Cognitive Remediation for Eating Disorders

Posted on by ncfed

What is it?

Monday Musings: Cognitive Remediation for Rigidity and Fixations in Eating Disorders.

Many of you readers are not sure what we do to treat eating disorders and overweight. So, these musings are to give you a peep into the secrets of treatment.

Eating disorders are problems with behaviour. Therapists seek to know what lies beneath problem behaviour like purging, starving and binge eating. Some therapists say it is all about early experiences. Other therapists think it is all caused by trauma or not having better ways to self-soothe.

People get into eating disorders by one road only. For whatever reason, they want to change their weight to feel better about themselves. So, they stop eating what they want and begin eating what they think they should.   The unintended consequence for some people is getting into serious food restriction. For other people,   dieting or cutting out food groups leads to binge eating and a small number of people  end up purging to try and manage their binges.

A tangle of different “maintaining factors”.

Tangles of EDs

Very few people know what keeps people stuck inside the tangle of an eating disorder.  There are many different things and so we must UNPICK the eating disorder, one tangle at a time. One of these tangles is very stuck habits. Everything inside an eating disorder is a habit, what food you binge, how you binge or purge, how and when you exercise, how often and when you might weigh yourself.

Some people with eating disorders,  especially people with anorexia or ARFID are very rigid by nature and they are easily fixated by the small details of the food they eat and what they think it does to them.  Many show signs of Obsessive Compulsive Disorder. This is partly to do with how their brain works. If we ask a person with anorexia to describe a picture, they tend to focus on a great deal of detail.  A person who eats normally tends to tell us about the overview of a scene, such as “This is a picture of the countryside in autumn”.

To recover from eating distress,  a person needs to become more flexible – to allow them to make more helpful food choices, and to worry less about their eating.

Cognitive Remediation (CRT) is a therapy  that works directly with the brain. The therapist is trained to do tasks with their client like picture work, or use of symbols, so that the brain learns how do several useful things. Firstly, to stop focusing on small details like “the food I just ate for lunch” and secondly to stop obsessing about ideas and thoughts so that the sufferer develop better coping strategies.

Cognitive Remediation Therapy is not the only thing we use to help restore a client to health. This is simply addressing one of the tangles in which they are trapped. Most good eating disorder specialists, like ours,  will have done some training in CRT.  If you need help with an eating disorder, have a look at our counsellor list at https://booking.eating-disorders.org.uk/counsellors/search

Young people at risk – test an App

Posted on by ncfed

stem4 Self Worth/Eating Disorders app Research Study – request for help in recruiting participants.

stem4 is a London-based teenage mental health charity that aims to develop positive mental health in teenagers through education and early intervention. stem4’s digital portfolio of award-winning evidence-based apps (Calm Harm, Clear Fear, Move Mood and Combined Minds) have been created by Consultant Clinical Psychologist Dr Nihara Krause in collaboration with young people, and are available free of charge on the App Store and Google Play.

This study is a preliminary evaluation of a new app called Worth Warrior for young people who experience early stage eating disorders. Like the other stem4 apps, this app, which will also be available free to users, has been developed by a Clinical Psychologist and stem4 Chief Executive Officer and Clinical Lead, Dr Nihara Krause and has been funded by the National Institute of Health Research (NiHR). The app uses techniques from a talking therapy called, Cognitive Behavioural Therapy for eating disorders to help tackle the symptoms of early eating disorders and low self-worth.

stem4 would like to know if the Worth Warrior app works well and if it can help young people manage their early symptoms of eating disorders by contributing to improving their self-worth. They will use a ‘before and after’ design to see if the Worth Warrior app is user friendly and can help to reduce symptoms in young people aged between 17-25 years.

The research will take place over a 7-week period and aims to include up to 30 young people. stem4 would like to collect information using online questionnaires at three time points, followed by a brief interview online. Young people will be recruited via stem4’s networks, social media, and their website. The project is divided into three stages:

Time 1: Introduction and familiarisation with the app.
Time 2: Post-app familiarisation (1 week).
Time 3: Follow-up after 6-weeks to see if the app was helpful.
Data will be collected via questionnaires at each time point. In order to collect more detailed feedback of using the app and its benefits (or qualitative data) participants will also be invited to take part in a brief online interview at Time 3. This qualitative part of the study will be jointly produced with young people.

