Introduction
An eating disorder is a mental disorder defined by abnormal consuming behavior that negatively affects someone's physical or psychological health (APA, 2013). According to the American Psychiatric Association, eating disorders happen along with side other mental disorders like panic, anxiety, depression, obsessive-compulsive disorder, and alcohol and substance abuse problems. Consisting of DSM-V, eating disorders are illnesses during which people experience severe disturbances in their eating behaviors and related thoughts and emotions (APA, 2013). However, with proper medical aid, people who suffer eating disorders perhaps could restart appropriate eating behavior and return to raise mental and emotional health. People with eating disorders usually grow to be preoccupied with food and their weight. Without treatment of both the emotional and physical symptoms of those problems, malnutrition, coronary heart problems, and other potentially fatal conditions might also happen (Hay, 2009). Based on my opinion, people with an eating disorder can hold the secret for decades, as their look could be commonly routine, and they could often eat in public. Cultural idealization of thinness believes it could be a factor to contribute to some eating disorders (Rikani et al., 2013). It could be argued that that is a result of such societies putting stress at the value of particular body types, especially among women. It is also essential to keep in mind whether or not there are cultural differences within societies. Even as it is clear that females are more likely to experience eating disorders than males, there was a significant growth within the identification of men with eating disorders in the latest years (APA, 2013). There may also be a more occurrence among those in at-risk professions where there is a focus on body shape and weight, such as dancers, athletes, models (Arcelus, et al., 2014).
Bulimia Nervosa
According to NICE guidelines, bulimia nervosa is characterized, utilizing recurrent binge consuming, excessive weight-manage behavior, and over concern about body shape and weight. Bulimia nervosa is significantly more common than anorexia nervosa within the population, though services are frequently more centered on the care of anorexia nervosa. The disorder generally begins in late adolescence or early adulthood (APA, 2013). Nevertheless, after a few months or years, the nutritional restrict turns into punctuated with the aid of repeated binges. Compensatory behaviors follow these binges, in most instances, self-triggered vomiting or the misuse of laxatives in an attempt to reduce their effect on body weight (Hay, 2009). In-among binges, there are also usually persevering with efforts to limit ingesting. Notwithstanding this, any weight loss tends to be progressively regained, and similarly, weight gain is a common consequence (Hay, 2009).
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Statistics
Followed by the Diagnostic and Statistical Manual of Mental Disorder (DSM-V), people who had bulimia might be preoccupied with their body shape and weight. They are probably dwelling in fear of gaining weight, feeling a loss of manage at some point of bingeing, and forcing themselves to vomit or workout an excessive amount of to maintain from gaining weight after bingeing (DSM-V, 2013). There also have individuals who use laxatives, diuretics, or enemas after ingesting. Besides, fasting, limiting calories, or averting certain ingredients between binges also a particular manner of purging. A few people even using nutritional dietary supplements or natural products, excessively for weight reduction (DSM-V, 2013). Being obese as a child or teen might also increase the risk. Mental and emotional issues, which include depression, anxiety disorders, or substance use disorders, are intently related to eating disorders (APA, 2013). In a few instances, traumatic activities and environmental stress can be contributing factors — individuals who weight-reduction plan are at higher risk of developing eating disorders. Many people with bulimia significantly limit calories among binge episodes, which can also cause an urge to eat once more and then purge (Kendler et al., 1991). Other triggers for bingeing can consist of strain, negative body self-image, food, and boredom. Bulimia may additionally motive extreme or even life-threatening complications (Harrington, 2015).
What Do Studies Say?
According to some research, Cognitive-Behavioral Therapy has the most reliable scientific evidence of all the proven psychological aid for bulimia nervosa (Fairburn, Marcus, & Wilson, 1993). The cognitive-behavioral treatment of eating disorders emphasizes the reduction of destructive thoughts about body appearance and the act of ingesting and tries to regulate harmful and dangerous behaviors that might be concerned in and continue consuming issues (Walter, 2012). Comply with Fairburn's research record that the enhancements in bulimic sufferers who have acquired CBT seem like nicely maintained. Studies indicate that the outcomes of cognitive-behavioral therapy within the remedy of bulimia nervosa are appropriately managed. An evaluation of the literature suggests that healing modifications are nicely maintained over the six to one year following treatment (Fairburn et al., 1995). Cognitive-behavioral therapy, as handling for bulimia nervosa, has been substantially studied (Murphy et al., 2010).
