Search Results for 'CBT'

Cognitive Process and Remediation in Anorexia Nervosa, with James Lock, MD, PhD

The Center for Eating Disorders at Sheppard Pratt is excited to welcome Dr. James Lock to Baltimore on September 25, 2010 as one of six featured speakers at our annual professional symposium, Eating Disorders: State of the Art Treatment.

James Lock, MD, Ph.D. is a Professor of Child Psychiatry and Pediatrics in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine where he also serves as Director of the Eating Disorder Program for Children and Adolescents. Dr. Lock is the co-author of the only evidenced-based treatment manual for anorexia nervosa, and one of his newest publications is a treatment manual for adolescent bulimia entitled: Treating Bulimia in Adolescents: A Family-Based Approach. Dr. Lock has lectured extensively across the U.S., Canada, Europe, South America, Asia and Australia. More recently, Dr. Lock has been involved in research regarding a form of treatment called Cognitive Remediation Therapy (CRT) for individuals with eating disorders. Prior to his presentation in Baltimore on September 25th, we were eager to hear what Dr. Lock had to say about CRT and what attendees could expect to learn from his upcoming talk, “Cognitive Process and Remediation in Anorexia Nervosa”. Read Dr. Lock’s responses below and register for the upcoming professional symposium in Baltimore to hear more.

Q & A with James Lock, MD:

What is CRT and how did it originate?

JL: Cognitive Remediation Therapy (CRT) is a therapy designed to improve brain processing inefficiencies such as difficulty focusing, staying on task, and processing speed. CRT was originally devised for remediating thinking processes in people with brain injuries. It has subsequently been used in schizophrenia and obsessive-compulsive disorders. Most recently it was refined for use with adults with anorexia nervosa to specifically address difficulties in flexibility in thinking and over focus on details to the neglect of the big picture.

What sets CRT apart from other therapeutic approaches such as cognitive behavior therapy (CBT) or dialectic behavior therapy (DBT)?

JL: CRT does not focus on eating disorder symptoms, but rather on thinking style. CBT focuses on thoughts, behaviors, and beliefs that putatively maintain the eating disorder. DBT focuses on thoughts and emotional processes using skill-based learning and groups focused on eating disorder symptoms or general emotional and cognitive functioning. In other words, CRT does not aim to address the specific problems related to the eating or psychiatric disorders per se, but rather focuses on a problematic thinking style that may contribute to the development and maintenance of symptoms.

What general benefits could CRT offer individuals with eating disorders? Are there specific individuals who are particularly well-suited for CRT?

JL: The main benefit of CRT for individuals with eating disorders is that they could learn how their particular thinking style effects their thinking processes. In addition, they can learn ways to change some aspects of this thinking style using cognitive exercises. This in turn could help them understand how this relates to decisions they make about eating, exercise, and related behaviors. It is unknown if there are specific individuals who would make particularly good candidates for CRT. It should be stressed that CRT is a very new treatment in the context of eating disorders and its benefits remain largely unknown.

The title of your Sept. 25thpresentation is “Cognitive Process and Remediation in Anorexia Nervosa” what do you hope attendees will take away from this talk?

JL: I hope attendees learn what CRT is (and isn’t) and to understand how it may be useful in the context of other eating disorder specific treatments to enhance therapeutic alliance and increase motivation.

Where can professionals go to read more about the use of CRT in the treatment of individuals with eating disorders?

JL: There are a number of articles that have been published on CRT by Kate Tchanturia, Ph.D and colleagues from the Maudsley Hospital in London. Reading these would be a good place to start.

We are greatly appreciative to Dr. Lock for his responses and look forward to hearing more about this intriguing new treatment approach on September 25th. To register for the symposium (7 cme/ceu credits) please download the program brochure (pdf) or visit our Events page. Don’t delay, space is limited and discounts expire soon! For more information about Dr. Lock’s publications, please click on the images of the books below:

Published by Kate Clemmer
September 3rd, 2010 in CED Events, Celebrity Topical News, Editor's Picks, In the News, Recovery
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Dialectical Behavior Therapy: PART I

What is a life worth living?  That is the essential question behind Dialectical Behavior Therapy (DBT), the goal of which is to help individuals build a life that has meaning and worth, with a freedom from suffering.

DBT was originally developed by Marsha Linehan, Ph.D., to treat individuals who engage in self-harm behavior, many of whom meet the diagnostic criteria for borderline personality disorder.   DBT represents a merging of therapeutic approaches, including cognitive behavioral therapy (CBT) and Eastern therapuetic modalities. CBT which emphasizes one’s ability to change thoughts and behaviors,  has been criticized for not addressing emotional dysregulation (a difficulty with responding to emotions in the culturally accepted manner), often a significant problem for people with Eating Disorders (EDs).  Thus, in developing DBT, Linehan also integrated Eastern psychological and spiritual philosophies, including the practice of mindfulness, which provide for a heightened focus on acceptance (rather than change) and on the healthy regulation of difficult emotions.

