Tables in Italics, Figures in Bold
abstinence violation, 99, 101, 104
activity. See exercise
administrative staff, 5
adolescent cognitive behavioral therapy. See child and adolescent cognitive behavioral therapy
agenda
characteristics, 136–8
collaboration, 137
deviation, 138–9
monitoring mood and eating and, 136
setting, 9, 137–9
structure, 136, 137
troubleshooting, 138
alcohol
abuse, 37, 156, 262–4, 336, 410
appropriate levels, 92–3, 430
calorie content, 70, 93, 377, 384, 430
dehydration and, 81
detoxification programs, 263
impulse control and, 77, 92, 93, 430
snacks and, 77 (see also snacks)
alexithymia, 132, 276, 276
amenorrhea. See menustruation: amenorrhea
anemia, 90, 394
analogy use in cognitive behavioral therapy
“anorexic gremlin”, 221–3, 236–8
“concept of prejudice”, 200
“cupboard”, 260
“hub, spoke and rim”, 23
“inviting the eating disorder into the room”, 282, 305
“itchy jumper”, 66–7
“Newton’s cradle”, 267, 268, 275, 280, 303
“river”, 116, 121
“schema as prejudice”, 187
“supermarket”, 157–8
“trek along the coast of South America, A”, 8–9, 341, 343, 347, 348
anorexia nervosa
binge-eating/purging, 36
case formulation, 107–10
categories, 36
complications, 376, 394–7
DBT treatment, 3
DSM-IV criteria, 36
energy levels, 147
pro-anorexia websites and, 143
See also eating disorders; patient(s); treatment of eating disorders
anxiety, 38, 107, 245, 266, 347, 377, 396. See also clinician: anxiety; social anxiety
assessment
aims, 31
of behaviors, 39
of chronic risk, 21
of cognitions, 39
of comorbidity, 37–9
extended, 40
family structure, 38
interview, 31–4
life history, 38
medical, 19, 21, 37
of motivation and goals, 39
of problems and goals, 60–1
of pros and cons of change, 59, 62
symptom profile, 38
of therapy-interfering behaviors (see therapy-interfering behaviors)
of trauma history, 38
of treatment history, 38
of treatment preferences, 39
trouble shooting during, 39–41
See also interviews
asthma, 37
avoidant personality disorder, 256
Axis I pathology, 245–6 (see also anxiety; depression)
Axis II pathology, 241
avoidant personality disorder, 266
cluster B personality disorders, 266
cluster C personality disorders, 266
comorbidity with eating disorders, 266
obsessive compulsive disorder (see obsessive-compulsive disorders)
beauty, societal attitudes towards, 231
Beck Anxiety Inventory, 39, 338
Beck Depression Inventory, 39, 246, 338
Beck Hopelessness Scale, 246
behavioral
change, 14
experiments (see behavioral experiment(s))
therapies, 12
triggers, 280
behavioral experiment(s), 11–12, 167, 170, 172
belief reattribution by, 190
categories, 192–3
cognitive change and, 12, 190
definition of, 190
design, 191
discovery, 191, 192
following case formulation, 112, 190
as homework assignment, 120
purpose, 190
surveys as, 193
bias
cognitive, 155, 233, 236
depressogenic atributional, 248
documenting with diaries, 249
self-serving, 233
binge eating, 69, 99
blood sugar and, 146
DBT treatment for, 3
emotion-driven, 102
food types, 32
frequency, 32
long-term consequences, 100
weight gain with, 151
binge eating disorder (BED), xxiii, 155
bipolar disorder, 246
black and white thinking, 101, 184, 208, 272, 313
bladder function, 397, 399, 403, 405, 406 (see also kidney failure)
body
avoidance, 233–4
checking, 34, 99, 106, 225, 233–4, 250
comparison, 234–5
concept, 34
fat functions and requirements, 230–1 (see also nutrients: fats)
function understanding, 229–30
image (see body image)
percept, 35, 36, 167, 225
physiology, 230
Body Checking Cognitions Scale, 233
Body Checking Questionnaire, 233