The Problem of CBT
The primary findings which have been recognized are as follows: CBT has considerable useful consequences on all factors of the psychopathology of bulimia nervosa (Dattadeen, 2015). Some of the research has established a noticeable decrease within the rate of purging and binge ingesting, reduced nutritional control in addition to development in cognition about weightiness and configuration (Dattadeen, 2015). Further, those essential effects are typically related to a lower within the level of broad psychiatric signs and symptoms and enhancements in self-confidence and interpersonal performance (Dattadeen, 2015). Besides, CBT has been proven to be stronger than numerous different mental care, consisting of stress control remedy, supportive psychotherapy, dialectical behavior modification, and supportive-expressive psychotherapy (Wilson & Fairburn, 2002). The capital exception is interpersonal psychotherapy (IPT), which has been proven to have similar consequences to CBT (Fairburn et al., 1993; Agras et al., 2000).
Therapists can also guide sufferers during a self-help model of Cognitive-Behavioral Therapy for bulimia nervosa (Fairburn, Marcus, & Wilson, 1993). The primary section includes training regarding weight and therefore the harmful physiological effects of binge consuming, purging, and severe dieting, and facilitates the patient set up a daily pattern of intake, to withstand the urge to binge eat and purge, and the proper weight tracking schedule (Fairburn, 2008). The therapist and affected person utilize specified statistics of food intake, episodes of binge consuming, and purging in addition to related cognition and feelings (Wilson, 1997). Within the second section, the primary goal shifts to lowering shape and weight issues and weight-reduction plan conduct, and figuring out precipitants to any final binge-purge episodes (Fairburn, 2008). The third phase specializes in preserving alternate after the treatment has ended. In this stage, relapse prevention techniques used to prepare for ability setbacks with treatment (Fairburn, Marcus, & Wilson, 1993).
Jane is a 22 years old Chinese female. She is currently a uni-students study fashion design, and her also a dancer. She is presently single and from a middle-class socioeconomic background. Jane is of average height and is medium-built. During the interview, she has dressed appropriately and possessed a pleasant demeanor. She was open and honest with her responses and maintained good eye contact when speaking with the therapist. Jane is a referral by her doctor for Cognitive-Behavioral Therapy.
Jane presented with complaints of depressed mood, anxiety, concentration difficulties, loss of control over the eating, and sleep disturbances. She cannot sleep in the night and constantly going to the bathroom right after eating, during meals or for long periods of time. She reported experiencing these symptoms for the last three months. In addition to these symptoms, Jane said that continually worrying about being fat, causing her to have much anxiety. She also reported an inability to control her anxiety and had to use dietary supplements or herbal products excessively for weight loss. According to Jane, she has attempt suicide before by cutting herself to stop that behavior.
Jane said she was a dancer in year one and prepared for a competition. Thus, she must keep a good body figure. Jane reported that the competition only chooses the best dancer to perform, and it is an international competition, will invite many famous dancers as judges. Therefore, a lot of stress and anxiety coming out as she needs to challenge with other dancers to get the chance. However, Jane mentioned that she used to binge to release stress, and she could not be able to control her food intake. Her classmates started laughed and teased at her because of her body size getting fat and always said some bad words to hurt her like you are a loser, fat women cannot dance. Jane reported that until now, she still felt like someone was looking at her and criticized her body size. She has to eat secretly and purging after her meal to keep weight.
According to Jane, she grew up in a single-parent family with her mother. Her father divorced her mother because her mother was getting fatter and almost become obesity after born Jane. She had these core beliefs when she grew up that slim people are pretty. She believes that people more likely to like a thin person rather than fat people as her mother was an example. There is significant stress for ladies to comply with feminine beauty beliefs, and, since thinness is prized as female, many girls sense disillusioned with their body shape. Body dissatisfaction is a precursor to extreme mental troubles, including depression, social tension, and eating disorders (Jefferson & Stake, 2009).
Jane mentioned that her classmates have a slim body shape and the food amount of them only half of her. In her belief, people who are thin or have an attractive look will have more friends. She had seen some students being a bully by other students because of their body size and a large amount of eating. Therefore, she believes that if she had a skinny body size, her classmates would be more likely to befriend her. Due to this situation, she was kept worried and anxious about her body size will be criticized by her classmates.
According to Jane,she had learn some healthy coping skills to deal with her stress more effectively. She felt lucky and energize that her mother was supportive of going to exercise together with her. Her boyfriend also never left her alone when she was having a lot of anxiety but still by her side. They provide support and let her understand that she was not alone. Her boyfriend even suggests she make an appointment with some counselor to solve her problem as well as can normalize her eating behavior and recovery.