Research has shown DBT to be effective in the treatment of borderline personality disorder, substance dependence, chronic life threatening behavior, and dissociative behaviors.  These are issues that often co-occur with EDs.  The research directly linking the utility of DBT for EDs is preliminary, but investigations have shown promising results for patients with Bulimia Nervosa and Binge Eating Disorder.

The Center for Eating Disorders utilizes DBT at all levels of care. The first three modules are introduced in our inpatient and partial hospitalization programs, while full coverage of all four modules is applied in our intensive outpatient program, as well as in individual therapy at all levels of care.  If you’d like to read more about the four modules of DBT, check back to our blog again soon for Dialectical Behavior Therapy: Part II.

The Center for Eating Disorders is now offering DBT group therapy on an outpatient basis.  For more information about these groups or any of our DBT programming, please call (410) 938-5252.

References

Linehan, M.M. (1993).  Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.

Behavioral Tech, LLC. (1996-2009). What is DBT?  Available at: http://behavioraltech.org/resources/whatisdbt.cfm 

 Written by Kristen Grasso, Psy.D, Center for Eating Disorders at Sheppard Pratt

Published by Kate Clemmer
May 8th, 2009 in Editor's Picks
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Q & A with Stewart Agras, M.D.

On April 18th, 2009  Dr. Stewart Agras will be among five national speakers to present in Towson, Maryland at The Center for Eating Disorders’ annual professional symposium, Eating Disorders: State of the Art Treatment.  Dr. Agras is currently a Professor Emeritus of Psychiatry at Stanford University School of Medicine and has made significant contributions to the field of eating disorder treatment through his extensive research over the last twenty years.   At this year’s symposium, Dr. Agras will deliver the most up-to-date treatment information for professionals in his talk,  Improving the Treatment of Bulimia .  He responded to some of our questions about this topic and we’ve posted them in today’s blog.  

Dr. Agras, how have the treatments for bulimia nervosa changed and progressed over time?  What do you think has driven these changes? 

“When the number of individuals with bulimia began to increase in clinics during the 1970’s no treatment for bulimia nervosa had been described in the literature.  This led researchers at Oxford University (UK) and Stanford to develop cognitive-behavioral therapy based, in part, on clinical insights into the disorder and using elements from the behavioral treatments of binge eating and depression. Subsequent research studies over the years refined the treatment, adding elements such as attention to interpersonal triggers of binge eating.  Hence, the changes were largely driven by research studies and more extensive clinical experience with this difficult patient group.”

Why is cognitive behavioral therapy (CBT) considered the “treatment of choice” for bulimia nervosa? 

“A fairly large number of controlled studies have shown that CBT is more effective than medication (both tricyclic antidepressants and SSRI), supportive-expressive psychotherapy, stress management, and interpersonal psychotherapy (IPT).  However, in a large-scale controlled trial interpersonal therapy was as effective as CBT at 1-year follow-up.  Hence, the evidence clearly suggests that CBT is the treatment of choice and that it will act more quickly than IPT.”

What is guided self-help (GSH) and is it beneficial for patients who are struggling with bulimia nervosa? 

“Guided self-help is a shortened version of CBT in which the patient is encouraged to read a book describing the disorder and its treatment and is “coached” by a therapist in brief 20-30 minute sessions. Within the session the emphasis is on using the book to solve problems.  A number of small scale trials have shown that GSH is about as effective as full CBT, and one large-scale trial has confirmed this finding.  Hence, GSH is clearly effective for at least some patients who are struggling with bulimia nervosa, and the question arises whether GSH should be used as a first step in the treatment of bulimia nervosa.”

Many thanks to Dr. Stewart Agras for his responses and participation in today’s blog.  The Center for Eating Disorders is happy to present eating disorder professionals with the opporuntinity to hear Dr. Agras speak live at the symposium on April 18th.  Additionally, he has several recent publications that are available from Gurze Books online.

To download the symposium program brochure or to register for the April 18th symposium, please visit our events page.  This event is open to all professionals who treat patients with eating disorders and has been approved for 6.25 CEUs for physicians, nurses, psychologists, social workers and counselors and 6.5 credits for dietitians.  The discounted registration rate expires on April 10th and space is limited so don’t delay!  Please call (410) 938-4593 if you have any questions.

Published by Kate Clemmer
April 6th, 2009 in Celebrity Topical News
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What Are the Treatments Anyway?

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Cognitive-Behavioral Therapy For Eating Disorders

There are many things to consider when looking for treatment for an eating disorder.  Is hospitalization necessary? How do I convince him/her to get treatment?  How long does it take to overcome an eating disorder?  Where do I go for help? And … What are the treatments anyway?  One type of psychological treatment, known as Cognitive-behavioral therapy (CBT), will be described here.

