Anorexia Nervosa Research Paper
Treatment of Anorexia Nervosa
Treatment of Anorexia Nervosa Anorexia Nervosa, a type of eating disorder common among young ladies as stated in The New York Times Health Guide. According to Ohio State University Wexner Medical Centre, more than 90 percent people in the United State diagnosed with Anorexia Nervosa were female. It can be categorized as refusal to maintain a minimal body weight, fear in weight gain, body image distortion and loss of menses as mentioned in the Journal of the American Academy of Child and Adolescent Psychiatry (Hagman, et al., 2011). Those diagnosed with anorexia nervosa usually avoid eating. Their perception on body shape and weight differs from others. They may be underweight to society; …show more content…
however, to them they are always fat. To reach their ideal body shape and weight, anorexic client will follow a strict diet and exercise excessively.
According to Diagnostic and Statistical Manual of Mental Disorder, there are two subtypes of anorexia nervosa; restricting type and binge-eating/purging type (American Psychiatric Association , 2000). Client under the category of restricting type usually stick with a strict diet where they only consume food with low calorie level. They exercise excessively and at times fast; whereas for binge-eating/purging client, they usually induce themselves in vomiting and misuse of laxatives.
Humans have the tendency to assess their personal characteristics and abilities by comparing themselves to others (Hamel, Zaitsoff, Taylor, Menna , & Grange, 2012). Clients compare by looking and perceiving themselves as fat and ugly resulting in social anxiety and causes depression. Social anxiety is the fear in facing others where the client themselves think and feel that they will be embarrass (Hedman, Strom, Stunkel, & Mortberg, 2013). Anorexic client faces social anxiety due to having the perception that others will look at their large distorted figure and might laugh at it.
On the other hand, depression is defined as a cluster of specific symptoms with associated impairment as stated in the journal article, “Depression in Adolescence” which also stated that depression is notably in girls after puberty; it causes one to feel sad and down on nearly everything surrounding them including themselves (Thapar, Collishaw, Pine, & Thapar, 2012). Anorexia nervosa client usually diagnosed with depression, as they are upset and unsatisfied with their look. There are many kinds of depression; one of it is major depressive disorder. An estimated 26.2 percent of Americans age 18 and above are diagnose with major depressive disorder which made up to one out of four adults (Mental Health Information & Organizations, n.d.). The client, “Nadia” was a 19-year-old female college student working her way towards a bachelor degree. She resided in an apartment that is within walking distance to her college and is only able to visit her immediate family whenever there is at least a 3-day break. Nadia had a close relationship with her younger sister whom she grew up with. Her transition to college was tough as Nadia not only had to leave her sister but her close friends as well. She spent the majority of her time studying, socializing with her peers, exercising, and trying out the various clubs in her college. Nadia described herself as a cheerful and carefree person before entering college. She had a close relationship with members of her family as well as several close friends. She was active in co-curricular activities and did well in terms of academically. In addition, she maintained a healthy body weight and had no symptoms of eating disorder or mental health problems. Nadia’s immediate family reports neither history of mental illnesses, nor any history of suicidal or homicidal ideation or attempts in the past and present. Nadia had an insignificant medical history. She was never hospitalized and reported no history of physical, sexual or emotional abuse. Nadia’s eating disorder symptomatology began during the final semester of her first year of college, three years before seeking treatment. Nadia was actively involved in the dance club. She started restricting her caloric intake and exercise excessively in order to be as slim as the other dancers. She expressed concern that certain parts of her body were too fat. Nadia developed amenorrhea approximately 6 months after the onset of these behaviors, and this was still present at the time of treatment. She expressed having features of perfectionism when it came to her dance performance. In addition, she noted frequent symptoms of depression, which included difficulty sleeping, decreased energy, and trouble concentrating. After a humiliating experience during one of her performance, she noted a fear of being judged by others. Upon referral, in accordance to Diagnostic and Statistical Guidance of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000), her Body Mass Index (BMI) was significantly below normal (significantly underweight is presented as BMI ≤ 17.5 kg/m²) at 16.8 kg/m². Nadia noted that her symptoms improved when she went home during the holiday season. She presented for treatment after her friends and family told her was she too skinny and that her eating behavior was not normal. Upon presenting for treatment, the counselor conducted a semi-structured interview to assess multiple domains (history, frequency, severity and type) of Nadia’s eating disorder symptoms, as well as her current functioning in social, academic and family domains. The symptoms supporting Nadia’s Diagnostic and Statistical Guidance of Mental Disorders-IV diagnosis include (a) her refusal to maintain body weight at or above a minimally normal weight for her age and height; (b) her intense fear of gaining weight, even though underweight; (c) a distorted body image; and (d) the absence of more than three consecutive menstrual cycle. Nadia does not engage in binge eating or purging behaviors, placing her in the restricting type. With a well-planned treatment course executed rightly, Nadia’s eating disorder and any associated disorders will be treated successfully.
