Introduction
Anorexia Nervosa (AN) is a psychological disorder, wherein individuals deny eating food to maintain their body weight. They feel internally over-weight and hence, decide to stop eating the food. The average risk of AN in woman is found to be around 0.4% to 1%, as per one of the researches carried out in this direction. Anorexia nervosa involves neurobiological, psychological, and social components which all contribute to the complexity of the disorder. Although this condition mainly affects women, it sometimes also affects the males.
As per one of the statistical records obtained from one of the researches, it has been found that, in 10% of the cases it can also affect males. Diagnostic criteria for anorexia nervosa include the patient are refusing to increase their body weight above certain level. They do not want to increase their body weight further because they will become fat. Other people find this disorder, majority amongst women, since they do not want to turn fat. Women suffering from disorders even face an issue in their menstrual cycles (American Psychiatric Association, 2000).
The symptoms can be easily identified since, people have stopped eating food. They want to reduce their weight through regular exercising, voluntary starvation or taking other measures to control their weight. It might even include taking of drugs associated with it. Treatment of anorexia nervosa is not well understood and continues to be viewed by clinicians as one of the most frustrating and recalcitrant forms of psychopathology. The illness is also often comorbid with depression, anxiety and thoughts of suicide. Anorexic behavior also consists of constantly thinking about food, avoiding circumstances in which food is involved and becoming obsessive over food. These symptoms make the treatment of anorexia particularly difficult because of their multidimensional context.
The purpose of this paper will be to compare and contrast the effectiveness of Cognitive Behavioral Therapy (CBT), Pharmacological Therapy (PT), and Narrative Therapy (NT) & Dialectical Behavior Therapy (DBT) in treating young adult women, who are suffering from anorexia nervosa. As per one of the researchers, Anorexia Nervosa has the highest mortality rates in the Statistical Manual of Mental Disorders (Arcelus et al., 2011). With rising prevalence coupled by the deadly diagnosis of the disorder, it becomes crucial for clinicians to understand the effectiveness of these therapies in treating Anorexia nervosa. The thesis of this paper is then to compare the three techniques CBT, PT, and DBT& NT that can help in curing this disorder, and finally decide upon the best one.
Brief description of disorder Anorexia Nervosa (AN)
In this order, people will observe significant disturbances in the eating habits, in the duration of eating habits, and in the frequency of eating. They would not seem to be reasonable in nature, and hence, individuals need to put this disorder into the category of mental illness disorders (American Psychiatric Association APA, 2000). Some of the behaviors include people taking too much care of the shape of their body and their weight. Often, they will be concerned with their food and exercise routines. Such disorders often occur with severe medical or psychiatric comorbidity. The reluctance to openly discuss this disorder makes the treatment of eating disorders especially challenging. Women between the ages of 17-23 are majority influenced with this disorder. Social settings such as college environment tend to increase the risk of developing eating disorders among women.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has two specific diagnoses of such disorders. These include anorexia nervosa (AN) and bulimia nervosa (BN). The criteria for anorexia nervosa include individuals who are dedicated to achieving thinness through extreme dietary restraint.
There are significant changes in an individual’s mood, psychical health, and social health in patients with Anorexia Nervosa (Bamford & Mountford, 2012). Bulimia Nervosa is distinguished through binge eating; however, the rest features are similar. Individuals suffering from BN will have no idea on how much food they are consuming, and hence, will be facing with the issues of over-eating. He then might make a control on his eating through regular exercise routines, controlling the amount of food intake and through fasting.
Overcoming the AN Disorder
Individuals have often been found to be facing with the issues of Anorexia Nervosa due to several reasons. It is always a challenging task for the counseling practitioners to heal them, to make them positive, and to help them come out of their respective mood disorder. In some of the cases, it is even found that, patients lose their mental balance, and even commit suicides. Mental illness seems to be disturbing the peace of mind and the psychological thought. The patient keeps upon thinking negatively, and due to which, he makes no further attempts or efforts to improve the situation.
