Treatments for Eating Disorders - Essay Example

?Critical Analysis of the Article: “Evidenced-based Treatments for Children and Adolescents with Eating Disorders: Family Therapy and Family-facilitated Cognitive-Behavioral Therapy” By James Lock & Kathleen Kara Fitzpatrick Journal of Contemporary Psychotherapy (2007) 37:145–155 1. What is the purpose of the Abstract? The abstract gives a summary of recent research on treatments of children and adolescent found to be suffering from eating disorders. It then tells readers that the study focuses on two evidence-based treatments for Anorexia Nervosa and Bulimia Nervosa which are Family-Based Treatment and Cognitive-Behavioural Therapy respectively. Both therapies are illustrated in detail through corresponding case studies. The purpose of the abstract is to draw the readers’ attention to the issues that the paper deals with such as the eating disorders Anorexia Nervosa and Bulimia Nervosa and to focus their attention accordingly on the details of the main topic of the paper which are the evidence-based treatments for children and adolescents afflicted with these eating disorders. The article was crafted very well that it was able to achieve its goal of informing the readers thoroughly about the eating disorders of Anorexia Nervosa and Bulimia Nervosa as well as the available psychological interventions effective for treatment and management of the disorders. 2. What are the main areas of information contained in the Introduction? In the introduction, eating disorders were discussed, specifically, the onset of Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in children and adolescents. It also identified the demographic data of the patients having these eating disorders and the reported symptoms and consequences of having such disorders such as cognitive distortions regarding body shape and size, obsession with weight loss, anxiety disorders, avoidant personality disorders, feelings of loss of control, morbid fear of becoming fat, and other physical and psychiatric complications. It then moves on to discuss probable treatments and interventions for these disorders as well as the developmental factors associated with treatment implementation. Although the descriptions of the patients and their symptoms have been reported clearly, what was lacking was the possible causes of incurring such disorders. It was not reported what factors may be responsible for it and if family-based interventions were suggested, it was not clear why. On the other hand, the introduction gave a clear overview of what the readers may expect throughout the article, focusing on treatments and how patients will go through them. This is useful for individuals interested in such psychological interventions for personal reasons and for future envisioning of a career as a psychotherapist. 3. How has the rationale for the Research questions been developed? Rationale for this study is the need for effective interventions to help out children and adolescents suffering from eating disorders such as AN and BN which not only disrupts their normal functioning but also affects the family dynamics of the patients, most often leaving negative outcomes. This rationale was developed from giving examples of the presenting problem and its deleterious effects detailing the causes and corresponding effects leading to the need for interventions. These cases were well-chosen as they represented a majority of patients suffering from similar symptoms for Anorexia Nervosa and Bulimia Nervosa. Although there may be other symptoms and causes in other cases that are not reported in the examples, the two chosen examples were enough to present a general overview. 4. What are the research questions in this study? The study does not pose any overt research questions, but it is presumed from the content of the study that it asks about effective methods and interventions in dealing with eating disorders of children and adolescents. It may also ask for specific ways how the patient’s family may come into play with regards to the treatment interventions and how such interventions may affect the patients and their families. 5. What was included in the literature review? The literature review comprised in the introduction discussed findings about Anorexia Nervosa and Bulimia Nervosa and which particular intervention methods have been tried out in research to treat such eating disorders. It described the interventions of Family-Based Treatment and Cognitive Behaviour Therapy in relation to the treatment of eating disorders. 6. Was this adequate to provide a background to the study? The literature review was quite short and seemed lacking in content. It did not go in deeper detail about the disorders and just treaded the surface information gathered about the disorders and its interventions as found by researchers mentioned in the literature review. In the conclusion the authors admitted that literature addressing treatment interventions for adolescents with eating disorders is very sparse. It could have drawn on the review of Anorexia and Bulimia cases in children and adolescents as documented in the work of Steiner (1998). This 2007 article would have been a good addition to the collection of work on children’s psychological disorders in the 2008 edition of the Childhood Mental Health Disorders: Evidence base and contextual factors for Psychosocial, Psychopharmacological and combined interventions by Brown et al. (2008). 