Wildes, Ringham and Marcus carried out a research in 2010 which aimed to identify and evaluate the relationship between emotional avoidance in client and eating disorder. 75 patients under the age of seventeen participated in this research. The result of this research has concluded that emotional avoidance causes anxiety symptoms and depression to eating disorder. However the demographics information of the participant raises concerned on the validity as it is not stated in the research.
In 2012, Levinson and Rodebaugh conducted a research identify how five specific domains (social interaction anxiety, social appearance anxiety and fear of scrutiny, positive evaluation and negative evaluation) can be related to eating disorder. 118 undergraduates at Midwestern Metropolitan University participated in this research. The participants were White, Asian, Pacific Islander, Black, Multiracial and Hispanic. Research concluded that social appearance is the leading contribution towards social anxiety and eating disorder. Due to the amount of variables being tested, participant may be confused with the research aim and effect the validity of it. In 2012, Mattar, Thiebaud, Haus, Cebula, and Godart carried out a research to investigate the links between depressive and anxiety symptoms among anorexic patients and nutritional status. The nutritional status of a total of 24 hospitalized women diagnosed with anorexia nervosa was assessed by body mass index (BMI). After follow-up weights and heights at 4-12 years after hospital discharge, a significant improvement was seen in body mass index score, depressive and anxiety symptoms with nutrition rehabilitation. However, future similar studies should use an assessment other than body mass index to indicate nutritional value. Salbach-Andrae, Lenz, Simmendinger, Klinkowski, Lehmkuhl, and Pfeiffer (2007) conducted a study to investigate the comorbid Axis I diagnoses associated with anorexia nervosa. A total of 101 psychiatrically treated female adolescents diagnosed with anorexia participated in this study. Some comorbid Axis I such as mood disorders and obsessive-compulsive disorder were most commonly identified among 73.3 percent of the anorexic patients. One of the limitations was that the sample was all female and largely Caucasian, the results gained may not generalize to other gender, racial and ethnic groups.
Proposal Section The Family-Based Treatment is based on the Maudsley approach which focuses on improving the eating behavior and weight restoration under the parents’ direction (Hurst, Read, & Wallis, 2012). The family is temporarily asked to take this responsibility of re-feeding the client. Once successful, parents return appropriate control to the client. Cognitive Behavior Therapy will be applied to depression, by educating and reinforcing positive behaviors. The treatment involves identifying and challenging negative thoughts, shift focus away from symptoms associated with depression and guided steps returning to a routine of productive activities (Somers & Querée, 2007). Exposure therapy treats social phobia by helping people confront their fears. Out of several variations of exposure therapy, vivo exposure will be used; fear and avoidance can be reduced by allowing the client to experience or come into contact with the feared stimulus in a safe environment (Davis III, Whiting, & May, 2012).