People can understand that it might not be so easy for him to overcome the given situation; but, still he needs to try hard within himself, and fight against the dark forces of mental illness. He might feel very much sad, worried, empty, guilty, worthless, and hurt during such situations. He has no clue regarding how to overcome such situations or how to exit from such instances.
He needs to take support of his parents, his children, his managers and other senior officials, and his colleagues in order to come out of this situation. However, if the situation further worsens, and he starts demonstrating mad behavior, then there is a need of a psychologist to solve this case. The psychologists, therefore, need to find out the exact cause of such mental illness and prevent him from committing suicide. Instead, he can provide medication and oral encouragement that will help him to recover soon from such activities and incidences.
Applying the Curing Techniques
A Cognitive Behavioral Therapy (CBT)
The Cognitive Base Therapy approach is often the most common preferred therapy for treating eating disorders such as AN and BN. It helps women in controlling their weight and shape. As researchers and contributors it is important to explore research pertaining to the effectiveness of cognitive based therapy compared to other therapies and if it has any limitations.
The traditional application of CBT for anorexic patients consists of the goal setting to restore weight by having a controlled intake of food. It also includes counseling sessions, wherein the patients are encouraged to become their therapist by coming up with behavioral experiments. They need to encourage them to identify challenges and modify unrealistic cognitive behaviors related to eating, shape, and weight (Bamford & Mountford, 2012).
The mind-set applied in CBT is, if clinicians help anorexics replace their inaccurate beliefs about weight and food with accurate ones, then they will no longer fear of gaining weight. Instead, it will help in resuming the normal eating habits. Thus, the key method involves counseling sessions and face-to-face meetings, wherein the counselors will try to make the patient understand about positive thinking and positive beliefs.
There is another therapy named, Cognitive Emotional Behavior Therapy, which is a subdivision of CBT. This therapy has been gaining increasing interest among clinicians treating patients with anorexia. The aim of CEBT is to make patients understand the experience and expression of emotions. They accordingly need to provide their response to their emotions in a flexible manner (Corstorphine, 2006). CEBT focuses on developing skills that will help in coping with eating behaviors and other impetuous and uncontrollable behaviors. The added components of experiential exercises and elements of psychological training will help the patients to get cured of this disorder. The emotions neglected in CBT are focused upon in CEBT. CEBT offers the patient, opportunity for imagination and self-exploration and a better ability to identify and treat negative mood states that coexist within the patient.
In a clinical case study conducted by Draxler and colleagues (2012), the CBT treatment protocol was investigated with added modifications to the therapy. The clinical case study investigated the change in affective personality during treatment course of CBT.
The woman was treated with cognitive behavioral therapy as she was suffering from the AN disorder. There were about 15 sessions conducted on a weekly basis, with a view curing her of this order. The physicians even inspected her on a regular check-up basis. The end results showed positive signs evidenced by improvements on the woman’s behavior. Thus, the CBT technique seemed to be working in such cases (Draxler & Hiltunen, 2012). The results of this study suggest that the treatments of CBT with these proposed modifications were highly successful for this client. Thus, CBT can provide effective treatment for people suffering from anorexia nervosa (Draxler & Hiltunen, 2012).
Pharmacological Therapy
In this therapy, the physicians determine the impact of Anorexia Nervosa. They accordingly, devise necessary medications and treatment plan for such patients. The medicine need to be taken at regular intervals. In addition, they also need to adhere to the dieting schedules prepared by them (American Psychological Association, 2000).
It is important to complete the entire medicine course so as to achieve the desired effect on the patients. These medicines work on the given disorder and help the patients to get recover from it soon. However, sometimes it might happen that, such medicines are changed due to its side-effects on the health of the patient. The dosage might also be changed keeping in mind the impact on other health parameters. Further, the physician regularly checks the health of the patient and accordingly suggests the nursing staff to provide injections or medications. If the health further deteriorates the medicines will be changed instantly, along with the dosage.
