtereallyslowlytomakeitlast
Hungryagain.WorkwasreallydullasKatewasonholidayBoughtfoodfromapetrolstationonmywayhome.Wished Ihadn'tstopped.Iwasdoingsowell,nowI’veruinedit.Mademyselfsick.
Hadtoeatorhusbandwouldknowsomethingwaswrong.Full.
Stupidstupid stupid
Day&DateMonday29th April
Time Food&Drinkconsumed Where/withwhom
* V/L/E Context,thoughtsfeelings
710.301112.30122.303.3047.309102.30
YoghurtCookiesCakeSandwichYoghurtCookiesSandwichApplesSweetsSaladCerealToastCereal
HomeWorkWorkWorkWorkWorkWorkWorkWorkHomeHomeHomeHome
**
****
***
V
V
V
V
StructuredEating
• Psychoeducation– starvationsyndrome/hunger-satietydisturbance/binge-purgecycle
• 3mealsand3snacksperday• Planinadvance• Eatallplannedfood• Nomorethan4hoursbetweenfood• Canswitchbutcannotskip• Emphasisonhow youeatnotwhat youeat
Structuredeating(continued)
• Collaborative• Pragmatic• Realistic• Encouraging
Assessmood
• CompleteHam-D• Diagnosedepressionifpresent• ReviewHam-Datsession8andsession15• IfnodepressiondonotcontinueHam-D• Discusssickrole
SickRole
• AswithIPTfordepression– validateillness,allowtimeofffromsometasks/motivatetostarttasks,withtheaimofrestoringnormalfunctioning
• EDpatientsareoftendriven,perfectionistsorwithatendencytooverwork
• Focusisoftenonlookingafterself,lettingthingsgo• Guilt
Linkmoodandeatingproblemstointerpersonalworld
• Context• Vulnerabilityfactors• Triggers• Consequences
Session2
• Reviewfooddiaries• Reviewdepressivesymptoms• Linksymptomchangetointerpersonalworld• Reviewsickrole• Psychoeducationasneeded• CompleteTimeline
Session3
• Reviewfooddiaries• Reviewdepressivesymptoms• Linksymptomchangetointerpersonalworld• Reviewsickrole• Psychoeducationasneeded• CompleteInterpersonalInventory
Session4
• Reviewfooddiaries• Reviewdepressivesymptoms• Linksymptomchangetointerpersonalworld• Reviewsickrole• Interpersonalformulation• Choosingafocus• Markendofearlysessionsandmovetomiddlesessions
Choosingafocus
Same4focusareas:
InterpersonaldeficitsInterpersonalroletransitionsInterpersonalroledisputesComplicatedgrief
MiddleSessions
• TrackEDsymptomsalongsidedepressionsymptoms• Relatethesetothefocalarea.• Reviewdiariesandencourageuseofstructuredeatingplan
• Problemsolving• ThemainfocusofsessionsisInterpersonal- staywiththefocusstrategiesaswithIPTDepression
• Allthefocalareasandstrategiesremainthesame• Reviewatsession8(Ham-D)
TowardstheEnd
• ThesameaswithIPTforDepression• Endwhenagreed• Encourageregulareatingforthehunger/satietymechanismsmaystillbedisregulated
• Contingencyplanning• Continuedimprovementaftertherapy• RepeatHam-Difusing
IPTBNm &CBT-E
PreviousFindings
• 3RCTs
• IPTBNslowertoshowresults
• Legitimatealternative
IPTBNm &CBT-EOutcomesinaclinicalsetting
LeicestershireAdultEatingDisorderService
BulimicSpectrumDisorders
IPTBNm&CBT-EOutcomesinaclinicalsetting
Slideredacted– unpublisheddata
IPTBNm &CBT-EOutcomesinaclinicalsetting
Slideredacted– unpublisheddata
IPTBNm &CBT-EOutcomesinaclinicalsetting
Slideredacted– unpublisheddata
IPTBNm &CBT-EOutcomesinaclinicalsetting
Slideredacted– unpublisheddata
Anyquestions?
THEDEVELOPMENTOFASHORTERFORMOFTHERAPYFORBULIMIANERVOSA:
IPTBN10
WE FOUND THAT
• OurIPTwaseffectiveforthetreatmentofpatientswithBN.
• Changesineatingdisordersymptomatologyoccursfast,withinthefirst8sessions.
Eur.Eat.Disorders Rev.17 (2009) 260-268
§ The manual for IPT-BN10 was collaboratively developed by collecting the views of the 6 level D (supervisory level) IPT therapists working at the Leicester IPT team.