Treatment Planning and Procedure During treatment, Nadia will be given the Eating Disorders Examination Questionnaire (EDE-Q). It has 28 items rated on a 7-point scale, with six reflecting greatest severity and zero none. It is used to assess eating disorders and their associated features and pathology and has been proven to have high reliability and validity, with Cronbach’s alpha score of .95 (Aardoom, Dingemans, Slof Op’t Landt, & Van Furht, 2012). The Beck Depression Inventory-Second Edition (BDI-II), a self-rating 4-point scale (three showing greatest severity and zero lowest), of 21 items that assess cognitive symptoms of depression will be given as well. It has shown high reliability and validity with a Cronbach’s alpha score of .94 in studies (Jakšić, Ivezić, Jokić-Begić, Surányi, & Stojanović-Špehar, 2013). Lastly, the Liebowitz Social Anxiety Scale (LSAS), a clinical interview divided into 2 sets of 24 questions each to assess the range of social interaction and performance situations will be administered. It is rated on a 0-3 Likert-type scale, and also shows high validity and reliability with a Cronbach’s alpha score of .96 (Heimberg et al., 1999). Nadia will undergo a combination of individual and family therapy throughout her treatment process which is estimated to end in two years. Nadia’s counseling session will be done once a week and gradually decreases before termination. Nadia’s treatment process will be done phase by phase. Starting off with the first phase, where counselor introduce the inform consent to Nadia and explain to her the process. In the first phase, the counselor takes down Nadia’s background history and tries to understand and get to know Nadia better. Besides that, the counselor will establish a helper-needing help relationship by rapport building. For this phase it is estimated to take up to four counseling session and it focuses on process goal. The second phase on Nadia’s counseling session will be focus on family therapy in treating her anorexia nervosa. This phase will be focus on having Nadia’s families keep track and guiding her into having a proper meal. This phase also encourages Nadia to open up to her family and to boost her confidences level. This will allow the counselor to pass the message that she is not alone. In this phase, both Nadia and her family will be given a task. Nadia will be asked to do a food journal, whereas her family will have to contact Nadia daily on her eating habits. Family therapy will be done twice a month; this phase is estimated to last for 40 counseling sessions (six month). During the first session in phase two, an Eating Disorder Examination questionnaire (EDE-Q) will be given; and in order for the counselor to identify her progress, the same questionnaire will be given during her 14th counseling session for comparison purposes. Base on Nadia’s improvement, her family will be advised to gradually reduce the amount of calls. In order to proceed to the third phase, the counselor must ensure that Nadia has made progress from previous phase. In this phase, Nadia’s treatment will be focusing on treating major depressive disorder and social anxiety by using cognitive behavioral technique and exposure therapy respectively. Cognitive behavioral technique is used mainly to change Nadia’s thoughts and behavior (Blenkiron, 2013). Before cognitive behavioral technique is carried out, Nadia will be assessed by Beck’s Depression Inventory-Second Edition (BDI-II) and Liebowitz Social Anxiety Scale (LSAS). Along the way as Nadia progresses, the counselor will introduce a new technique which is the exposure therapy, where the counselor will expose her to the society by getting her involve in college activities. This phases is estimated to last for 40 counseling session, Nadia will be reassess on the 20th counseling session on both of the assessment. As Nadia improves from her initial condition, the counselor will gradually reduce her counseling session. Once Nadia reaches her final phase of the helper-needing help relationship, her counseling session will be reduced to once a month. This is to ensure that Nadia is capable in adapting on her own instead of relying on the counselor. In this phase Nadia will be asses on EDE-Q once more to assure Nadia’s progress. Once her progress is determine Nadia will be brief on her termination.
Discussion
By the end of the helping process, Nadia should have a healthy eating habit and normal weight, as well as a positive, cheerful attitude and the confidence to face others. Another alternative in treating Nadia’s eating disorder is by using cognitive affective therapy. According to Rawal, Williams, and Park, the counselor could apply the framework of eating disorder psychopathology and manipulate the mode of self-focus prior to exposure to a stressor (Shafran, Teachman, Kerry, & Rachman, 1999).