As a thank you to the young people participating, stem4 will be offering a £30 Amazon voucher.

Participants can find out more and see if they are eligible for the study here:

https://stem4.org.uk/body-image-eating-disorders-app-research-study/

Chewing & Spitting Adam Kay

Posted on by ncfed

Adam Kay the famous writer and broadcaster admits to a “serious eating disorder” where he chews large amounts of food (usually junk food) and spits it out.

He became painfully aware of his size after a sexual encounter where his partner said that he had done well despite being “a big guy”.

He took the comment to heart and he decided to lose weight the quick way, by starving. Unsurprisingly he developed extreme hunger and began to crave food. Having failed to throw up, he decided to spit food out as a way to lose weight. He began to spit out more and more, to the extent that he kept a bin bag full of spat out food in his room until one day he was “found out”.

For a while, this strategy to lose weight worked. He lost a lot of weight and people began to be concerned about his appearance.

We have an article about chewing and spitting on our information pages. Some people have written in; they are annoyed about the things I have written. They are annoyed about me writing that we can take in a lot of calories when we spit out food, because a lot of energy is inadvertently swallowed.

The psychology of spitting


Spitting can become a major addictive behaviour because of the dopamine hits it gives. But the psychology of spitting is complicated.

For a short time, chewing food and spitting it out will calm the hunger drives. But this doesn’t work well in the long term. When the mouth receives food that the stomach doesn’t get, the brain is not fooled. Chewing palatable tasty and forbidden food will give us a dopamine “hit” that feels gratifying, but there are other physiological processes going on that could make it more likely that we will gain weight in the long term – one month, one year down the line. That is personal. The quick fix of spitting has a cost.

One reader wrote to me that the psychology of spitting food out is simple. He says it is simply about getting the taste without the calories. I do NOT agree.

Why people might chew and spit

What is the person REALLY spitting out? Who is the person REALLY spitting out?

I have found out that most people who chew and spit are very anxious, and this is a way of calming themselves down.

What is the underlying deep sense low self-worth that causes someone to believe that they do not deserve to eat real food. It is not just fear of getting fat.

What is the source of the pain that is being expressed by a behaviour that would be generally seen as shameful?

Does this person really believe that this is the only method of weight control available to them?

What is the cost of doing this, and what is stopping them from getting help?

How to get help

I wish that I had worked with Dr Kay, to find out what led him to take the comment about his size so much to heart, and to be the victim of someone else’s unguarded opinions about him. Maybe it is this fragility that lay behind so many of his other problems with life, work and relationships.

If you need help with chewing and spitting, we understand. Contact 0845 838 2040 and explore your options


https://www.thetimes.co.uk/article/my-secret-eating-disorder-by-adam-kay-2qrghx65m







Anorexia: Inspiring recovery story

Posted on by Sam Storey

“Through my experience with anorexia I have learnt that it is possible to work through trauma and regain control, and to accept myself for everything I am” – Amy, 26

I was 12 years old when I was diagnosed with anorexia nervosa. At the time this was a completely foreign term and one that took me another decade to finally acknowledge, begin to process, and then recover from. 16 years later I can proudly say I am in remission; the journey is still ongoing but when I look back at who I was and where I used to be, I can be kind to that little girl and not see her as the enemy.

What follows is an account of my experience with and recovery from anorexia nervosa.

Fasting as a means of control

As a child I struggled with eating, I was fussy and picky and found it difficult to eat certain foods which were out of my comfort zone. I never had school dinners and eating at friends’ houses was always a struggle because I found it hard not being able to control what I was being given. I feel that it’s important to note that these are reflections I have made in recovery, at the time it wasn’t a noticeable issue, merely a young child who was a picky eater. At 12 years old, when I went to high school things began to change and I was forced to adapt to a new environment, new people, and new experiences.