§ Feedback was also collected from 14 patients with bulimic disorderswho participated in semi-structured interviews concerning their experience with this treatment.
§ Interviews were transcribed verbatim and analysed using thematic analysis for emergent themes (Haslam et al, 2011).
§ IPT BNm was analysed in detail, with particular reference to aspects of therapy identified as most helpful by patients and therapists as well as the areas felt to be intrinsic to IPT.
The Development of IPT BN10
It was felt important that aspects of treatment that were inherently IPT were maintained, whereas some of the areas could be reduced or removed.
A patient psychoeducational booklet plus homework activities were designed which allowed the patient to be placed in charge of their own recovery.
IPT-BN10 consists of 10 weekly sessions, each of 45 minutes duration.
The first 3 sessions are for the assessment of current difficulties and the interpersonal context of these, then formulate the focus area to be work through the middle 6 sessions
The final session focuses on ending and how the patient moves on from therapy to continue putting into practice what they have learned.
IPTBN(m)
• 16sessions• 4assessmentsessions• 10middlesessions• 2terminationsessions• 4focusareas• Midwayreview• Ham-Dcompleted
beginning,middle,end• Followupat3monthsby
assessor
IPTBN10
• 10sessions• 3assessmentsessions• 6middlesessions• 1terminationsession• 4focusareas• Noreview• BDIcompletedbefore
sessions1and9• Followupat3monthsby
therapist
IPTBN10PILOTSTUDY:AIM
• Tomeasureeatingdisorderspsychopathologychangesinasmallcaseseries
IPTBN10PILOTMEASUREMENTS
• EDE-Q• BDI• BITE
PretreatmentPosttreatment
T0 T1
PARTICIPANTSAll Females
Age range 18-43
Mean = 28.20
5 – EDNOS 2 – BED 3 - BN
OUTCOME DATA
IPT BN10 Start and End Therapy
05
101520253035
Start Therapy End Therapy
EDEQBDIBITE
All 3 measures were significant (p<0.05)
EDEQ scores start & end therapy for 3 treatment groups
0
1
2
3
4
5
Start Therapy End Therapy
IPT BN10IPT BN16Controls
IPT BN10 vs Control significant p(<0.05)
OUTCOME DATA
CONCLUSIONS
• Todate,thenewtreatmenthasbeeneffectivealthoughitrequiresaresearchprojecttovalidatethis.
• OnesessionofIPTcosts£202:Areductionof6sessionsin10patientshassavedtheNHS£12120
Arcelus, J., Whight, D., Brewin, N and McGrain L. (2012) A Brief form of Interpersonal Psychotherapy for adult patients with Bulimic Disorders: a pilot study. European Eating Disorders Review, 20(4), 326-30
OUTCOME DATA
IPT BN10 Start and End Therapy
05
101520253035
Start Therapy End Therapy
EDEQBDIBITE
All 3 measures were significant (p<0.05)
IPTinaCAMHSEatingDisorderTeam
ZoeThistlewood
IPTA
• 12weeksduration• SamefocalareasatIPTforDepressioninAdults
• Parent/Carerinvolvementisadvisableandcriticalinpromotingwellbeingandsuccessoftreatment,thiscanbebetween0toseveralsessions,e.g.3sessions,1ineachphase
AdaptationsforIPTA-BN
• 16sessions+parentsessions
• Rationale- increasedcontentduetoextratasksrequiredtoaddresstheeatingdisorder
ConsiderationsforIPTA-BN
Treatingco-morbidities Suicidalityandself-harm Non-medicalprescribing
CAMHSAssessmentandDiagnosis
Feedbacktofamily/youngperson,optionsexploredandtreatmentplandevised
MDTdiscussionandformulation
MDTassessment[within1-4weeks]
Phoneassessment[within24hours]
ReferralfromGP/SchoolNurse/CAMHS
Phases
PhaseOne•Sessions0-4
PhaseTwo•Sessions5-14
PhaseThree•Sessions15-16
PhaseOne
Session0• Assessingsuitabilitywiththeyoungpersonandparent/carer
• Physicalchecksincludingbloodtests• ExplainIPTandexpectationsi.e.fooddiary,cancellationsandlateness