References
Aardoom, J. J., Dingemans, A. E., Slof Op’t Landt, M. C. T., & Van Furth, E. F. (2012). Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q). Eating Behaviors, 13(4), 305-309. doi: 10.1016/j.eatbeh.2012.09.002
American Psychiatric Association. (2000). Anorexia Nervosa. Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., 583-589). Washington DC: American Psychiatric Association.
American Psychiatric Association. (2000). Eating Disorder. In Diagnostic and Statistical Manual of Mental Disorder IV (IV ed., pp. 583-589). Washington DC: American Psychiatric Association.
American Psychiatric Association. (2000). Social Phobia (Social Anxiety Disorder). In A. P. Association, Diagnostic and Statistical Manual of Mental Disorders IV (Vol. IV, pp. 450- 456). Washington DC: American Psychiatric Association.
Anorexia Nervosa. (n.d.). Retrieved from The Ohio State University Wexner Medical Center: http://medicalcenter.osu.edu/patientcare/healthcare_services/mental_health/mental_health _about/eating/anorexia_nervosa/Pages/index.aspx
Blenkiron, D. P. (2013, July). Cognitive Behavioural Therapy. Retrieved from RCPsych Public Education Editorial Board: http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/cbt.aspx
Davis III, T. E., Whiting, S. E., May, A. C. (2012). Exposure Therapy for anxiety disorders in children. In Neudeck, P., & Wittchen, H.-U (Edss), Exposure Therapy: Rethinking the Model – Refining the Method (pp.111-125). New York, NY: Springer.
Hagman, J., Gralla, J., Sigel, E., Swan, E., Dodge, M., Gardner, R., Wamboldt, M.
Z. (2011, August 5). A double-blind placebo controlled study of risperidone for the treatment of adolescents and young adults with anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 50(9), 915-924. doi:10.1016/j.jaac.2011.06.009
Hamel, A. E., Zaitsoff, S. L., Taylor, A., Menna, R., & Grange, D. L. (2012, September). Body- Related Social Comparison and Disordered Eating among Adolescent Females with an Eating Disorder, Depressive Disorder and Healthy Controls. Nutrients, 4(9), 1260-1272. doi:10.3390/nu4091260
Harvey Simon, D. Z. (2013, August 3rd). Health Guide; Anorexia Nervosa. Retrieved from The New York Times: http://health.nytimes.com/health/guides/disease/anorexia-nervosa/risk- factors.html
Hedman, E., Strom, P., Stunkel, A., & Mortberg, E. (2013, April 19). Shame and Guilt in Social Anxiety Disorder. PLoS One, 8(4), e61713. doi:10.1371/journal.pone.0061713
Heimberg, R. G., Horner, K. J., Juster, H. R., Safren, S. A., Brown, E. J., Schneier, F. R., & Liebowitz, M. R. (1999). Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine, 29, 199-212. Retrieved
from http://www.temple.edu/phobia/int/Publications/2000%20and%20before%5C/144- %20Heimberg%20et%20al%20Psychological%20Medicine%20LSAS%20Psychometrics %201999.pdf
Hurst, K., Read, S., & Wallis, A. (2012). Anorexia Nervosa in adolescence and Maudsley Family-Based Treatment. Journal of Counseling and Development, 90(3), 339-345. doi: 10.1002/j.1556-6676.2012.00042.x
Jakšić, N., Ivezić, E., Jokić-Begić, N., Surányi, Z., & Stojanović-Špehar, S. (2013). Factorial and diagnostic validity of the Beck Depression Inventory-II (BDI-II) in Croatian primary health care. Journal of Clinical Psychology in Medical Settings, 20(3), 311-322. doi: 10.1007/s10880-013-9363-2
Levinson, A. C., & Rodebaugh, L. T. (2012, January). Social anxiety and eating disorder comorbidity: The role of negative social evaluation fears. Eating Behavior, 13(1), 27-35. doi: 10.1016/j.eatbeh.2011.11.006
Mattar, L., Thie´baud M.-R., Huas, C., Cebula, C., & Godart, N. (2012). Depression, anxiety and obsessive-compulsive symptoms in relation to nutritional status and outcome in severe anorexia nervosa. Psychiatry Research, 200(2), 513-517. doi:10.1016/j.psychres.2012.04.032