Looking back on my experience with an eating disorder, the one word that stands out to me is control. Control is defined as ‘the power to influence or direct people’s behaviour or the course of events’ – as the one thing that I felt I didn’t have external access to, I looked inwards to attempt to establish control.

The scales became my best friend and my worst enemy, I couldn’t go a day without stepping onto them to check my weight, and on the bad days I could barely go a few hours without watching them settle on a number which held such significance in my life for over a decade. If the number was too high, I would restrict myself and if the number was too low, I would have a moment of elation, followed by a wave of self-hatred which fuelled further restrictions. A never-ending cycle of restricting and exercising excessively allowed me to control my body, making myself thinner and thinner until I was barely more than skin and bone.  

Doctors, disassociation and deception

My body became the physical embodiment of my trauma and a reflection of my pain, but I never thought I had a problem.

The weight loss gave me an illusion of strength, power, and control. The more I lost, the better I felt. When in reality each pound I shed came with more complications; I began to lose my hair and bone density, my nails and teeth became brittle, and I was losing consciousness due to malnutrition.  

Family members and doctors became concerned for my physical health, I was severely underweight for my age, and they didn’t know what to do to help me. My parents were out of their depth, they did everything they could to encourage me to eat more, sleep more and build my strength, but through this I only took a more calculated approach. I would be seen to eat at the table for dinner and disguise my frame in baggier clothes, but behind closed doors there was no food being eaten and the exercising was obsessive to the point where I would collapse from exhaustion.

Working with my doctors a food diary was suggested to log my daily intake. I found this extremely difficult – seeing everything on paper was a trigger, one I learnt to dissociate from when I went to my appointments.

Around three years after my diagnosis my physical health was so bad that an ultimatum was given. Gain weight now or you will be made an inpatient.

At the time both concepts were abhorrent to me, if I gained weight, I wouldn’t be able to live with myself, but if I went inpatient, I wouldn’t have any control and I would be forced to eat by people I didn’t trust. This marked the beginning of one of the darkest times in my journey. I was able to maintain a weight deemed ‘safe’ by the practitioners and my parents were happy with my ‘progress’, but in reality I was spiralling deeper into depression, dissociating to manage daily life, and self-harming to try and feel something.

My lightbulb moment

This cycle continued for the next 7 years, until at 22 years old, 10 years since my first diagnosis, I was able to recognise and acknowledge that I was suffering from anorexia, and it was time to change.

 When we talk about eating disorders, we’re often focused on the physical ramifications, however, in my experience, it is primarily a disorder of the mind. Obsessing over my weight and my food intake was my way of maintaining control, a control which gave me purpose but was ultimately killing me.

The acknowledgement was difficult and met with resistance, but I now had a healthy purpose and a reason to carry on even if I hadn’t consciously become aware of it at that time. I was able to slowly make changes and to accept the support I was being offered.

After years of obsessing over pro-ana websites (where anorexia is portrayed positively as a lifestyle choice rather than disorder and condition) , Pinterest boards and social media accounts which promoted an unhealthy and unrealistic representation of beauty, I rechannelled my energy into more productive activities. I read books which made me feel powerful, journaled regularly and found joy in the things I had once been afraid of.

My first positive experience with support was my introduction to the charity, Beat, an eating disorder charity which understood what I was going through and didn’t try to force changes. I got to choose when I was ready to make changes, and which changes to try…

This was a stark contrast to the experiences I had received previously with doctors and practitioners, who unfortunately had not been trained effectively in eating disorder care.

Working through the ‘why’

As a result of my experience with Beat, I felt comfortable enough to start work with my first therapist. I was terrified about opening up and speaking about this ‘thing’ I had protected for the past decade, and I had no idea how to even begin to address it.

One of the many revelations that came from therapy was that I had actually developed anorexia before I was 10 years old, although I was diagnosed at 12, the disordered patterns that led to this began long before.

Over the decade of actively battling my eating disorder the main question I would be asked was ‘why?’, and as is the case with a lot of mental illness, I just didn’t know.