• Nodieting• Schoolandmulti-agencyliaison• Confidentiality
PhaseOne
Session1• Reviewofrisks• Psychoeducation• HamiltonD(otherROMScompletedpre- andpost-treatment)
• Limitedsickrole• Regulareating• Begintoidentifymood-foodlink
PhaseOne
Session2• Reviewofrisks• Reviewofdiary,includingregulareating• Introducestrategiestomanagebinge-purgeurges
• Interpersonalnetwork
PhaseOne
Session3• Reviewofrisks• Reviewofdiary,regulareating,binge-purges• Timeline,includingepisodesofbullyinganddisappointments
PhaseOne
Session4• Reviewofrisks• Reviewofdiary,etc.• Choosefocalarea• Setgoals• PreparationforPhaseTwo
• Parentliaison(optional)
PhaseTwo
Sessions5-14• AimistoresolvesymptomsofBulimiaorBingeEatingDisorder
• IPTstrategies:CommunicationAnalysis
RolePlay
EmotionalLiteracyandExpression
Problem-Solving
PhaseTwo
Sessions5-14• Specificadolescentissues
Newtotherapyandtalking
Intenseexperienceofaffectandoftenfeeltheyarenotincontrolandnotsure
whereemotionsarecomingfrom
Importanceofbehaviouralchange,oftenrequiressupportofothersand
parent/carerinvolvement,e.g.buyingfoodand
mealtimes
CognitiveCapacity
ASD Bodyimageissues ParentalMentalHealth
PhaseTwo
Sessions5-14FocalArea:Disputes
Bullying
Parents/step-parentscanrequireconjointcoaching;assessparentswillingnessfirst
PhaseTwo
Sessions5-14FocalArea:InterpersonalSensitivities/Deficits
Networkofeatingdisorderpeers?
Developmentalaspects
NEET
Parents/step-parentscanrequireconjointcoaching;assessparentswillingnessfirst
PhaseTwo
Sessions5-14FocalArea:Transitions
Bullying
Familystructuralchange
Changeofschool
Puberty
PhaseTwo
Sessions5-14FocalArea:Grief
Potentiallyfirstsignificantloss
Impactsonfamily
Griefinadolescentsmaybemoreepisodicthanpervasive
Griefcanbeexpressedinpsychosomaticsymptoms
Socioeconomicimpactfromdeathofaparent
Developmentalstagee.g.youngerchildmoredependentonparents
PhaseThree
Sessions15-16• TerminationPhase• Liaisonwithparentsre.relapsepreventionplan
• Particularfocusonfutureevents,e.g.Christmas,Eid,etc.
• Continuationofdiary?• Supportfromnetworke.g.BEAT• Diets
CaseStudy
IPTA/AN
• Trialusedinabsenceofothersuitableindividualtherapies
• 2caseswerecompleted• IPTANAdultmodelfollowed
AFT:IsthisIPTindisguise?
• NICEGuidelinerecommendedtreatmentforAnorexiainAdolescents,whenFBTisnotappropriateorsuitable
AFT:IsthisIPTindisguise?
• AFThas3Phases• 10sessions• Addressweightgain• Developtherapeuticalliance• Developformulation
PhaseOne
•5sessions• Targetmaintainingfactors• Developnewskills• Continuetogainweight
PhaseTwo
•8sessions• Relapseprevention• Identifyingfuturedifficulties
PhaseThree
AFT:IsthisIPTindisguise?
Caseconceptualisation
themes
Depressivecharacteristics
Anger/Controlissues
Deficitsinself-esteem
Regressiveneeds/
independenceneeds
AFT:IsthisIPTindisguise?
• AFTstrategies– Problem-solvingskills– FirmandNurturingstance– Self-disclosure– ParentCollaterals– Skilldevelopment
IPTforAnorexiaNervosa
Why?
• RCTMcIntoshetal2005• ComparedIPT,CBTandSSCM• SSCMmoreeffectiveatend,butnodifferenceat5yearfollow-up(2011)
• InsufficientadaptationtoAN
• ‘SeveredifficultiesseeninIPfunctioninginpatientswithAN,whicharecentraltodevelopmentandmaintenanceofthisdisorder’EvansandWertheim1998
• OverlapofcorepsychopathologyofBNandAN
• CouldtreatmentforBNbeusedforAN?
PartialsyndromeAN
• 20weeklysessions• Fortnightlyfor6months• Fortnightly/Monthlyforfurther6monthsifclinicallyindicated
Anorexianervosa
• Usually1-2yearsweeklytherapyforAN–couldthisbeIPT?
• Recognisedneededfurtheradaptation
How?