Mental Health Information & Organizations. (n.d.). The Numbers Count: Mental Disordeers in America. Retrieved September 24, 2013, from National Institute of Mental Health: http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in- america/index.shtml
Rawal, A., Williams, J. M., & Park, J. R. (2011, October). Effects of analytical and experiential self-focus on stress-induced cognitive reactivity in eating disorder psychopathology. Behavioral Research and Therapy, 49(10), 635-345. doi: 10.1016/j.brat.2011.06.011
Salbach-Andrea, H., Lenz, K., Simmendinger, N., Klinkowski, N., Lehmkuhl, U., Pfeiffer, E. (2008). Psychiatric comorbidities among female adolescents with Anorexia Nervosa. Child Psychiatry and Human Development, 39(3), 261-272. doi: 10.1007/s10578-007-0086-1
Somers, J., Querée, M. (2007). What is Cognitive Behavioural Therapy (CBT)?. In Cognitive Behavioural Therapy: Core Information Document (chapter 2). Retrieved from http://www.health.gov.bc.ca/library/publications/year/2007/MHA_CognitiveBehavioural Therapy.pdf
Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012, March 17). Depression in adolensence. Lancet, 379(9820), 1056-1067. doi:10.1016/S0140-6736(11)60871-4
Wildes, E. J., Righam, M. R., & Marcus, D. M. (2010, July). Emotion Avoidance in Patients with Anorexia Nervosa: Initial Test of a Functional Model. The international Journal of Eating Disorders, 43(5), 398-404. doi:10.1002/eat.20730
Appendix A
Eating Disorder Examination Questionnaire (EDE-Q)
Appendix B
Beck Depression Inventory-II (BDI-II)
Scoring the Beck Depression Inventory
After you have completed the questionnaire, add up the score for each of the 21 questions. The following table indicates the relationship between total score and level of depression according to the Beck Depression Inventory.
Classification
Total Score
Level of Depression
Low
1-10
Normal ups and downs
11-16
Mild mood disturbance
Moderate
17-20
Borderline clinical depression
21-30
Moderate depression
Significant
31-40
Severe depression
Over 40
Extreme depression
Appendix C
Liebowitz Social Anxiety Scale (LSAS)
Treatment of Anorexia Nervosa Anorexia Nervosa, a type of eating disorder common among young ladies as stated in The New York Times Health Guide. According to Ohio State University Wexner Medical Centre, more than 90 percent people in the United State diagnosed with Anorexia Nervosa were female. It can be categorized as refusal to maintain a minimal body weight, fear in weight gain, body image distortion and loss of menses as mentioned in the Journal of the American Academy of Child and Adolescent Psychiatry (Hagman, et al., 2011). Those diagnosed with anorexia nervosa usually avoid eating. Their perception on body shape and weight differs from others. They may be underweight to society; …show more content…
however, to them they are always fat. To reach their ideal body shape and weight, anorexic client will follow a strict diet and exercise excessively.
According to Diagnostic and Statistical Manual of Mental Disorder, there are two subtypes of anorexia nervosa; restricting type and binge-eating/purging type (American Psychiatric Association , 2000). Client under the category of restricting type usually stick with a strict diet where they only consume food with low calorie level. They exercise excessively and at times fast; whereas for binge-eating/purging client, they usually induce themselves in vomiting and misuse of laxatives.
Humans have the tendency to assess their personal characteristics and abilities by comparing themselves to others (Hamel, Zaitsoff, Taylor, Menna , & Grange, 2012). Clients compare by looking and perceiving themselves as fat and ugly resulting in social anxiety and causes depression. Social anxiety is the fear in facing others where the client themselves think and feel that they will be embarrass (Hedman, Strom, Stunkel, & Mortberg, 2013). Anorexic client faces social anxiety due to having the perception that others will look at their large distorted figure and might laugh at it.