Cognitive-behavioral therapy is a well-researched and proven method for the treatment of eating disorders.  The cognitive-behavioral model for the treatment of eating disorders emphasizes the important role of both the cognitive (e.g., attitudes regarding weight and appearance) and behavioral (e.g., dietary restriction, binge-eating) factors that maintain the eating disorder and associated problems.  It is a structured treatment that focuses on the present and the future.  It is time-limited, although the amount of time may vary from 6 months to several years.  The treatment is presented in stages with an initial emphasis on stabilization of symptoms and behavioral change. The patient and therapist work together to formulate a plan for stabilizing eating and eliminating symptoms, beginning with the very first session.  Because emotions often intensify during this phase of treatment, tools (coping strategies) for managing these feelings are developed and become an important part of the work.  CBT includes in-session activities as well as homework so that new behaviors can be practiced.

As treatment progresses, cognitive restructuring techniques (e.g., techniques aimed at recognizing and changing problem thinking patterns) are introduced.  Thoughts and beliefs that perpetuate the problems (e.g., “I’m so fat and disgusting”; “I will only be happy if I can lose this weight”) are identified and work aimed at developing new perspectives and ideas (“my self-worth doesn’t depend on my size or shape”) begins.  Additionally, during this stage of treatment, broader concerns such as relationship problems, body image, self-esteem problems, and emotion regulation are addressed.  Even though CBT is focused on the elimination of symptoms, the overall goal of the treatment is to assist the patient in making their return to a happy life.  So, very often, once symptoms are stabilized, treatment will expand to include other areas of concern and conflict.  The final stage of CBT concentrates on relapse prevention and maintenance planning.

Although CBT is widely recognized as a first-line psychological treatment for eating disorders, not all therapists are trained in this treatment model.  If you are looking for treatment for an eating disorder, it is always a good idea to make inquiries into the type of treatment provided and the training of the therapist.

The Center for Eating Disorders has well-trained and highly experienced clinicians who provide CBT at all levels of care.  If you would like information regarding CBT available at the Center, please call (410) 938-5252 or email EatingDisorderInfo@sheppardpratt.org.

Submitted by Kim Anderson, Ph.D., Director of Psychology, CED

Published by Kate Clemmer
December 17th, 2008 in Celebrity Topical News
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Muscle Dysmorphia: the Misconceived Notion of Not Measuring Up.

Muscle dysmorphia, a disorder most commonly experienced in males, is the obsession of feeling “too small” or belief that one has inadequate muscles. However, those with the disorder are usually not small, and have very well-developed muscles, but most are too self-conscious to recognize their muscular bodies.

Often referred to as “bigorexia” or “reverse anorexia,” those with this disorder constantly worry about how others perceive their appearance. They suffer from low self-esteem and a misconstrued body image, inflicted with constant self-doubt, causing them to exercise compulsively and adhere to a strict diet. These behaviors can even result in developing an eating disorder, such as bulimia. Those with this disorder can also experience depression or an anxiety disorder. Other risky behaviors employed to build bulk includes the use of steroids.

Muscle dysmorphia is attributed to genetics, psychological factors and/or societal pressures. The media barrage of images at all levels of our society send misguided messages that pressure individuals to try to measure up. The men who struggle with this illness view images that lead them to believe that “real men have muscles,” even in something that seems as innocuous as a toy like G.I. Joe. Women see similar messages, but most of the messages targeted towards women depict a different body, one that states that “beautiful women are thin,” with images like Barbie.

Signs and Symptoms:

  • Checking themselves in a mirror up to 12 times a day.
  • Becoming distressed if they miss a .
  • Constant comparison of their own body to the bodies of others around them.
  • The use of anabolic steroids – check out Powered by Me for information about the side effects of anabolic steroids use.
  • Worrying about their percentage of body fat.
  • Psychological symptoms – Anxiety, depression, low self-esteem, or hiding away for days at a time due to embarrassment about their body shape.
  • Unlikely to come forward for treatment as they rarely see themselves as having a problem.

Diagnosis and Treatment: The disorder can be difficult to diagnose because patients often appear healthy. Many people with this disorder resist getting help as they are happy with the way they are, similar to individuals with Anorexia Nervosa. One way to help a family member or friend is to bring to their attention the negative impact the disorder has had on their lives, such as placing aspects of their personal lives on the backburner, like their career or relationships.

Studies have shown positive responses from individuals treated with a combiniation of antidepressant medication and cognitive behavioral therapy (CBT). CBT helps the patient to analyze their problem using logical steps to understand the thought process behind their behaviors and make changes in their thinking, which will allow them to subsequently change the behaviors that follow.

To begin to make changes, our culture needs to take a look at our priorities and the messages that it is imposing on its youth.

Published by Anthony1
June 20th, 2008 in Editor's Picks
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