As we near to the end of Eating Disorder Awareness Week, its importance does not diminish any further. In fact, we should remember that this awareness week is but a reminder for society to start seeing and treating eating disorders as public health concerns, rejecting stigmas and encouraging people to get screened and seek help continuously and not just for seven days.
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Continuing from our interview with patient/activist Emma Louise Pudge earlier this week, discover our final and latest insightful conversation below with psychologist Amy Wood-Mitchell. In this interview, Amy spoke with M3 Global Research about treatment types and their efficacy, the blunders of BMI, social stigmas and more.
Psychology and the treatment of eating disorders
From a psychologists perspective, what do you personally feel are the pitfalls in regards to the treatment of eating disorders?
Treatment of an Eating Disorder is generally quite complex and resource intensive. In general, it’s not the sort of thing which will respond to a few sessions of therapy! It requires highly skilled and sensitive therapists, who are very self aware- often therapists can become burnt out, lose patience and don’t truly listen to the person’s story, applying blanket approaches to treatment. Services should also be set up to provide physical and psychological support under one roof in order to intervene holistically. People with Eating Disorder’s are sometimes, but not always, difficult to engage in treatment, which can lead to discharge from services. If resources allowed, more time should be spent in developing a rapport and motivating the person to want to make changes. Also there needs to be more of a focus on early intervention- where possible supporting a person struggling asap to focus on overall mental health so they do not venture further down the Eating Disorder path.
BMI has a lot to do with a patient ‘being taken seriously’ by treatment services. In your experience with eating disorders however, have you found that the battle is more mental or physical?
Good question, and of course being a psychologist I will sit on the fence and say it is both and really depends on the stage of the illness and the individual! When someone is severely unwell, the priority often has to be their physical health- research has shown that when someone is so underweight they do not respond to psychological therapy as they are too cognitively impaired. However, that does not mean their psychological health should be ignored and a the importance of a supportive ear should not be undervalued (in some circumstances people are denied individual therapy as their weight is too low). Similarly, someone with a BMI in a ‘normal’ range or just outside normal, may be struggling psychologically more than someone classed as under/overweight. With Eating Disorders psychological and physical health are opposite sides of the same coin and it’s important to remember than just because someone looks ‘better’ from the outside, it does not mean that their body or their mind is in a ‘healthy’ place.
CBT - Cognitive behavioural therapy as a treatment
You practice CBT (cognitive behavioural therapy) as a main approach for eating disorders. What are the benefits of this treatment?
I think my approach is actually much more eclectic. CBT has a good evidence base for treatment of Eating Disorders, but in clinical settings it can be difficult to stick to one therapy rigidly. However, CBT can be beneficial as it can support people to consider other ways of thinking. Everyone has certain thinking patterns and styles and these become much more rigid where eating is disordered, particularly in the case of Anorexia. A psychologist using CBT should gently support a patient to discover new ideas and beliefs, which can be tested out, and which ultimately aims to influence a patient’s feelings and behaviours. However, there are many other treatment approaches that are beneficial, such as Dialectical Behaviour Therapy, Interpersonal Therapy, Family Therapy and I am a big believer in the importance of the therapeutic alliance in the treatment of Eating Disorders.
Dr Amy Wood-Mitchell, as a psychologist expert in CBT, what do you feel could and should be done to improve the treatment services of patients with eating disorders?
The million-dollar question! Of course, a lot depends on the resources of the service and ideally, people would be able to be seen quickly and for longer. But it’s not just about that- I think often when people have worked with Eating Disorders for some time it can become harder to empathise with the individual and therapists become burnt out. Understanding the person’s perspective and fears about letting go of the illness is hugely important, but also considering what is preventing the person from doing so, such as social factors, significant others or struggles to manage complex emotions in an alternative way. This is a really difficult question and there is so much we don’t know about how to treat Eating Disorders effectively. With reference to the earlier question, integrating physical and psychological services – like CBT -would be a good starting point, recognizing that holistic treatment is required. But on an individual level, remaining patient, kind, understanding, and optimistic. Oh, and pragmatic.
Stigmas on eating disorders
In regards to the general public and an outsiders opinion of eating disorders, we know that stereotypes and stigmas are rife. What do you think could be done to better unafflicted individuals understandings of eating disorders?
When people think of Eating Disorders they often think about weight or Anorexia. Of course there are different types of Eating Disorders are so much more than weight! Although Eating Disorders are diagnosable I prefer to think about them on a continuum. They are many people who do not have a diagnosis but may have maladaptive behaviours around weight/shape. People who are constantly on yoyo diets, people who exercise obsessively, people who are very controlled about what they eat etc. But I think it’s important for people to understand that someone with an Eating Disorder did not choose to be this way. Sure, they may have initially been an element of choice, such as deciding to exercise for an hour a day to change body shape, but no-one would choose months, years or sometimes even a lifetime of suffering. And once a person is far enough down an Eating Disorder path it can be very difficult and complicated to reverse those thoughts and behaviours.
Do you feel that all ED patients respond to the same treatment or should each patient’s treatment be individual and personally catered for ?
Well obviously there are treatment guidelines which suggest the treatments that work best in clinical trials. Clearly there are pitfalls in this process and of course every individual should be treated as such and have some element of choice in their treatment. But with Eating Disorders it can be more complex than that- someone may find it very difficult to choose/buy into treatment and sometimes when the illness threatens life then sadly an individual’s choices become more limited. However, as a psychologist, I think it’s really important to discover what that person’s motivation is, what would make life worth living, and then work with that. It’s crucial to shape treatment to an individual and where they are at. For example, a person with Anorexia who supports Veganism and who is given blanket advice from the outset to eat meat-based protein with every meal is likely to reject the meal plan. So start with the Vegan meal plan and go from there. I realise that this may be a bit controversial, but sometimes in treating Eating Disorders we need to be more pragmatic.
What is the expected average recovery of an ED patient?
There is research on the course of Eating Disorders, but of course it all depends on what you class ‘recovery’ as and how satisfactory this is to the individual. For example, recovery based on weight gain is often viewed by patients as unsatisfactory. Some patients fully ‘recover’, some may dip in and out of a diagnosable threshold for some time, and some sadly experience symptoms for many years. As a psychologist expert in CBT, I always see recovery as a journey and moving towards physical and psychological health.
What would you advise family of ED sufferers? Do you think they too need therapy to help them cope?
Whether formal family therapy or just support is needed is entirely dependent on the case. And again, this can’t be something which is forced onto families. I do think there aren’t enough support groups or forums for families to access however, and patients and families alike often want to link up with people at a more advanced stage in the recovery journey. Family and/or significant others often play a big part in the recovery process, so it is key that they understand what is going on for the person and how to help them, but also for their own psychological wellbeing, as caring for a person with an Eating Disorder can be challenging!
Dr Amy Wood-Mitchell, what would you advise a person visibly suffering ED who has comments thrown at them from the small percentage of the general public?
Hard question! Comments about someone’s appearance or mental health can be very upsetting. The response would depend on the person experiencing the Eating Disorder and I’d work with the person to develop something that felt right for them. It would also be important to consider why a comment is made- ignorance? Fear? Sometimes people may not know their comments are hurtful, and these may have particular connotations for someone with an Eating Disorder, such as being told they are ‘skinny’ or ‘looking well’, so it’s important to consider this too.
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