body image
acceptance, 226
behavioral experiments and, 233–5
beliefs associated with, 227–9
case formulations, 227–9
definition, 225–6
dissatisfaction, 224
disturbance, 224, 227
exposure, 235–6
imagery, 228, 236–8
monitoring, 232–3
origins, 227
psychoeducation, 229–31
puberty and, 237
self-control and, 224
treatment for dysfunctional, 225–9, 231–8
bone. See osteoporosis
blood pressure, 19
breast
enlargement, 231
feeding, 34, 78, 94
bulimia nervosa
case formulation, 99–105
categories, 36
cognitive-behavioral models, 98
complications, 377, 398–400
DBT treatment, 3
DSM-IV criteria, 36
energy levels and, 147
See also eating disorders; patient(s); treatment of eating disorders
calorie(s)
counting, 81
and food planning, 81–2
requirements, 86
cancer, 71, 91
cardiovascular disease, 17, 19, 21, 71, 80, 152, 395, 398, 401, 403, 405
care plan, 20, 21
case formulation
accuracy, 110–12, 112
aspirational outcomes, 199
bulimia, 99–105
characteristics, 11, 96–8, 101–6, 111–12, 246–9
comorbidity in, 11, 98
complex, 110
emotion-regulation function in, 100
examples, 246–9, 251, 255, 260
feedback, 102
focus, 97, 98, 101
ideal, 97
importance, 11, 96, 200
improvement, 112–13
individualized, 97
interrelated problems in, 110
meta-cognitive awareness and, 96
models, 265
overvalued beliefs in, 199–202
in patient’s terms and expressions, 98
personal control in, 106
problem list and, 110
in restriction-based cases, schema-focused,106–10, 278, 279, 305
transdiagnostic, 98–9
CBT. See cognitive behavioral therapy
child and adolescent cognitive behavioral therapy
agenda setting, 311
assessment, 300, 303
behavioral experiments, 314, 320
case formulation, 306–9
clinician stance, 295, 318–20
cognitive behavioral change in, 309, 310, 314, 320
comorbidity in, 299, 301
confidentiality, 298–9
control issues, 306
ending, 323–8
diagnostic categories, 290–1, 301, 316–8
diaries in, 311, 313
drawings and visualization in, 304, 312–14
DSM-IV criteria, 290
family engagement in, 292–3
flash and cue cards in, 306, 312
homework and, 311
interventions, 306, 309–23
language use in, 297, 311
motivation and, 297, 301, 303–6, 310, 327
multidisciplinarity in, 299–300, 326
non-confrontational approach, 296
physical assessment in, 294–5
psychoeducation and, 306, 312
psychometrics in, 304
‘real world’ re-entry and, 320–1
recovery and relapse management, 321–3
risk and, 301
role-playing, 320
special considerations, 269, 291–300, 304
stages of change model, 268, 303–6
use of other patients and families in, 305
vs. adult CBT, 289, 290, 294, 303, 306, 309–23
weighing and, 312
See also children
children
educational considerations, 293
friendships and peers, 293–4
identity formation, 291
intellectual and emotional capacities, 267, 291
motivation in, 295–6
perfectionism in, 293–4 (see also perfectionism)
starvation effects in, 294 (see also starvation)
See also child and adolescent cognitive behavioral therapy
cholesterol/lipid levels, 19, 394
clinical practice, 3–11 (see also clinician)
clinician
anxiety, 96, 127, 128, 348
balanced working by, 134
“burn out”, 345, 346
curious, 4–6, 46, 219
effectiveness, 126, 132–4
empathy, 62
expectations, 43, 131
food and nutrition knowledge, 68
investment, 46–7
issues with body image, 131
motivation, 131
personal characteristics, 130–1, 134
power differentials and, 131–2
responsibility for change, 9, 11
stance, 4–6, 14, 45–6, 132–3, 295
supervision, 133
tracking of progress, 96
coeliac disease, 94
cognitive behavioral models and theories, 97, 98, 100, 310–11, 339
cognitive behavioral therapy (CBT)