The same physicians will be preparing the diet plan for the patients. They are not allowed to eat anything else outside of this diet plan. Further, they need to take in fruits, green leafy vegetables, protein-rich diets, and energy drinks in their diet plan. It will help them to get recover soon. These medicines can heal the patient; however, it has side-effects that can impact the health of the patients in many other ways. It is, therefore, recommended to provide medicines but under careful observation. At the same time, periodic monitoring is required by a physician so that he can modify or keep the same plan of medications. The diet plan will also change on the basis of recovery achieved by the patient.
Alternative Therapies: Dialectical Behavior Therapy (DBT) and Narrative Therapy (NT)
DBT is an approach through which the physicians combine the strategies of traditional cognitive behavior therapy and Zen traditions. Both genetic issues and emotional experiences play a significant role in causing such disorders (Golan, 2013). Hence, the patient needs to be treated more from a psychological perspective so as to get cured completely. Highlighted strategies include pros and cons of committing to change, playing devil’s advocate and heightened a sense of self-control to achieved desired goals.
On the other hand, Narrative therapy focuses on the development of an anti-eating disorder lifestyle and values. This therapy helps the patients to develop those characteristics that will help them overcome the issues of AN. There are certain underlying values that will make people fearless of becoming fat. However, at the same time will also make them realize the importance of a healthy diet, which they need to take in order stay healthy for a lifetime (Lock et al., 2005).
The stories about their experiences and situations are informed to the patients, which will help in overcoming the traumas associated with this disorder. Narrative therapists work in detangling the person from the problem, despite the uphill battle constructed by cultures that were to identify the person as the problem.
Researchers have suggested that this viewpoint and therapy is better at treating people with eating disorders than cognitive based therapy (Lock et al., 2005). It is argued by many physicians and psychological counselors that DBT is an excellent form of therapy in treating patients with anorexia (Salbach-Andrae et al., 2008). DBT includes techniques for working with varying commitments to change. It will thereby, serve successful for the patients suffering from anorexia. Narrative therapy has been found to be successful treatment in patients with anorexia. The narrative perspective approach is uniquely separated from other treatment therapies (Lynch et al., 2013).
Selecting the best Therapy
In the event of comparing all the three therapies, more or less all three are same. They differ in the approach or the methodology, and hence, it is important to distinguish them all. However, conceptually, all of them are working on the fundamentals of removing fear of eating disorders, and making people think positive.
Individuals with AN show signs of rather than getting frightened from food are confused on how to overcome this disorder. They get nervous and tensed and hence, it becomes all the more difficult for them to overcome this situation. CBT is a technique that suggests increasing motivation levels as well as increasing one’s self-esteem that will help him to overcome the situation of AN. DBT works on providing skills and techniques, through which the given individual will be able to think on a positive note, and will look out for positive energy. NT therapy works on understanding and diagnosing a current situation, and accordingly provides dosage on how to turn positive in a given situation through counseling sessions, and through face-to-face discussions. People are frightened to such an extent that, they even think of committing suicides (McCabe & Marcus, 2002). On the other hand, PT treatment works only on the basis of medications and dieting plans. These medicines might work for some patients while the same medicines might not work for other patients. It is, therefore, important to determine the type of medicines, the dosage and the dieting plan on a separate basis for each of the patient.
Now, comparing all the three therapies, it seems that, all three are best for the improvement of and individual with Anorexia Nervosa, but to select the superior will depend upon the situation of the patient. If he needs more motivation levels, CBT and enhanced CBT methods will work best. If he wants, skills that will help him to overcome the given disorder DBT will work best. Moreover, if, he feels more comfortable in the care of a physician, and then carry out the treatment, then NT will work best. Moreover, PT therapy should work as a complementary approach along with each of these therapies. Providing psychological consultation along with medications will provide an effective therapy to the patient soon.