On the other hand, depression is defined as a cluster of specific symptoms with associated impairment as stated in the journal article, “Depression in Adolescence” which also stated that depression is notably in girls after puberty; it causes one to feel sad and down on nearly everything surrounding them including themselves (Thapar, Collishaw, Pine, & Thapar, 2012). Anorexia nervosa client usually diagnosed with depression, as they are upset and unsatisfied with their look. There are many kinds of depression; one of it is major depressive disorder. An estimated 26.2 percent of Americans age 18 and above are diagnose with major depressive disorder which made up to one out of four adults (Mental Health Information & Organizations, n.d.). The client, “Nadia” was a 19-year-old female college student working her way towards a bachelor degree. She resided in an apartment that is within walking distance to her college and is only able to visit her immediate family whenever there is at least a 3-day break. Nadia had a close relationship with her younger sister whom she grew up with. Her transition to college was tough as Nadia not only had to leave her sister but her close friends as well. She spent the majority of her time studying, socializing with her peers, exercising, and trying out the various clubs in her college. Nadia described herself as a cheerful and carefree person before entering college. She had a close relationship with members of her family as well as several close friends. She was active in co-curricular activities and did well in terms of academically. In addition, she maintained a healthy body weight and had no symptoms of eating disorder or mental health problems. Nadia’s immediate family reports neither history of mental illnesses, nor any history of suicidal or homicidal ideation or attempts in the past and present. Nadia had an insignificant medical history. She was never hospitalized and reported no history of physical, sexual or emotional abuse. Nadia’s eating disorder symptomatology began during the final semester of her first year of college, three years before seeking treatment. Nadia was actively involved in the dance club. She started restricting her caloric intake and exercise excessively in order to be as slim as the other dancers. She expressed concern that certain parts of her body were too fat. Nadia developed amenorrhea approximately 6 months after the onset of these behaviors, and this was still present at the time of treatment. She expressed having features of perfectionism when it came to her dance performance. In addition, she noted frequent symptoms of depression, which included difficulty sleeping, decreased energy, and trouble concentrating. After a humiliating experience during one of her performance, she noted a fear of being judged by others. Upon referral, in accordance to Diagnostic and Statistical Guidance of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000), her Body Mass Index (BMI) was significantly below normal (significantly underweight is presented as BMI ≤ 17.5 kg/m²) at 16.8 kg/m². Nadia noted that her symptoms improved when she went home during the holiday season. She presented for treatment after her friends and family told her was she too skinny and that her eating behavior was not normal. Upon presenting for treatment, the counselor conducted a semi-structured interview to assess multiple domains (history, frequency, severity and type) of Nadia’s eating disorder symptoms, as well as her current functioning in social, academic and family domains. The symptoms supporting Nadia’s Diagnostic and Statistical Guidance of Mental Disorders-IV diagnosis include (a) her refusal to maintain body weight at or above a minimally normal weight for her age and height; (b) her intense fear of gaining weight, even though underweight; (c) a distorted body image; and (d) the absence of more than three consecutive menstrual cycle. Nadia does not engage in binge eating or purging behaviors, placing her in the restricting type. With a well-planned treatment course executed rightly, Nadia’s eating disorder and any associated disorders will be treated successfully.
Wildes, Ringham and Marcus carried out a research in 2010 which aimed to identify and evaluate the relationship between emotional avoidance in client and eating disorder. 75 patients under the age of seventeen participated in this research. The result of this research has concluded that emotional avoidance causes anxiety symptoms and depression to eating disorder. However the demographics information of the participant raises concerned on the validity as it is not stated in the research.