affect regulation and, 33, 45, 253, 263, 267, 270, 271, 290
agenda setting, 9, 137–9
alternatives to, 333
analogy use in (see analogy use in cognitive behavioral therapy)
assessment in (see assessment)
behavioral experiments in (see behavioral experiment(s))
case formulation (see case formulation)
for children and adolescents (see child and adolescent cognitive behavioral therapy)
cognitive restructuring in, 183
comorbidity and, 245
continuum thinking in (see continuum thinking)
day-patient, 15, 249, 263
delivery of, 15
dimensional approaches to, 184–6
effectiveness in eating disorders, 3
elements, 4, 34–5
evidence and, 3–4, 206–8
expectations, 25–6
evaluation, 14
failure, 20, 25, 113, 326–8, 333
flexibility in, 159
formulation in (see case formulation)
goal setting in, 10–11
group, 15
homework in, 9, 43, 113
in-patient, 15
motivation and (see motivation)
cognitive behavioral therapy: non-negotiables in, 40, 41, 43, 127, 162, 297
patient role in, 4, 9, 44–5 (see also patient(s))
preparation for, 16, 48
problems and goals technique, 56
protocols, 13
psychoeducation, 140
schema-focused (SFCBT) (see schema-focused cognitive behavioral therapy)
setbacks, 113
Socratic questioning in (see Socratic methodology)
stages (see stages of cognitive behavioral therapy)
supervisory format and, 133
termination, 16, 22–3
thought levels in, 179
transdiagnostic approaches in, 6–7, 101
transparent nature of, 121
treatment (see treatment of eating disorders)
trouble-shooting in, 25–6
weighing during (see weighing)
cognitive dissonance, 201
cognitive-emotional-behavioral therapy (CEBT), 270–3, 272, 305
cognitive levels, 198
cognitive restructuring, 183, 206–13
of body image, 232–3
comorbidity with obsessive-compulsive disorders, 250–2
depression and, 248
evidence evaluation in, 206–8
collaborative working relationships, 5–6, 23. See also multidisciplinary working environment
community mental health professionals, 23
comprehensive validation, 46, 49, 277, 290
compulsive behavior. See obsessive-compulsive disorders
comorbidity
CBT expectations and, 26
case formulation and, 11, 98
diversity, 13
impulsive behavior, 37
self-harm, 37 (see also self-harm)
substantial, 14
See also obesity: comorbidity with eating disorders
constipation, 78, 394, 399, 404, 406
continuum thinking, 10, 184, 204, 205, 208, 210,232, 272, 313
contraception, 34
convulsions, 398, 401, 403
coping mechanisms, 9, 254–7, 260
cystic fibrosis, 94
dehydration, 79, 80, 398, 401, 405
dental problems, 22, 337, 398, 402
Department of Health (UK), 91, 407
depression, 38, 124, 246–9, 390
antidepressant medication for, 248
assessment, 246
behavioral experiments for, 36, 249
case formulation in, 246–7
cognitive restructuring and, 248–9
comorbidity with eating disorders, 246
treatment, 247–8
diabetes, 19, 91, 93, 94
diagnosis
criteria, 7, 36
DSM-IV, 36
of eating disorders, 36
role in CBT, 7
dialectical behavior therapy (DBT), 266–9, 291–300
comprehensive validation, 269
mindfulness skills, 269
reduction of dissociation, 269
diarrhea, 78, 384, 399, 403, 412, 429
diet
Atkins, 141, 417
changes, 83–5
content, 84–5 (see also nutrients; nutrition)
fad, 417
failure, 377, 416–17
feelings towards, 416
improvement, 82–5
patient rules and, 99, 101
pills, 33
unbalanced, 410
dietitians, 5, 23, 69, 93, 126, 128
dissociative features, 38
diuretics, 17, 33, 377, 401, 405, 406, 413
domestic violence, 346
downward arrowing, 49, 199
clinician empathy in, 179
definition, 179
procedure for, 180, 183
trouble-shooting in, 182
draining, 49, 101, 107, 297