7. What methodological approach did the study use and why? The study made use of case studies to illustrate the process of counselling therapy for two interventions namely Family-based Therapy and Cognitive-Behaviour Therapy. Each case detailed the onset of the disorder, its presenting symptoms, and the development of harmful outcomes to the patients and their families and the road to finding the appropriate intervention to help the patient overcome the disorder with the help of the therapist and the families of the afflicted. The use of case studies is a wise decision in this qualitative study because it gives the readers a glimpse of the whole psychological disorder and how it was managed through therapy. It also afforded the chronicling of events in the duration of the therapy and encapsulated everything in the case study. It gave a summary of the significant events that transpired in the course of each phase in the therapy, leading to its successful conclusions. 8. Was this appropriate? For the particular topic on hand, yes, the use of case studies was appropriate. It gave a clear picture of the eating disorder and the therapy it involved as represented by the case study. In the Case study of Yvonne, an adolescent afflicted with Anorexia Nervosa, details of the onset of symptoms, her parents’ and siblings’ emotional reactions to the disorder as well as Yvonne’s irrational behaviours were discussed. The therapy was divided into 3 phases and it dealt not only with Yvonne’s Anorexia but also the issues of the family – marital and parenting issues of Yvonne’s parents as well as hurt feelings of the siblings. The long intervention’s (approximately 8 months) progress towards fruition and closure of the issues was explicitly described, giving the readers a very clear picture of Family-Based Therapy. Hannah’s case of Bulimia Nervosa was likewise presented in detail. It began with a general discussion of Cognitive Behaviour Therapy and how it is applied to adolescents, which usually involves their parents. CBT also follows a three-stage model. Each stage was explained according to what was done with Hannah, along with her reactions and progress in terms of her relationship with food. The case was built up until the end of the therapy when Hannah successfully overcame her eating disorder with the help of CBT strategies and her support network. Key to the effectiveness of this case is the researcher’s keen observation and objective reporting of each detail. This is paramount to building up the case study since each contributory factor needs to be analyzed and tied to the case. 9. What were the findings? The readers are to assume the findings from the conclusions of the case studies because the study did not dedicate a particular portion for it. The case studies indicated that the selected interventions of Family-Based Treatment and Cognitive-Behavioural Therapy are effective in treating Adolescent Anorexia Nervosa and Bulimia Nervosa respectively, if complete cooperation and support are extracted from the patient and her family. For the case studies concerned, although the interventions took quite a long time, the patients and their families struggled to keep their appointments and assignments no matter how difficult it seemed. It created consequential problems within the family, however, these were temporary, and the intervention still turned out to be successful in helping the patients overcome these eating disorders. Although the case studies were written well, this study did not give much value to the findings derived. It concentrated on the cases discussed and treated these as the main evidences of the therapies’ effectiveness. It would have been more convincing if the actual results of the aforementioned interventions were allotted its own portion so they are highlighted as actual “evidences”, as referred to by the article’s title. 10. How were they were reached? The researcher was very detailed in writing the case studies, documenting everything that happened within the span of treatment. It showed the progress as well as some setbacks to treatment that the reader will get to follow the trend of the intervention and how it moves forward. The findings were eventually reached upon the conclusion of the interventions when the patient has shown remarkable progress and ability to eat and live normally with the stable support of their family members. Both patients Yvonne and Hannah survived their eating disorders. However, such conclusions were not romanticized as the main evidences of the counselling treatments. Both good and bad things were objectively reported and contributed to the study’s findings. 