IPTforEatingDisorders

Friday10th November20172-4pm

IPTUKEDUCATIONFORUM

DebbieWhightNicolaBrewin

ZoeThistlewoodBarbaraThompson

PROGRAMME

• BriefintroductiontoEatingDisorders• IPTforED• IPTBN(m)- forbulimianervosaorbingeeatingdisorders

• IPTBN10- brieftreatmentformildtomoderateseveritybingeeatingdisorders

• IPTBNmA – IPTforadolescentswithbulimianervosaorbingeeatingdisorder

• IPTAN- foranorexianervosa• Plenary

TheEatingDisorders

AnorexiaNervosaBulimiaNervosa

BingeEatingDisorder

Anorexianervosa(NIMH)

Anorexianervosaischaracterizedby:

• Extremethinness(BMI17.5orlessICD10)• Arelentlesspursuitofthinnessandunwillingnesstomaintainanormalorhealthyweight• Intensefearofgainingweight• Distortedbodyimage,aself-esteemthatisheavilyinfluencedbyperceptionsofbodyweightand

shape,oradenialoftheseriousnessoflowbodyweight• Extremelyrestrictedeating.• Otherformsofweightcontrol(ICD10)(e.g.exercise)• Manypeoplewithanorexianervosaseethemselvesasoverweight,evenwhentheyareclearly

underweight.Eating,food,andweightcontrolbecomeobsessions.Peoplewithanorexianervosatypicallyweighthemselvesrepeatedly,portionfoodcarefully,andeatverysmallquantitiesofonlycertainfoods.Somepeoplewithanorexianervosamayalsoengageinbinge-eatingfollowedbyextremedieting,excessiveexercise,self-inducedvomiting,and/ormisuseoflaxatives,diuretics,orenemas.

• Somewhohaveanorexianervosarecoverwithtreatmentafteronlyoneepisode.Othersgetwellbuthaverelapses.Stillothershaveamorechronic,orlong-lasting,formofanorexianervosa,inwhichtheirhealthdeclinesastheybattletheillness.

• Purgingandnon-purging(DSM)

BulimiaNervosaDSM-V•Recurrent episodes of binge-eating

• Recurrent inappropriate compensatory behaviour (such as self-induced vomiting, misuse of laxatives, diuretics, enemas or other medications, fasting, excessive exercise) in order to prevent weight gain

• Binge-eating and compensatory behaviours occur on average at leastonce per week for 3 months

• Self-evaluation is unduly influenced by body shape or weight

• The disturbance does not occur exclusively during episodes of anorexia nervosa

BingeEatingDisorder(BED)DSMV• Recurrent episodes of binge eating.

• Bingeing episodes are associated with three or more of the following:

– Eating more rapidly than normal – Eating until uncomfortably full – Eating large amounts of food when not hungry – Eating alone because of being embarrassed by how much one is eating– Feeling, disgusted, depressed or very guilty after overeating

• Binge eating occurs on average at least 1 day per week for 3 months

• Marked distress regarding binge eating

• Absence of regular compensatory behaviours (e.g. purging)

WhyIPTforEatingDisorders?

References• Agras,W.S.,Walsh,B.T.,Fairburn,C.G.,Wilson,G.T.Kraemer,H.C.(2000);Amulticenter comparison

ofcognitive-behaviouraltherapyandinterpersonalpsychotherapyforbulimianervosa:ArchGenPsych.;57:459-466

• Arcelus,J.,Whight,D.,Langham,C.,Baggott,J.,McGrain,L.,Meadows,L,,Meyer,C.(2009);AcaseseriesEvaluationofamodifiedversionofinterpersonalpsychotherapy(IPT)forthetreatmentofbulimiceatingdisorders:Apilotstudy;Eur.Eat.DisordersRev.;17;260-268

• Fairburn,C.G.,Kirk,J.,O'Connor,M.,&Cooper,P.J.(1986).Acomparisonoftwopsychologicaltreatmentsforbulimianervosa. Behav ResTher,24, 629-643.

• Fairburn,C.G.,Jones,R.,Peveler,R.C.,Carr,S.J.,Solomon,R.A.,O'Connor,M.E.,Burton,J.,&Hope,R.A.(1991).Threepsychologicaltreatmentsforbulimianervosa:Acomparativetrial. ArchGenPsychiatry,48, 463-469.

• Fairburn,C.G.(1992).Interpersonalpsychotherapyforbulimianervosa.InG.L.Klerman &M.W.Weissman (Eds.), Newapplicationsofinterpersonalpsychotherapy (pp.353-378).Washington,D.C.:AmericanPsychiatricPress.

• Fairburn,C.G.,Jones,R.,Peveler,R.C.,Hope,R.A.,&O'Connor,M.(1993).Psychotherapyandbulimianervosa:Thelonger-termeffectsofinterpersonalpsychotherapy,behaviourtherapyandcognitivebehaviourtherapy. ArchGenPsychiatry,50, 419-428.

• FairburnCG,NormanPA,WelchSL,O’ConnorME,DollHA,Peveler RC(1995):AProspectiveStudyofOutcomeinBulimiaNervosaandtheLong-termeffectsofThreePsychologicalTreatments. ArchGenPsychiatry, 52,304– 312,April

• McIntosh,V.V.,Jordan,J.,Carter,F.A.,etal.(2005):Threepsychotherapiesforanorexianervosa:arandomized,controlledtrial. AmJPsychiatry;162:741–747.