drug abuse, 37, 156, 262, 263, 336
dysphagia, 277, 290, 398
eating
continuum of, 159
improvement of, 141, 276, 376
overevaluation of (see overevaluation)
restrictive, 52, 57, 85, 158, 197, 290 (see also anorexia nervosa)
eating disorders
chronic history of, 221
cognitive elements of, 11
compensatory behavior in, 36
diagnosis, 6, 36
ego-syntonic nature of, 44, 50, 61, 128, 129, 198, 222, 344
emotion-regulation function in, 98, 100–1
food role in, 68–9 (see also food)
functional avoidance in, 45
health consequences (see medical risk factors in eating disorders)
historical approach to, 6
long-term course of, 132
mortality, 16
not otherwise specified (see eating disorders not otherwise specified)
obesity and, 88
perpetuating factors, 141
physical factors, 45, 126–8
positive reinforcement of, 44
pros and cons of change in, 59–60, 62
psychological factors in, 45, 396
relinquishing, 64–6
risk assessment in, 17 (see also risk assessment in eating disorder treatment)
services, 325–6, 338, 344
social factors in, 44
treatment (see treatment of eating disorders)
triggers, 156 (see also behavioral: triggers)
vegetarianism/veganism and, 88–90
See also anorexia nervosa; binge eating; bulimia nervosa; eating; restrictive; hunger
Eating Disorder Examination Questionnaire, 39, 338
eating disorders not otherwise specified (EDNOS)
atypical bulimia nervosa, purging subtype, 102
binge eating, 37
classification, 6, 339
DSM-IV criteria for, 37
normal weight purging behavior, 165
eating patterns
normal, 71, 74, 149, 377, 381, 424
regular, 8, 379–80
timing of eating and, 84
electrolytes, 126, 152, 401, 403, 405
emotion
acceptability, 270
anxiety (see anxiety)
avoidance of, 100, 132, 275, 276
awareness of, 271, 273
beliefs about, 269
changes due to low weight, 145
mislabeling, 233
monitoring, 273
numbing of, 106, 109, 245, 336
positive functions of, 271–2
primary, 270, 272
regulation, 264, 267–9
secondary, 270–2
enema, 36
energy graph, 145–50
function of, 145
joint construction with patient, 145
and normal energy supply, 148–50
patient eating patterns and, 148
patient preparation for, 146–8
exercise, 407–8
assessment, 91
classes, 91
compulsive, 91–2, 276, 407
energy requirements, 91
excessive, 33, 36, 91–2, 156, 336, 407–9
healthy levels of, 91, 377, 407
inadequate, 71, 86
motivation for, 91
recording of, 33
eye problems, 399, 402
families, 292–3. See also child and adolescent cognitive behavioral therapy
fasting, 36, 45, 85
Fear of Negative Evaluation Scale, 254
flashcards, 61, 281, 282, 305
flatulence, 78
‘flight into health’, 343, 344
fluid intake
excessive, 80, 401
inadequate, 79, 81, 398, 401, 405
measurement
misconceptions, 80
normal, 79–81, 384, 404
thirst and, 79, 384
food
allergies, 32, 94
‘banned’, 101
calcium-rich, 77–8
calorie content, 81–2, 83
composition (see nutrition)
dairy, 78, 409
desserts/fun, 70, 79
diaries (see food diaries)
in eating disorders, 68–9, 312, 378
eating of previously avoided, 8
fruits and vegetables, 78–9, 377
grading, 386
groups, 72–3, 385
monitoring, 120
planning, 81–2, 150
portion sizes, 84
preferences, 32
psychoeducation on, 94
rituals, 32
snacks (see snacks)
supplement drinks, 87
See also meal(s); nutrients
food avoidance emotional disorder (FAED), 290
food diaries
eating disorder treatment and, 25, 32, 154, 156, 342, 350
form, 155–7
limitations, 160–1
monitoring, 159–60
purpose, 154–5, 159
ready made, 155
non-completion of, 157–8
review with patient, 158–9
‘supermarket’ analogy and, 157–8
termination, 160
formulation. See case formulation
gastric
bloating, 78, 402