In 2012, Levinson and Rodebaugh conducted a research identify how five specific domains (social interaction anxiety, social appearance anxiety and fear of scrutiny, positive evaluation and negative evaluation) can be related to eating disorder. 118 undergraduates at Midwestern Metropolitan University participated in this research. The participants were White, Asian, Pacific Islander, Black, Multiracial and Hispanic. Research concluded that social appearance is the leading contribution towards social anxiety and eating disorder. Due to the amount of variables being tested, participant may be confused with the research aim and effect the validity of it. In 2012, Mattar, Thiebaud, Haus, Cebula, and Godart carried out a research to investigate the links between depressive and anxiety symptoms among anorexic patients and nutritional status. The nutritional status of a total of 24 hospitalized women diagnosed with anorexia nervosa was assessed by body mass index (BMI). After follow-up weights and heights at 4-12 years after hospital discharge, a significant improvement was seen in body mass index score, depressive and anxiety symptoms with nutrition rehabilitation. However, future similar studies should use an assessment other than body mass index to indicate nutritional value. Salbach-Andrae, Lenz, Simmendinger, Klinkowski, Lehmkuhl, and Pfeiffer (2007) conducted a study to investigate the comorbid Axis I diagnoses associated with anorexia nervosa. A total of 101 psychiatrically treated female adolescents diagnosed with anorexia participated in this study. Some comorbid Axis I such as mood disorders and obsessive-compulsive disorder were most commonly identified among 73.3 percent of the anorexic patients. One of the limitations was that the sample was all female and largely Caucasian, the results gained may not generalize to other gender, racial and ethnic groups.
Proposal Section The Family-Based Treatment is based on the Maudsley approach which focuses on improving the eating behavior and weight restoration under the parents’ direction (Hurst, Read, & Wallis, 2012). The family is temporarily asked to take this responsibility of re-feeding the client. Once successful, parents return appropriate control to the client. Cognitive Behavior Therapy will be applied to depression, by educating and reinforcing positive behaviors. The treatment involves identifying and challenging negative thoughts, shift focus away from symptoms associated with depression and guided steps returning to a routine of productive activities (Somers & Querée, 2007). Exposure therapy treats social phobia by helping people confront their fears. Out of several variations of exposure therapy, vivo exposure will be used; fear and avoidance can be reduced by allowing the client to experience or come into contact with the feared stimulus in a safe environment (Davis III, Whiting, & May, 2012).
Treatment Planning and Procedure During treatment, Nadia will be given the Eating Disorders Examination Questionnaire (EDE-Q). It has 28 items rated on a 7-point scale, with six reflecting greatest severity and zero none. It is used to assess eating disorders and their associated features and pathology and has been proven to have high reliability and validity, with Cronbach’s alpha score of .95 (Aardoom, Dingemans, Slof Op’t Landt, & Van Furht, 2012). The Beck Depression Inventory-Second Edition (BDI-II), a self-rating 4-point scale (three showing greatest severity and zero lowest), of 21 items that assess cognitive symptoms of depression will be given as well. It has shown high reliability and validity with a Cronbach’s alpha score of .94 in studies (Jakšić, Ivezić, Jokić-Begić, Surányi, & Stojanović-Špehar, 2013). Lastly, the Liebowitz Social Anxiety Scale (LSAS), a clinical interview divided into 2 sets of 24 questions each to assess the range of social interaction and performance situations will be administered. It is rated on a 0-3 Likert-type scale, and also shows high validity and reliability with a Cronbach’s alpha score of .96 (Heimberg et al., 1999). Nadia will undergo a combination of individual and family therapy throughout her treatment process which is estimated to end in two years. Nadia’s counseling session will be done once a week and gradually decreases before termination. Nadia’s treatment process will be done phase by phase. Starting off with the first phase, where counselor introduce the inform consent to Nadia and explain to her the process. In the first phase, the counselor takes down Nadia’s background history and tries to understand and get to know Nadia better. Besides that, the counselor will establish a helper-needing help relationship by rapport building. For this phase it is estimated to take up to four