Anorexia nervosa and bulimia: an activity-oriented approach

Rationale and development of a manualised dietetic intervention for adults undergoing psychological treatment for an eating disorder

PURPOSE

Due to the current dearth of literature regarding dietetic treatment for patients with an eating disorder (ED), no manualised dietetic interventions exist to enable the testing of dietetic treatments in this population. This paper aims to: (1) describe the rationale and development of a manualised dietetic intervention for adults undergoing concurrent psychological treatment for an ED; and (2) provide an overview of the feasibility testing of this intervention.

METHODS

Current best evidence to date for dietetic treatment in EDs was utilised to develop a manualised dietetic intervention for feasibility testing alongside outpatient psychological 'treatment as usual'.

RESULTS

The developed intervention consists of five, dietitian-delivered outpatient sessions: (1) getting started; (2) mechanical eating and dietary rules; (3) estimating portion sizes and social eating; (4) maximising your meal plan and meal preparation; and (5) review and treatment planning as well as pre- and post-intervention assessments.

CONCLUSION

This paper is intended as a resource for clinicians and researchers in the conduct of future studies examining dietetic treatment for patients with an ED.

LEVEL OF EVIDENCE

Level V, description of a new manualised, reproducible dietetic intervention.

Benefits of yoga in the treatment of eating disorders: Results of a randomized controlled trial

Yoga has begun to be incorporated into the treatment of eating disorders despite limited empirical support for this practice. The purpose of this study was to investigate the efficacy of incorporating Yoga into the treatment of eating disorders. This preliminary randomized controlled trial investigated the benefits of participating in an eight-week Kripalu Yoga program for 53 women with symptoms of bulimia nervosa and binge eating disorder. Compared to waitlist controls, Yoga participants experienced decreases in binge eating frequency, emotional regulation difficulties and self-criticism, and increases in self-compassion. Yoga participants also experienced increases in state mindfulness skills across the eight weeks of the Yoga program. While these results are encouraging and suggest Yoga may have a valuable role to play in the treatment of eating disorders, it is important to stress their tentative nature. Further research, adopting a more rigorous design, is needed to address the limitations of the present study and expand on these findings.

Exploring the perceived usefulness of practical food groups in day treatment for individuals with eating disorders

BACKGROUND/AIM

Recovery from eating disorders is a challenging process. Emerging literature suggests that occupational therapists may provide a useful contribution in delivering purposeful eating-related interventions as a potential treatment to support sustained cognitive and behavioural changes for individuals with eating disorders. This study aimed to evaluate participants' perceptions of the contribution of occupational therapy practical food groups (food based outings and cooking groups) in supporting their functional recovery.

METHODS

Individuals attended practical food groups as part of standard treatment at an outpatient eating disorders day program. Ninety-nine participants completed questionnaires at discharge and up to three follow-up points (6, 12 and 24 months). Questions related to practical food groups were analysed, exploring participants' experiences and perceived usefulness of groups using rating-scale and open-ended questions. Open-ended responses were analysed using thematic analysis. Descriptive statistics were calculated for responses to rating-scale questions.

RESULTS

At discharge, participants rated the importance and usefulness of practical food groups as high (4.73 and 4.43 on 5-point scales, respectively), but tended to rate their enjoyment of the groups lower (3.50 on a 5-point scale). Some skill transfer was typically reported by participants at discharge (3.92 on a 5-point scale). One core theme, 'success through participation', emerged from qualitative comments. Six subthemes were also identified: helpful components of practical food groups; perceived benefit of exposure; impact of applying cognitive and behavioural skills; challenges affecting participation; facilitating adaptation; and influence of eating disorders on challenging feared foods.

CONCLUSION

This study highlights that participation in practical food groups was perceived as useful in assisting individuals to improve eating behaviours and, in some circumstances, transfer these skills into their lives outside of day program. Results suggest that occupational therapists may have an important contribution in delivering these interventions to support recovery and facilitate application of adaptive coping strategies.

Occupational Therapy with Eating Disorders: A Study on Treatment Approaches

The incidence of two complex and serious eating disorders, anorexia nervosa and bulimia nervosa, has increased markedly during the last decade. Despite much research, there is still no consensus on the aetiology or treatment of eating disorders. It has been recognised that multiple factors of causation are Involved and a multidisciplinary team of various health workers, including occupational therapists, is needed for optimal treatment.

The aim of this pilot study was to determine treatment approaches currently used by occupational therapists in some major centres in Australia. It was found that, while respondents believed that psychological issues, cognitive distortions, dysfunctional families and societal pressures were major causes of eating disorders, the preferred treatment approaches appeared to be based on cognitive-behavioural and occupational dysfunction models. Implications for occupational therapy, limitations of the study and future recommendations are discussed.

Occupational Therapy in the Treatment of the Patient with Chronic Pain

This paper discusses the role of the occupational therapist in the treatment of chronic pain. It begins with a critical evaluation of our current theoretical understanding of pain, concentrating on the link between physical and psychological factors. A unit for the treatment of patients with chronic pain is described and assessment and practical treatment approaches are outlined. Emphasis is placed on a functional approach which maximizes the individual's control over his own pain.

Facilitating Change in Anorexia Nervosa: The Role of Occupational Therapy

Patients with anorexia nervosa benefit from a multidisciplinary approach. This article gives a brief description of, first, the illness and its treatment and, secondly, the occupational therapy techniques used at the Maudsley Unit. It then demonstrates the progress of patients through examples of projective art.

Yoga: An Ancient Occupational Therapy?

Yoga is a complete system of occupational regulation, based on complex theories that address occupational risk factors while relating occupation directly to health and wellbeing. Although aspects of yoga have been used in Western occupational therapy settings, some of its underlying theories may have been overlooked. If validated by research, these theories may enrich occupational therapy philosophy. Yogic techniques of potential clinical use include pulse diagnosis, meditation and breath control. These are not described in detail in this opinion piece, but should be the subject of thorough literature reviews and, perhaps, further research.