dilatation, 90, 398
emptying, delayed, 69, 78
glucose
levels, 19, 77
tolerance, 19
Guide to Medical Risk Assessment for Eating Disorders, A, 17
guided self-help, 15, 247
heart disease. See cardiovascular disease
height measurement, 25, 33–4
HIV/AIDS, 94
homework
assigning, 120
audiotape review as, 121–2
concerns surrounding, 123
guidelines, 122–4
in-session practice for, 123
instructions, 123
non-compliance with, 124–5
purpose, 120, 122–3
self-evaluation pie charts and (see self-evaluation pie charts)
success in CBT and, 120
summarizing, 123–4
typical assignments, 120
hospital admissions, 127
hunger
control, 84, 383
eating disorders and, 382
emotional, 68, 69, 382
physical, 68, 69, 382
recognition, 69, 379, 382
Huntingdon’s disease, 94
hypertension, 19
Impact of Events Scale, 258
impulsive behaviors, 262–3
inflammatory bowel disorders, 94
in-patient care, 15, 23, 263
interventions
CEBT-ED and, 271
goals of, 62, 64, 278
matched to patient, 49
psychodynamic, 24
SFCBT, 246–9, 278–9
interviews
assessment and, 31–4, 50
demographic information and, 32
eating behaviors and, 32–3
semi-structured protocol for, 31, 376
ketoacidosis, 37
kidney failure, 80, 403, 405, 406 (see also bladder function)
laxatives
eating disorders and, 33, 101, 156, 377, 398–400, 403–4, 412
calorie absorption and, 100, 412
injurious effects of, 17
mechanism of, 403, 412
weight gain and, 36, 152
lipid levels, 19
liposuction, 231
logs
positive data, 187–9, 280–2
prediction, 217
See also food diaries
meal(s), 76
breakfast, 76, 85
dietetic input on, 93–4
dinner, 76
structure, 76, 84
See also food; nutrients
medical practitioners, 16, 21, 23, 126
medical risk factors in eating disorders, 17, 22, 126–8, 126–8, 141, 376–7, 387
blood in vomit, 17
dehydration, 17
disruption of eating habits, 17
excessive exercise, 17
inadequate fluid intake, 17
management, 349
monitoring, 17–18, 22–3
esophageal/gastric tears, 17
psychological, 17
rapid weight loss, 17, 19–20
medical safety in cognitive behavioral therapy, 16–21, 127
medical tests
blood counts, 18, 20, 21, 127, 394
blood pressure, 18
electrocardiogram (ECG), 18, 20, 21
electrolytes, 126, 152, 401, 403, 405
erythrocyte sedimentation rate (ESR), 18
liver, 18
phosphate, 18
SUSS, 18
thyroid stimulation hormone (TSH), 18
urea and electrolytes, 18, 85
menopause, 34
menstruation
amenorrhea, 22, 36, 394, 408, 409
eating habits and, 145
fertility and, 394
history, 34
premenstrual syndrome (PMS), 377, 419–20
resumption, 337
metabolism and metabolic rate, 86, 91, 152, 171, 172, 377, 380, 391, 422
Minnesota experiment on starvation, 88, 388–92
‘miracle’ question, 50–6, 52, 58
Morgan-Russell scales, 334
motivation
assessment, 50–5
CBT expectations and, 26
changes in, 55
collaboration and, 46
diversity/fluctuation in, 13, 50–5, 61
eating and, 68
enhancement, 46, 55–61
friend or foe letters and, 56–7, 57–63, 278, 305
for homework, 124 (see also homework)
learning and, 46
level, 47
passivity and, 46
pros and cons lists, 50–1, 232–3, 279
self-acceptance and, 46
trouble-shooting, 61–7
multidisciplinary working environment
in child and adolescent CBT, 299–300
clinical decisions in, 24
collaborative working relationships, 5–6, 23, 126, 127, 133–4
‘hub, spoke and rim’ model, 23
multiimpulsivity, 14, 262–3
assessment, 263–4
case formulation for, 264
characteristics, 263
risks, 263
treatment, 264–5
See also obsessive-compulsive disorders
multiple sclerosis, 94
muscle
dysfunction, 21, 397, 401, 403, 405
strength testing, 20–1
narcissism, 266
National Institute for Clinical Excellence, 85, 88, 299, 344, 345