• Todevelopaframework– Initial8-16sessions– Middle20-40– Ending5-10
Initialstages
• Psychoeducation• Dietarydiary• Menuplanning• Weighingweekly• Physicalmonitoringifappropriate
• NoHam-D• Timeline• IPinventory• Sickrole
Targetedsymptomchecklist
• Intentionalrestriction• Weighingself• Vomiting• Chewandspit• Laxatives• Exercise• Bodychecking
• Weightgainisgoal• Piechartoflife
• Focus- sameasforIPTBNm• Transitionfrombeingunwelltowellness• Explorephysical,emotionalandrelationalaspectsofhavingANandwhatwouldchange
• Dealingwithambivalence
IPT-ANPilotCases
IPTAN- Outcomes
0 10 20 30 40 50
Patient1
Patient2
Patient3
LengthofTherapy(months)
No.ofSessions
IPTAN– OutcomesBMI
0
5
10
15
20
Start End
Patient1
Patient2
Patient3
IPTAN- Outcome
0
2
4
6
8
10
12
14
16
18
Patient1 Patient2 Patient3
EDE-QStart
EDE-QEnd
InterpersonalDistrustStart
InterpersonalDistrustEnd
Whatworked?• Someweightgain
• Interweavingassessmenttoolsthroughearliersessions
• Abletoutilise/buildnetworkmore
• LossofANseenaslossofrole
Whatdidn’twork?• Safeguardingissues• Comorbidity/Alcoholmisuse
• Changeoccursslowly
• OverlapwithothermodelsforAN,hardertostayonmodel
CaseStudy
• Divorced• Son20• Daughter15• Depressionwithhistoryofalcoholmisuse• AnorexiaNervosa
• ClearIPissues• Focusoftransition• WeightwentfromBMIof14to15.6
• Understoodimportanceofnetwork• Abletoestablishregulareating• Lackofsignificantweightgain• Usingalcohol?• LearningtolivewithAN
Questions?
N.I.C.E.Psychological treatment for bulimia nervosa in adults
• 1.5.2 Consider bulimia-nervosa-focused guided self-help for adults with bulimia nervosa.
• 1.5.4 If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED).
• 1.5.5 Individual CBT-ED for adults with bulimia nervosa should:– typically consist of up to 20 sessions over 20 weeks, and consider twice-weekly
sessions in the first phase– in the first phase focus on:– engagement and education– establishing a pattern of regular eating, and providing encouragement, advice and
support while people do this– follow by addressing the eating disorder psychopathology (for example, the extreme
dietary restraint, the concerns about body shape and weight, and the tendency to binge eat in response to difficult thoughts and feelings)
– towards the end of treatment, spread appointments further apart and focus on maintaining positive changes and minimising the risk of relapse
– if appropriate, involve significant others to help with one-to-one treatment.
NICEGuidelines
• AllpeoplewithanEDandtheirparents/carersmusthaveequalaccesstotreatments
NiceGuidelines,2017
NICEGuidelinesAnorexiaNervosa• Support&careshouldbeprovidedforall peoplewithANà
whetherornottheyarehavingaspecificintervention• Keygoalà helpingpeoplereachahealthybodyweightorBMI&
weightgainiskeyinsupportingotherpsychological,physicalandqualityoflifechangesthatareneededtoimprovementorrecovery.
• ConsiderFT-AN- withfamilyandseparatefamilytherapysessions• Covernutrition,relapseprevention,cognitiverestructuring,mood
regulation,socialskills,bodyimageconcernandself-esteem• Createapersonalisedtreatmentplanà basedonprocesses
maintainingtheeatingproblemNice,Guidelines,2017
NICEGuidelinesBulimiaNervosa• Explainthatpsychologicaltreatmentshavealimitedeffectonbodyweight
• OfferFT-BNtochildrenandYP- ifunacceptable,contraindicatedorineffectiveà considerCBT-ED
• InitiallyfocusonroleBNplaysandbuildingmotivationtochange
• ProvidepsychoeducationaboutED’s,howsymptomsaremaintainedandencouragementtoestablishregulareatinghabits
• Userelapsepreventionstrategiesà preparationforpotentialfuturesetbacks
NICEGuidelines,2017
NICEGuidelinesBingeEating• Medicationnottobeoffered asthesoletreatment• ForchildrenandYPà offersametreatmentsrecommendedfor
adults• Explainthatpsychologicaltreatmentsaimedattreatingbingeeating
havealimitedeffectsonbodyweightandthatweightlossisnotatherapytarget
• First,offerguidedself-help• Ifinappropriateorineffectiveafter4weeks,offergroupCBT-ED• Ifgroupisunavailableordeclined,considerindividualCBT-ED• Addressbodyimageissuesifrequired• Advisenottotrytoloseweighte.g.dietduringtreatmentàmay
triggerbingeeatingNiceGuidelines,2017