counseling session and it focuses on process goal. The second phase on Nadia’s counseling session will be focus on family therapy in treating her anorexia nervosa. This phase will be focus on having Nadia’s families keep track and guiding her into having a proper meal. This phase also encourages Nadia to open up to her family and to boost her confidences level. This will allow the counselor to pass the message that she is not alone. In this phase, both Nadia and her family will be given a task. Nadia will be asked to do a food journal, whereas her family will have to contact Nadia daily on her eating habits. Family therapy will be done twice a month; this phase is estimated to last for 40 counseling sessions (six month). During the first session in phase two, an Eating Disorder Examination questionnaire (EDE-Q) will be given; and in order for the counselor to identify her progress, the same questionnaire will be given during her 14th counseling session for comparison purposes. Base on Nadia’s improvement, her family will be advised to gradually reduce the amount of calls. In order to proceed to the third phase, the counselor must ensure that Nadia has made progress from previous phase. In this phase, Nadia’s treatment will be focusing on treating major depressive disorder and social anxiety by using cognitive behavioral technique and exposure therapy respectively. Cognitive behavioral technique is used mainly to change Nadia’s thoughts and behavior (Blenkiron, 2013). Before cognitive behavioral technique is carried out, Nadia will be assessed by Beck’s Depression Inventory-Second Edition (BDI-II) and Liebowitz Social Anxiety Scale (LSAS). Along the way as Nadia progresses, the counselor will introduce a new technique which is the exposure therapy, where the counselor will expose her to the society by getting her involve in college activities. This phases is estimated to last for 40 counseling session, Nadia will be reassess on the 20th counseling session on both of the assessment. As Nadia improves from her initial condition, the counselor will gradually reduce her counseling session. Once Nadia reaches her final phase of the helper-needing help relationship, her counseling session will be reduced to once a month. This is to ensure that Nadia is capable in adapting on her own instead of relying on the counselor. In this phase Nadia will be asses on EDE-Q once more to assure Nadia’s progress. Once her progress is determine Nadia will be brief on her termination.
Discussion
By the end of the helping process, Nadia should have a healthy eating habit and normal weight, as well as a positive, cheerful attitude and the confidence to face others. Another alternative in treating Nadia’s eating disorder is by using cognitive affective therapy. According to Rawal, Williams, and Park, the counselor could apply the framework of eating disorder psychopathology and manipulate the mode of self-focus prior to exposure to a stressor (Shafran, Teachman, Kerry, & Rachman, 1999).
References
Aardoom, J. J., Dingemans, A. E., Slof Op’t Landt, M. C. T., & Van Furth, E. F. (2012). Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q). Eating Behaviors, 13(4), 305-309. doi: 10.1016/j.eatbeh.2012.09.002
American Psychiatric Association. (2000). Anorexia Nervosa. Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., 583-589). Washington DC: American Psychiatric Association.
American Psychiatric Association. (2000). Eating Disorder. In Diagnostic and Statistical Manual of Mental Disorder IV (IV ed., pp. 583-589). Washington DC: American Psychiatric Association.
American Psychiatric Association. (2000). Social Phobia (Social Anxiety Disorder). In A. P. Association, Diagnostic and Statistical Manual of Mental Disorders IV (Vol. IV, pp. 450- 456). Washington DC: American Psychiatric Association.
Anorexia Nervosa. (n.d.). Retrieved from The Ohio State University Wexner Medical Center: http://medicalcenter.osu.edu/patientcare/healthcare_services/mental_health/mental_health _about/eating/anorexia_nervosa/Pages/index.aspx
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Appendix A
Eating Disorder Examination Questionnaire (EDE-Q)
Appendix B
Beck Depression Inventory-II (BDI-II)
Scoring the Beck Depression Inventory
After you have completed the questionnaire, add up the score for each of the 21 questions. The following table indicates the relationship between total score and level of depression according to the Beck Depression Inventory.
Classification
Total Score
Level of Depression
Low
1-10
Normal ups and downs
11-16
Mild mood disturbance
Moderate
17-20
Borderline clinical depression
21-30
Moderate depression
Significant
31-40
Severe depression
Over 40
Extreme depression
Appendix C
Liebowitz Social Anxiety Scale (LSAS)