I didn’t know why I was doing it; I didn’t know what was happening to me. I was told I was struggling with body image and body dysmorphia, and this had materialised into an eating disorder, so this was the script I relayed to everyone who asked me, and it was the answer I gave in my therapist’s room as though it was my truth.

It took a lot of work and recognition of past trauma to realise that my eating disorder was a physical materialisation of the control childhood abuse had taken from me. It was also a manifestation of my desperation to connect with something that I was able to protect entirely – a vulnerable and terrified inner child who needed me.

If you’ve experienced childhood abuse and need support, I’d highly recommend The National Association for People Abused in Childhood, who can be contacted via support@napac.org.uk or on 0808 801 0331.

Recovery

My recovery journey has not been easy, there have been relapses and times of hopelessness, and although it is a battle I will have to face every day, it is one I am now equipped to fight.

Through my experience I have learnt that it is possible to work through trauma and regain control, to accept myself for everything I am and to recognise the parts of my life which my eating disorder was fuelling.

This is still a work in progress., Every day I am learning more about the person I am and want to be, and this gives me hope for my future.

I do not feel thankful for my eating disorder or the experiences which caused it, but I am grateful for the opportunity to share my story and hopefully to reassure others that you are not alone, this is not your fault, and the fight is worth it.

Guided Self Help for Young People with Eating Disorders:

Posted on by ncfed

Request for participants

I am a PhD student at UCL Great Ormond Street Institute of Child Health, working under the supervision of Professor Roz Shafran. The aim of my PhD is to develop and evaluate a guided self-help treatment for children and young people with eating disorders.

I am currently running focus groups to better understand stakeholders views on guided self-help interventions for children and young people with eating disorders. We will then use these findings to inform the development of the treatment to ensure that it is sensitive to the needs of children and young people with eating disorders, their families and the clinicians that work with them.

We are looking to recruit young people (aged 11-17) with eating disorders and parents/carers of young people (aged up to 17) with eating disorders for the focus groups. The focus group will be online and will last approximately 1.5 hours. Participants will receive a £40 Amazon or Love2Shop voucher for their time. The study has received ethical approval from the UCL Research Ethics Committee.

If you are interested please email admin@ncfed.com

Eating Disorders in Pregnancy

Posted on by ncfed

Pregnancy can be a difficult time for people with eating disorders.

In normal circumstances, hormones lead to weight gain and eating changes to support the additional 80,000 calories needed for the pregnancy and ongoing breastfeeding.

Regular weighing takes place to check the health of the mother and child, and to ensure that the baby is getting adequate nutrition for central nervous system health at the least. Weighing helps to against gestational diabetes and alert about dangerous conditions like pre eclampsia. Weighing can be traumatic for people with body image issues.

Sadly, there is a great deal of pressure on social media for women to gain as little weight as possible during pregnancy as a “badge of pride,” ignoring the effects that this might have on a child’s future mental and physical wellbeing.

For people with eating and body image issues, pregnancy can be very difficult.

Here are some of the dangers associated with different types of ED in pregnancy.

Bulimia

Binge eating and purging during pregnancy is dangerous, for example loss of potassium as a result of purging including laxative abuse might impair development of the central nervous system of the developing baby. Nutritional support to help prevent cravings is needed alongside urgent help to manage their eating disorder.

Anorexia

Some people living with AN give themselves a holiday from the ED and permit themselves to eat only to begin restricting after childbirth. Others continue to restrict and may not cope with looking pregnant. The risks to mother and child in such situations are critical and the person with AN during pregnancy needs a great deal of compassionate help.

Binge & compulsive eating

Binge eating is not just taking in a lot of food. Because binge eating is usually highly processed sugar rich food that provides emotional comfort, there are profound metabolic effects. These in turn can switch on epigenetic changes that predict future weight struggles in the developing child. People who enter pregnancy with pre existing struggles to control eating and weight need informed help to manage their relationship with food from the get-go.

They do NOT need being shamed by health professionals about size or weight gain and they do NOT need well-meaning advice about how to eat a healthier diet.