negative automatic thoughts, 122, 181, 183–5, 198, 248, 249, 263, 264, 268, 280, 303–6
neurodegenerative disorders, 94
nurses, 5, 126
nutrients
carbohydrates, 70, 71, 84, 145, 147, 377, 426
core, 70
daily requirements, 77, 141, 377
dietary fiber, 70, 71
fats, 70, 70, 71, 84, 377, 427–8
fruits and vegetables, 377, 429
health risks and, 71
healthy diet and, 70
minerals, 70, 90–1
protein, 70, 84, 377, 425
supplements, 78, 85, 90–1
vitamins, 70, 85, 429
water, 70
See also food; meal(s); nutrition
nutrition, 69–71
Balance of Good Health (UK) and, 70
junk/luxury/fun foods and, 70, 79
misuse, 71
principles, 76
standard meal structure and, 71
therapy, 416
See also food; meal(s); nutrients
obesity
comorbidity with eating disorders, 18, 87–8, 226, 344–5
diseases related to, 22, 71
management, 344
services, 88
weight loss and, 88
obsessive-compulsive disorders (OCDs)
assessment, 250
behavioral experiments, 253
case formulation for, 250
comorbidity with eating disorders, 32, 38, 245, 249–50, 266, 276, 336
services, 344
treatment, 250–3
occupational therapists, 5, 326
osteoporosis, 22, 344, 344, 377, 377, 396, 409–10
ovarian ultrasound, 337
overdose, 37 (see also alcohol: abuse; drug abuse)
overevaluation
alerting patient to, 202–5
behavioral experiments for, 205, 213–14, 220, 221
in case formulation, 199–202
cognitive restructuring for, 205–13
continuum thinking and, 208 (see also continuum thinking)
as diagnostic for eating disorders, 197
domain choice and, 203
of eating, 102, 202
self-evaluation pie charts and, 202, 203, 205 (see also homework; self-esteem and self worth: self-evaluation pie charts and)
of shape and weight, 225
surveys and, 211–13
treatment of, 205–6
patient(s)
anxiety (see anxiety)
approval seeking, 132
belief system, 198, 199, 211
body image (see body image)
concerns, 35, 36, 45, 59–60, 347
dietary rules, 101
diversity, 13
emotions (see anxiety; emotion)
engagement in treatment, 13, 49, 66–7, 114, 333
expectations, 44–5, 62, 226, 343
experiences, 45, 46, 62, 275
future, view, 58–60
investment, 46–7
life plans, 57–8, 272, 305
manipulation by, 130
mood swings, 107
motivation (see motivation)
multiple eating disorders in, 6, 49
perceptions, 129 (see also body: percept)
personal characteristics, 130–1
potential for change, 55
pregnant, 24, 34, 93, 94
problems and goals, 60–1
relation to clinician, 132
relinquishing eating disorder, 64–6
resources, 49
safety, 40, 172
secrecy, 320
self-directed prejudice in, 200
self-evaluation systems, 232
‘special’, 130
as therapist, 9, 55, 172, 347
therapy, failure of, 26, 333
treatment preferences, 3
perfectionism, 38, 100, 108, 249, 275, 293–4, 313
personality disorders, xxiii, 14, 38, 126, 246. See also Axis II pathology; obsessive-compulsive disorders
physical
disability, 94
exams, 19
monitoring, 20
positive data logs, 187–9
Posttraumatic Cognitions Inventory, 258
Posttraumatic Diagnostic Scale, 258
posttraumatic stress disorder (PTSD)
assessment, 258
behavioral experiments for, 260
case formulation in, 258–9
CBT and, 260
cognitive restructuring and, 261
comorbidity with eating disorders, 38, 258–62, 260
‘cupboard metaphor’ and, 260
imagery rescripting for, 260, 261, 283
safety behaviors and, 260
symptoms, 258
traumatic events and, 259, 261
treatment, 259
prediction log, 217
pregnancy, 24, 34, 93, 94
psychoeducation
cognitive behavioral therapy and, 140
description, 140
dietetic, 94
effectiveness, 140, 142–3
examples, 142
history, 140
internet use in, 143, 252
key topics, 143
leaflets, 70, 376