Conclusion
Anorexia nervosa is a disorder where people are frightened of eating more food. They see eating more food as increasing fat within the body. Hence, therapists alike want to overcome the situation of this fear and anxiety. Sometimes, AN patients turn so nervous that, they even think of committing suicides. It is not a disorder that will get cured within 1-2 weeks. It will take time, and the patients need to keep numerous amounts of patience for the effects to show. As of this era, there are several known therapies that could help with the AN situation; such as CBT, PT, and DBT & NT that will help these people to overcome this disorder.
During the time of mental illness, mood factor plays an important role. Mood is more of an energetic type, wherein an individual feels positive about everything, and he tries hard to achieve his or her desired needs and goals. However, if mood is not at the positive side, it keeps the given person many days without sleep, which in turn leads to depression. It is, therefore, very much important for the counselors to balance the mood cycles. Counselors need to make them alive, and provide them every sort of happiness in their lives. It is very much important for them not to hide any feeling and emotion within them. However, instead try to be open, so that they can communicate in a better way. Only, positive energy and positive mindset is required to cure this mental disorder. These people should realize the fact that, they now no more belong to the darker side of their lives, but instead belong to the brighter side of the lives.
In conclusion, all the three methods are quite powerful but vary in application. The methodological approach is different, but overall it seems to be the same from the conceptual perspective. There are counseling sessions, face-to-face discussion, narrations, medications, and so on, which will be applied to the given patients, depending upon a given situation. This paper has tried to compare all the three techniques and has tried to find out the superior one. All these techniques are best, but to find out the best one will depend upon the condition of the patient, as well as how much he is suffering from Anorexia nervosa disorder. At the same time, it is equally important to know the historical issues related with the patient, the frequency of this disorder and any other unknown factors, before carrying out the necessary and required treatment. Thus, the technique that will be used for curing a given patient will depend upon the decision of the clinicians and medical counselors.
References
American Psychiatric Association.(2000). Diagnostic and statistical manual of mental disorders.
Arcelus, J., Mitchell, A.J., Wales, J., and Nelson, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731.
Bamford, B.H., and Mountford, V.A. (2012). Cognitive behavioral therapy for individuals with longstanding anorexia nervosa: Adaptations, clinician survival and system issues. European Eating Disorders Review, 20(1), 49-59.
Corstorphine, E. (2006). Cognitive–Emotional–Behavioral Therapy for the eating disorders: Working with beliefs about emotions. European Eating Disorders Review, 14(6), 448- 461.
Draxler, H., andHiltunen, A. J. (2012). A Modification of Enhanced Cognitive Behavioral Therapy for Anorexia Nervosa: A Case Study. Clinical Case Studies, 11(3), 201-217.
Golan, M. (2013). The journey from opposition to recovery from eating disorders: Multidisciplinary model integrating narrative counseling and motivational interviewing in traditional approaches. Journal of Eating Disorders, 1(1), 31-47.
Lock, A., Epston, D., Maisel, R., and de Faria, N. (2005). Resisting anorexia/bulimia: Foucauldian perspectives in narrative therapy. British Journal of Guidance & Counseling, 33(3), 315-332.
Lynch, T., Gray, K., Hempel, R., Titley, M., Chen, E., andO'Mahen, H. (2013). Radically open dialectical behavior therapy for adult anorexia nervosa: feasibility and outcomes from an inpatient program. BMC Psychiatry, 13293.
McCabe, E., and Marcus, M. (2002). Is dialectical behavior therapy useful in the management of anorexia nervosa? Eating Disorders, 10(4), 335-337.
Salbach-Andrae, H., Bohnekamp, I., Pfeiffer, E., Lehmkuhl, U., and Miller, A. L. (2008). Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa among Adolescents: A Case Series. Cognitive and Behavioral Practice, 15(4), 415-425.