Every single pregnant woman with runaway weight gain during pregnancy will benefit from compassionate help from someone who can talk to them without blame about their relationship with food.

Pregnant women do not respond well to midwives and doctors telling them what they should do for the good of their baby. The best way to protect the baby is to look after the mother and the people who support her.

Resources

Kings College London has a Video to support women in Pregnancy https://www.kcl.ac.uk/archive/news/ioppn/records/2018/february/new-animation-enhances-support-for-women-with-eating-disorders-during-pregnancy?fbclid=IwAR319Yju4dSQXJkAaJpd7h4JbMWCmqTEEOU4IxrJPrSlgvus4JG_lp7v740

Here is another perinatal support website

Resources

The British Journal of Midwifery has an article to support midwives – hope they read this

https://www.britishjournalofmidwifery.com/content/clinical-practice/eating-disorders-in-pregnancy-practical-considerations-for-the-midwife/?fbclid=IwAR3R0G-OPxXZDvgcejWeP3RtAw0gpuK6y6UGhnXSkssKubSDdqIaHnCBOXU

Susie Orbach talks about the needs of eating disordered women during pregnancy. See her podcast Life After Diets with Susie Orbach, https://youtu.be/OhaVwcp9pqc

If you are expecting a child, and need compassionate help with your eating disorder, call us now
0845 838 2040

Research into Anorexia Treatment

Posted on by ncfed

Sophie is writing to you about the research project that she is conducting as part of the Doctorate in Clinical Psychology at UCL. My project aims to explore how Externalisation of Anorexia Nervosa can Help and Hinder Recovery from this Eating Disorder.

She says

We are carrying out this research because although externalisation (viewing and talking about anorexia as a separate entity that is external to the individual receiving treatment) is a widely used therapeutic technique within therapies for anorexia, research exploring how externalisation helps and hinders people’s recovery from an eating disorder is very sparse. Our research aims to further our understanding of people’s experiences of externalisation in treatment for anorexia in order to learn how this approach may or may not support recovery from an eating disorder. We hope that by exploring a common strategy used in therapies for AN, this project will help to inform and improve treatments for anorexia. To help increase people’s chances of recovering fully from an eating disorder, it is important that we understand the views of individuals who have received treatment for anorexia. Therefore, we aim to obtain people’s views through semi-structured interviews which I will be conducting online.  

We are looking for people aged 16 and above who have received at least one or more NICE recommended therapies for anorexia, who may or may not have reached a point of recovery from an eating disorder, and who are familiar with the notion of externalisation in treatment for anorexia.

To recruit participants, I have posted on my linked in, twitter and facebook accounts. However, I would be enormously grateful for any support that NCFED may be able to give to raise awareness of the study among the target population which NCFED have greater access to. I would be happy for you to post about the study or alternatively you can share / retweet my posts. Below I list my accounts on social media, however, please do let me know if there are alternative or additional methods of raising awareness that NCFED may be able to support with. I attach my leaflet for your reference.


Twitter: https://twitter.com/SophieCCripps/status/1545072159919308801

Facebook: https://www.facebook.com/sophiecharlottec

Linked  in: https://www.linkedin.com/feed/update/urn:li:activity:6950852244699283456/

Bikini Body Outrage

Posted on by ncfed

A Brummie Mummy has has invented a wooden bikini into which you can insert coins for every pound of weight you lose to get into a bikini body.

To get summer bikini body ready.

There is a WEDDING DRESS version for women to get sized down for their big day. I wonder how many men “fit-up-slim-down for their big day?

is this what women are supposed to eat so that they can have fun at the beach?

There is not an equivalent wooden weight loss “trunks” for men. We have to put an end to this kind of nonsense

https://www.bbc.co.uk/news/business-61881412

Children with ARFID Family Support Group

Posted on by ncfed

A monthly family support group with Jenny Phaure

Family Skills for Autism and Disordered Eating Monthly Psycho-Education and Coaching Group.  

This group is now open for referrals and bookings from Charities, Mental Health Teams, Eating Disorder Services, Social Care, Allied Health Professionals, GP’s, Therapists and independent providers.  