The Development of a Scoring System for the Kinetic House-Tree-Person Drawing Test

Objective/Background

The Kinetic House-Tree-Person Test (KHTPT) is already in widespread use amongst psychiatric occupational therapists in Taiwan, but the psychometric attributes of the test are somewhat limited. The primary aims of this study are to develop a quantitative scoring system for the KHTPT and carry out an assessment of its psychometric attributes.

Methods

Based on the test manual and the related literature, we identified 35 drawing characteristics relating to anxiety and depression, and we recruited 323 participants from two universities in northern Taiwan to participate in our study. These participants, who had a mean age of 20.1 years (SD = 3.0), were instructed to draw a KHTPT picture, and were then asked to complete related questionnaires. The data were subsequently analysed using WINSTEPS (Beavertown, Oregon: Winsteps.com ) and SPSS (SPSS Inc., Chicago).

Results

The results revealed that all of the items of the scoring system provided a good fit with the Rasch measurement model, with the Cronbach's alpha for the scale being .94. The Spearman correlation coefficients of the Rasch-transformed KHTPT scores with the Beck Anxiety Inventory, the Beck Depression Inventory-II, the Beck Hopelessness Scale, and the National Taiwan University Hospital Symptom Checklist were all found to be small, albeit with statistical significance (Spearman correlation coefficients, r = .140–-.226).

Conclusion

This study demonstrates our proposed KHTPT scoring system has eminently acceptable construct validity and internal consistency. We suggest that future studies should include patients with psychiatric disorders at varying degrees of severity or functional level to examine the applicability and predictive validity of our proposed scoring system.

Randomized controlled clinical trial of yoga in the treatment of eating disorders

PURPOSE

This was a pilot project designed to assess the effect of individualized yoga treatment on eating disorder outcomes among adolescents receiving outpatient care for diagnosed eating disorders (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified).

METHODS

A total of 50 girls and 4 boys aged 11-21 years were randomized to an 8-week trial of standard care vs. individualized yoga plus standard care. Of these, 27 were randomized to standard care and 26 to yoga plus standard care (attrition: n = 4). Standard care (every other week physician and/or dietician appointments) was required to meet ethical guidelines. The No Yoga group was offered yoga after study completion as an incentive to maintain participation. Outcomes evaluated at baseline, end of trial, and 1-month follow-up included Eating Disorder Examination (EDE), Body Mass Index (BMI), Beck Depression Inventory, State-Trait Anxiety Inventory, and Food Preoccupation questionnaire.

RESULTS

The Yoga group demonstrated greater decreases in eating disorder symptoms. Specifically, the EDE scores decreased over time in the Yoga group, whereas the No Yoga group showed some initial decline but then returned to baseline EDE levels at week 12. Food preoccupation was measured before and after each yoga session, and decreased significantly after all sessions. Both groups maintained current BMI levels and decreased in anxiety and depression over time.

CONCLUSIONS

Individualized yoga treatment decreased EDE scores at 12 weeks, and significantly reduced food preoccupation immediately after yoga sessions. Yoga treatment did not have a negative effect on BMI. Results suggest that individualized yoga therapy holds promise as adjunctive therapy to standard care.

Yoga as an intervention in the treatment of eating disorders: does it help?

This article explores the uses of yoga as an experiential adjunct to other forms of therapy in the treatment of eating disorders in residential and outpatient settings. Supported by other treatment modalities, yoga can be an effective method for increasing self-awareness, reflection and the ability to self-soothe. Like other interventions, yoga has potential misuses. These misuses are uncovered with suggestions made as to how therapists can support the practice of yoga in residential and outpatient settings.

Primary care from infancy to adolescence

The use of complementary and alternative medical (CAM) therapies is increasing among well children and adolescents and in those children who have special health care needs. Integrative pediatrics, a holistic practice that includes an examined integration of CAM and conventional therapies, is ideally suited for primary care. This article describes how to integrate evidence-based CAM therapies for colic, atopy, ADHD, eating disorders, and other conditions commonly seen in primary care practice.

Frames of reference utilized in the rehabilitation of individuals with eating disorders

An occupational therapist's role with clients diagnosed with eating disorders, both anorexia nervosa and bulimia nervosa, has been described throughout the literature. However, the frames of reference and treatment approaches that occupational therapists implement have not been clearly established or validated. This paper outlines the symptomatology of anorexia nervosa and bulimia nervosa, and critically reviews the current literature concerning the frames of reference and treatment approaches used by occupational therapists when intervening with this population. The literature reviewed indicates that therapists are using a variety of frames of reference and treatment approaches. There appears to be an emphasis on the psychoanalytical and cognitive-behavioural frames of reference, although there is a lack of empirical evidence in regards to all frames of reference and treatment approaches. Reasons for the lack of current research with this population, and possible future areas of research are suggested.

Occupational therapy and the treatment of eating disorders

The occupational therapist is vital to providing a complete assessment and thorough treatment of the population with eating disorders. Symptoms and etiology that effect the occupational therapist's reasoning are explored followed by the theoretical frameworks used and specific group intervention at the Sheppard and Enoch Pratt Hospital. Two case studies conclude the article.

Bulimia. A review of nutritional and health behaviors

Nurses working with adolescents need an understanding of the clinical syndrome of bulimia in order to identify individuals at risk for this disorder and implement preventive and therapeutic interventions. The epidemiology, early precipitants, physiology, and biochemistry of bulimia nervosa are reviewed. From this integrated framework, implications for treatment are explored with an emphasis on holistic nursing care including health education.