11. How have they been displayed? The findings were written in narrative form as part of the case study. The gains from the therapy were enumerated such as the patient’s return to her normal weight how she has maintained it for a certain period of time as well as her independence in maintaining her diet without the supervision of her family members. It also reported the current activities of the patient to emphasize that she has regained her normal routines as a regular adolescent. In the Family-Based Treatment, the positive outcomes for the parents as well as the siblings of the patient were also highlighted such as the acquired parental skills during the intervention phases and the reformed behaviours and attitudes which were identified initially as contributing to the patient’s eating disorders. With Cognitive Behaviour Therapy, the patient was able to overcome her negative thoughts and behaviours by being able to identify them and the situations when they were triggered and then to manage these issues and difficulties with the strategies learned from CBT. Of course, in both cases, the patients admitted to continuing struggles in their eating disorder histories and the risk of relapse, however, the researcher pointed out that the interventions included ways and means to manage this problem in order to prevent relapse. 12. What are the implications of the findings? The findings provide hope for troubled children and adolescents suffering from eating disorders and other psychological difficulties related to developmental issues. It is also a welcome alternative to parents and family members of these troubled youth that there are effective measures and interventions that can help their children, and consequentially, their families out of such disorders. However, for these interventions to work, it would entail much of their commitment and sacrifice to endure the difficulties expected throughout the journey to healing. It is not an easy road to take, and they must be strong enough to persist in the pursuit of overcoming the disorder. Another implication is that although the therapies discussed were borne out of thorough research, much can be done to adjust it to the needs of the patients and it takes a highly trained professional to facilitate the intervention to effect positive changes in the individuals concerned. This is especially true for adolescent and child patients who are in their crucial stages of growth and development. They can be very sensitive and highly reactive to the slightest comment and the therapist must be efficient in encouraging them to bring down their defenses so that she can get through to them. 13. How are they discussed? Again, the implications are not overtly stated in the study but assumed by the readers. Much as this study was written mostly in scientific language, the case studies have been very descriptive of the patient’s struggles that it was inevitable for readers to conclude the implications of their interventions. The case studies dwelt on the insights of the patients and their family members and their sharing was professionally interpreted in the case studies by the researcher. It is the insights and emotions reported that serve as the backbone of this qualitative study. Qualitative methods such as case studies are useful in unearthing new insights or perspectives on phenomena that are already much studied. It is possible to acquire more depth of information than what has surfaced so far, which may otherwise be difficult to explain quantitatively (Strauss & Corbin, 1990; Robson, 2002). In this study, it is the effectiveness of Family-Based Therapy and Cognitive Behaviour Therapy in treating eating disorders in children and adolescents. 14. What further research might arise from this study? In the conclusion of the study, it identified some areas for future applied research such as identification of specific components of treatment, dose effects of treatment, appropriateness of the treatment modalities for different ages (e.g., children versus adolescents) and efforts toward developing large-scale randomized clinical trials evaluating the efficacy of various treatment modalities (p. 154). Other recommendations are the use of other psychological therapy models to treat eating disorders in briefer durations such as Emotionally Focused therapy, Solution-Based therapy, or the Egan Model of counseling, among others, to test which one is the most effective and most appropriate for the case. Application of the psychotherapeutic models with other cultural or marginalized groups besieged with eating disorders or other psychological disorders common to adolescents would also be a relevant study to undertake in the future. References Brown, R.T., Antonuccio, D.O., DuPaul, G.J., Fristad, M.A., King, C.A., Leslie, L.K., McCormick, G.S., Pelham, W.E., Piacentini, J.C. & Vitello, B. (2008) Childhood Mental health Disorders: Evidence base and contextual factors for psychosocial, psychopharmacological and combined interventions, Washington, DC.: American Psychological Association. Lock, J. & Fitzpatrick, K. K. (2007) Evidenced-based Treatments for children and Adolescents with Eating Disorders: Family Therapy and Family-facilitated Cognitive-Behavioral Therapy, Journal of Contemporary Psychotherapy Vol. 37, pp.145–155 Robson, C. (2002). Real world research (2nd ed.). Oxford: Blackwell. Steiner, H. (1998) Anorexia nervosa and bulimia nervosa in children and adolescents: a review of the past 10 years, Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 37, No. 4, pp. 352-359. Strauss, A., & Corbin, J. (1990). Basics of the qualitative research: Grounded theory procedures and techniques. London: Sage. Read More

 

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