Why is there a need for this group?

Up to 70% of Autistic Children may experience atypical eating behaviours, many have issues with food or eating. Whilst research indicates that between 25-30% of those with Anorexia Nervosa also meet the diagnostic criteria for Autism there is a much larger number of autistic children, young people and adults who experience avoidant, restricted and disordered eating patterns.

Avoidant, Restricted and Disordered Eating patterns may be a precursor to Anorexia Nervosa or may exist alongside other Eating Disorders such as Bulimia Nervosa or Binge Eating Disorder.   This group is the only Family Skills for Autism and Disordered Eating Group in the United Kingdom and has been set up due to the need to provide more immediate support to families living with Autism and Eating Disorders.   With limited recourse to local or national autism specific services it is vital that parents/families are given access to essential psycho-education, tools and strategies to support their loved ones at home or in the community. Families are often the most important resource.

A Monthly Psycho-education and Coaching Group   with Jenny Phaure (Child and Adolescent Psychotherapist)  
2 hours on line via zoom   Wednesday 20th July (10.00am – 12.00pm)    

Family Skills for Autism and Eating Disorders  

Using positive psychological approaches to improve mood and food regulation.    

Cost: £45 per person     Bookings via service contracts or block bookings are available for those referred via a service provider. Please call: 07545 190915 for more information.  

Your facilitator Jenny Phaure

Can an Eating Disorder Service also offer Obesity Treatment

Posted on by ncfed

Yes, if the service is specified as two -sided and clear about the distinction between eating disorder treatment and weight loss coaching.

At the National Centre for Eating Disorders we do a holistic assessment of a person to ensure that no significant eating disorder is present; if it is present we make it clear that there are to be no weight loss attempts during treatment for the eating disorder and such a person might not in the future be suitable for intentional weight loss.

It is incorrect to assume that all people wanting weight change have an eating disorder.

If we agree after assessment to support a client in their weight change intentions, we will engage in a manner consistent with good practice and we have transformed many lives. Some of our clients have had a history of binge eating / bulimic disorders and have gained weight throughout the years because they have not had timely treatment for their eating disorder. We empathise with their desire to change weight if the time is right.

In such a case we would not do anything that would reactivate their eating disorder.

Weight loss “guidance / therapy”, does not imply dieting or food rules or boot-camping nor does it have goal weights. Nor does it require endless searching into childhood adversity. Nor is it HAES although they have some but not all, very good points.  The service includes bariatric counselling. Some people, with our help, decide that they are happy as they are. The ultimate outcome is flourishing.

We market obesity treatment because of the numbers of desperate people INCLUDING therapists who seek our help. It must mean something that over the course of 40 years no one entering our service has complained about stigma.  No therapist training with us over the same period has raised a complaint about anti-fat bias.

Activists who have not done our training are pitching against us with total ignorance about what we do. It interests us that while they are intolerant of the word “obesity” they bandy the term “fat” as if it means something different. Really?

What worries us at NCFED is the number of activists who actively try to deny people from having access to good weight change help; who wish to prevent therapists from learning about strategies that might work, and who wish to withhold from the public factual information about some health risks of living in a larger body. On top of this, no activist is able to come up with a single client or psychotherapist trained by NCFED who has been “traumatised” by weight stigma.

The NCFED has no need to make a big deal about inclusivity. We have therapists of all genders, races, religions, tribes and colours. We treat people without needing labels. Inclusivity is woven into our trainings and the first thing we do is delve into the history, generational issues, declared identity and value systems, of each individual in a place of complete acceptance.

I will not give the litmus of attention to angry people. Certainly, it is right to question the old “sacred cows” and reflect on their meaning and purpose. Having reflected, we feel good about what we do and we will not kowtow to aggression. People in the community who do not have a clinically significant eating disorder, who desire intentional weight change, deserve far better help than the traditional diet and lifestyle methods that do not work. They can come to us for that help, given by people we trust.

Meanwhile, Our amazing course, Essential Obesity: Psychological Interventions, next date June 2022