myths and, 150–3
resources, 376
uses for, 141,142
psychologists, 5, 126 (see also clinician)
psychosexual function, 34. See also menstruation
psychotherapists, 5
purging, 17, 100, 377, 412–13. See also bulimia nervosa
recovery
absence of behaviors and, 335
agents of change in, 341–3
approaches to, 341, 346
categories, 343
criteria, 334, 336, 338–9, 349
emotional factors in, 335–6
goals during, 336, 338
healthy eating plan during, 350
mood during, 335
patient’s perspective on, 343
physical factors in, 337
pseudo- 339, 340, 344
responsibility for change in, 342
social factors in, 337
stable body mass index and, 335
stages of change and, 339
transcendence in, 339, 340
See also relapse; treatment of eating disorders
relapse
management, 173, 309, 321–3, 343
prevention, 48, 283–4, 321, 347, 349–50
risk factors, 198, 340, 349–50
tools and exercises, 350
See also recovery; treatment of eating disorders
restrictive eating, 52, 57, 85, 158, 197, 290 (see also anorexia nervosa)
risk assessment in eating disorder treatment, 22, 38
baseline test, 18 (see also medical tests)
chronic, 21
initial, 18
insight/capacity, 17
medical (see medical risk factors in eating disorders)
motivation, 17
psychosocial, 17
risk in eating disorders. See medical risk factors in eating disorders
Rosenberg Self-Esteem Scale, 246
Royal College of Psychiatrists (UK), 85
safety, medical, 16–21, 127
schema-focused cognitive behavioral therapy (SFCBT)
assessment, 263, 274
attribution and, 278
case formulation in, 273–8
cognitive content in, 275–7
core beliefs and, 267, 275, 277, 280, 283
diaries and data logs in, 280–2 (see also logs)
flashcard use, 280–1
historical review in, 279–80
imagery rescripting, 283
intervention and, 278–9
Newton’s cradle analogy and, 267, 275, 280, 303
preparation for, 273–4
relapse prevention, 283–4
residual eating issues and, 283
schema avoidance and, 276
schema compensation and, 275
schema dialogue and, 282
therapy records in, 280
self-esteem and self-worth
assessment, 246
case formulation in, 246–7
cognitive restructuring and, 248–9
comorbidity with eating disorders, 38, 245, 320
dysfunctional, 99, 197, 246–9
self-evaluation pie charts and, 202–5, 203, 205, 281, 305, 335, 349 (see also homework)
self-harm
burning, 37, 262
cutting, 16, 37, 262
eating disorders and, 126, 248, 276
for emotional regulation, 262
hair pulling, 38
hitting, 37, 262
overdosing, 37 (see also alcohol: abuse; drug abuse)
sexual disinhibition, 37, 262
skin picking, 38
spending, compulsive, 37, 262
stealing, 37, 262
suicide, 248
self-evaluation pie charts. See overevaluation: self-evaluation pie charts and
sexual abuse, 34, 237, 346
smoking, 19, 410
snacks
forms, 77
use in eating disorders, 76–7, 381
weight gain and, 77
social anxiety
assessment, 254
case formulation for, 254–5
comorbidity with eating disorders, 253–7, 266
negative images and, 255
safety behaviors for, 254–7
self-focused attention and, 255
treatment, 256–7
social isolation, 106, 107, 253–7
Social Phobia and Anxiety Inventory, 254
Socratic methodology, 10, 46, 63, 65, 94, 98, 155, 177, 183, 188, 199–201, 203, 204, 206, 209, 211, 213, 229, 232, 233, 247, 249, 278, 280, 318–20, 334, 349
engagement with, 177
general questions, 177–8
principles, 177
probe questions, 178
reflections, 178
stages of cognitive behavioral therapy
assessment, 13
central targets, 14
comorbidity, 14
description, 13–14
dietary structure, 14
endings, 14, 345–8
engagement, 13
explanation, 13
formulation, 13
ineffectiveness, 14
model (see stages of change model)
motivation enhancement, 13