According to NICE guidelines, treatments of bulimia nervosa usually have up to 20 sessions over 20 weeks (4 to 5 months) (NICE, 2017). Sessions divided into four parts: a review of the patient’s self-monitoring form; setting and implementing the agenda for the meeting; a wrap-up of what was covered during the session; and the assignment of specific homework tasks.
Generally, in the first few sessions, it will more likely become a chit-chat setting to know more about the client and build a therapeutic alliance. During the treatment, the therapist must be genuine in relating to the client. Having a strong therapeutic alliance with the client would be more useful and more comfortable to gather the client data and apply the therapy on the clients to solve the problem. When a good relationship had built between client and therapist, the counseling session would be more effective because of trust and cooperation. The therapist must pay particular attention to this aspect of therapy, as the client has an inherent need to please others. The therapist should also be willing to listen to what Jane has to say while exhibiting patience, warmth, and interest. Further, the therapist must be willing to accept her without making judgments about her thoughts, feelings, or actions.
Self-symptoms measure usually done before the treatment start. Jane has to do a self-report measure while in the waiting room. This is a way to evaluate baseline functioning in addition to therapeutic progress (Cully, & Teten, 2008). After Jane completed, it will be assessed by the clinician throughout the consultation. Frequently self-report measures can function as a recurring schedule object in the course of CBT sessions and might spotlight critical enhancements and persevering with signs and symptoms (Cully, & Teten, 2008). Data acquired from these self-report inventories can also provide perception into the manner the affected person thinks and behaves and factors that are probably vital areas of need (Cully, & Teten, 2008). It might be helpful and faster for the therapist to understand the condition of the clients.
Before everything going on, the client has to know about the Cognitive-Behavioral Therapy model (Fairburn, Marcus, & Wilson, 1993). During the first few session usually begins with the psycho-education. Jane needs to have a strong understanding of the cognitive model to ensure the therapy effectively. Cognitive-Behavioral Therapy is based on the idea that our thoughts, feelings, and behaviors are continually interacting and influencing one another. Core beliefs are developed from an individual's unique personal experiences (Bulter, 2006). Therefore, Jane had the core belief that fat people will be bully and dislike by others was strengthened since she grew up. After constructing a public knowledge of the cognitive model, they will learn how to become aware of their cognitive distortions. Jane had to understand how her belief was affecting her thought and behavior. If the client has the insight and knows the link between their cognition and behavior, more likely, it will be easier for the client to stop the negative thought.
After Jane understood the model, treatment will continue by setting a treatment goal. The objective is to help Jane reduce abnormal eating behavior and normalize her life. The purpose of therapy should be discussed with the client to ensure that both sides are ready to make the changes and motivate them to do it. Perhaps it will also enhance the therapeutic alliance. It is essential to set a goal for the treatment to make sure that everyone is following in the same direction. Throughout the procedure, Jane could provide some feedback about the therapy to resolve some misunderstanding and able to keep track of the client's condition. Treatment goals can be changed at any time during the treatment (Cully, & Teten, 2008).
After every therapy session, Jane will need to do thought the report for recording experiences, together with the mind, emotions, and behaviors. This homework will assist her to turn out to be aware of cognitive distortions that formerly went disregarded and unquestioned. With practice, she may discover ways to pick out cognitive distortions for the time being and right now challenge them (Manus, 2012). Jane has to report her thought and behavior daily, and the scenario that she came out that binge behavior. Cognitive-behavioral therapy to help the client normalize their eating patterns and identify unhealthy, negative beliefs and behaviors and replace them with a healthy and positive way (Fairburn, 2008).
Conclusion
According to Agras study, it recommend that cognitive behavior modification, while implemented to patients with bulimia nervosa, operates via mechanisms particular to the present remedy and is stronger than both interpersonal psychotherapy and a simplified behavioral model of cognitive behavior therapy (Agras, 2000). Cognitive-behavioral therapy is a more effective treatment for adults in Eating disorder-Bulimia Nervosa. However, if patients are adolescents or children, treatment will be more recommend family therapy perhaps the parents can support their kids in changing their eating behavior. Although CBT is an effective therapy for eating disorders, however, it only is beneficial in some situations. There are a few studies had proven that CBT consists of some limitations. Cognitive-behavioral therapy relies on the desire of the patient. Each person must be invested in themselves for cognitive behavioral therapy to figure. Homework is arguably the first crucial element of cognitive-behavioral therapy. Cognitive-Behavioral Therapy might not be useful for individuals with specific learning difficulties.
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