planning, 13, 20, 24 (see also care plan)
psychoeducation, 13
relapse prevention, 14
weight gain and stabilization, 14
stages of change model
action, 48, 50, 340, 342
application of, 48, 339–40
contemplation, 48, 66, 339, 342
maintenance, 48
precontemplation, 47–8, 339
preparation, 16, 48, 340
transition between stages in, 48
young persons and, 268, 303
starvation
and anorexia reinforcement, 107
attitudes towards eating and, 144, 393
in children, 294
cognitive function impairment during, 107, 144, 391, 393
Minnesota experiment on, 88, 388–92
muscle breakdown during, 19
physical effects, 69, 126, 144, 376, 388–93
psychological effects, 143–5, 376, 388–93
social withdrawal during, 107, 144, 390–1, 393
steroids, 37
Structured Clinical Interview for DSM-IV, 254
sun tanning, 231
SUSS test, 20–1
Symmetry, Ordering and Arranging Questionnaire (SOAQ), 250
teeth. See dental problems
Testable Assumptions Questionnaire, 338
tests, medical. See medical tests
therapist. See clinician
therapy-interfering behaviors
appointment cancellation, 44, 114, 274
comorbidity and, 119
five minute session and, 117–18, 124
homework non-completion, 44, 114
inclusion in case formulations, 117
late arrival, 44
motivation and, 44
patient groups and, 119
reasons for, 115–16
re-engagement following, 117
responding to, 116–17, 333
‘river analogy’ in, 116
short-term contracts for, 117
therapy effectiveness and, 40
transdiagnostic cognitive behavior therapy model, 6–7, 101
trauma, 102. See also posttraumatic stress disorder; sexual: abuse
treatment of eating disorders
analogy use in (see analogy use in cognitive behavioral therapy)
behavioral interference with, 26
barriers to, 66
breaks in, 15
calorie descriptions and, 81
chronicity of, 129
duration, 8–9, 14–15, 227
emotional-behavioral therapy for, 269
ending, 345–50
equipment for, 25
external factors, 9
follow-ups, 347
format, 15
initial response to, 8
mission statement, 46
physical environment for, 25
physical monitoring during, 16
planning, 24
preparation for, 42–3
relapses in (see recovery; relapse)
sessions, 14
themes, 7
therapy-interfering behaviors and (see therapy-interfering behaviors)
weighing and, 171, 172 (see also weighing)
See also cognitive behavioral therapy; recovery; relapse
Vancouver Obsessive Compulsive Inventory (VOCI), 250
vegetarianism and veganism, 88–90
vomiting
binge-eating and, 101
bulimia nervosa and, 377, 398–400
calorie loss from, 412
phobia, 271, 290, 293
physical risks, 152
self-induced, 17, 36, 377, 401–2, 412
water. See fluid intake
weighing
assessment/interview, 33
children and adolescents, 312
by clinician, 162
guidelines, 33
as a non-negotiable, 41, 43, 127, 162 (see also cognitive behavioral therapy: non-negotiables in)
procedure, 165–7
refusal, 40–1
regular, in therapy, 8, 40, 127, 162, 167–70, 322
weight
change, 19–20
communication, 127
extreme control of, 99
fluctuation, 167, 173, 377
gain (see weight gain)
genetic basis for, 170–1
graph, 163–4
healthy, 171
history, 228, 229
loss and gain cycles, 88, 414
low, 69
maintenance, 89
management, 85, 87, 417
measurement (see weighing)
misconceptions, 171–2
overevaluation of, 102
PMS and, 419
set-point theory of, 171, 230
stabilization, 8
weight gain, 8, 85–6, 162, 344–5
cycles, 89
dehydration and, 86
fluid retention and, 86, 128
maintenance, 89
manipulation, 33
obesity and (see obesity)
physical factors, 89
physiological effects, 86–7, 162
psychological factors, 89
rapid, 86
targets, 85, 86
vegetarians/vegans and, 90
Young Schema Questionnaire, 39, 246, 274, 281, 338