• Whight,D.J.,Meadows,L.,McGrain,L.A.,Langham,C.L.,Baggott J.N.,Arcelus,J.A.(2011):IPT-BN(m):InterpersonalPsychotherapyforBulimicSpectrumDisorders:ATreatmentGuide; TroubadorPress

WhyuseIPTinEatingDisorders?

ChristopherG.Fairburn;RosemaryJones;RobertC.Peveler;R.A.Hope;MarianneO'Connor

PsychotherapyandBulimiaNervosa:Longer-termEffectsofInterpersonalPsychotherapy,BehaviorTherapy,andCognitiveBehaviorTherapyArchGenPsychiatry,Jun1993;50:419- 428

Outcomedatafor1993study

AMulticentreComparisonofCognitive-BehaviouralTherapyandInterpersonalPsychotherapyforBulimiaNervosaW.StewartAgras,MD;B.TimothyWalsh,MD;ChristopherG.Fairburn,MD;G.TerenceWilson,PhD;HelenaC.Kraemer,PhD

ArchGenPsychiatry.2000;57:459-466

Westartedthinking……

• HowtointroduceIPTintoourclinicalpractice• LearntIPTfordepression• Begantomakeadaptationstomodel• IPTusedinFairburn’sresearchandintheAgras research– notthesameasourpractice

CaseSeriesStudyIPTBNm

• TheLeicesterEatingDisorderServicehasbeenusinganadaptedmodelofIPTsuccessfullyforover20years

• Therewassomedatafromanunpublishedcaseseriesstudyof15patientsusingthismodel.

• Theaimofthisstudywastoevaluatethistherapyinabiggernumberofpatients.

StudyDesign

• 2yearperiod

• BNspectrumdisorder(1st Presentation)– EDNOS– 32– BN– 27

• n=59,females

Assessment&outcomestools

Timeline– assessments&outcomes

T1–assessmentatservice

T2– session8ofIPT-BNm

T4– 3monthsaftercompletionofIPT-BNm

T3– session16/endofIPT-BNm

5945

34

Findings– completers(n=45)

o inEDsymptomatology(exceptSIV)T1–T3

o inBDI&IIP-32scoreT1-T3

o Nodiffinweightandshapeconcerns,GlobalEDE-Q,binges,SIV&IIP-32T2-T3

o inallmeasures(exceptexercise)T1-T4

Findings– IntentiontoTreatanalysis(n=59)

0

2

4

T1 t2 T3 T4

EDE-QGlobal

0

5

10

15

20

T1 T2 T3 T4

Binges

SIV

1.4

1.6

1.8

2

T1 T2 T3 T4

IIP-32

0

20

40

T1 T2 T3 T4

BDI

Conclusions• IPT-BNmwaseffectiveforthetreatmentofpatientswithBulimicEatingDisorders.

• Changeineatingdisordersymptomatologycanoccurfast,withinthefirst8sessions

Published

• European Eating Disorders Review 17 (2009) 260-268

IPTBN(m)

Fortreatmentof:BulimiaNervosa

AtypicalBulimiaNervosaBingeEatingDisorderEDU(bulimicspectrum)

IPTforDepression IPTBN(m)

Noofsessions 12- 20 12- 20

Frequencyofsessions

Weekly Weekly

Earlysessions 1- 4 0- 4

Middlesession

5– 14 5– 14

Midtherapyreview

Yes Yes

Termination 15– 16 15- 16

Focusareas InterpersonalRoleTransitionsComplicatedGrief

InterpersonalRoleDisputesInterpersonalDeficits

InterpersonalRoleTransitionsComplicatedGrief

InterpersonalRoleDisputesInterpersonalDeficits

Session0tasks

• Assesscurrenteatingdifficulties• Namedisorder– psychoeducationasappropriate• Riskassessment• Introducefooddiaries• Discussweighing• Nodieting• DiscussIPTmodel• Goalsoftreatment• Timing/frequencyofsessions

Day&Date

Time Food&Drinkconsumed Where/withwhom

* V/L/E Context,thoughtsfeelings

Session1

• Reviewfooddiaries• Introducestructuredeating• Assessmood&diagnosedepression(Ham-D)ifpresent

• Sickrole• Starttolinkmoodwitheatingproblems

Day&DateThursday9th May

Time Food&Drinkconsumed Where/withwhom

* V/L/E Context/thoughts/feelings

6.45

101112

2.30

5.15

6.30

8.00-10

Oneslicetoast&marmalade

CoffeeCoffeeSmall salad

Tea

Bagofcrisps,largebarofchocolate,marshmallows,packetofcookies

Pastaandsaucewithroastedvegetables

LeftoverpastaCake,cereal,toast,icecream,cookies

HomealoneOfficeOfficeCanteen

Office

Car

Homewithhusband

Kitchen

*

*

V

V

I'mgoingtotryhardertodayanddietbetter.FeelinghungryStillhungryAtereallyslowlytomakeitlast

Hungryagain.WorkwasreallydullasKatewasonholidayBoughtfoodfromapetrolstationonmywayhome.Wished Ihadn'tstopped.Iwasdoingsowell,nowI’veruinedit.Mademyselfsick.

Hadtoeatorhusbandwouldknowsomethingwaswrong.Full.

Stupidstupid stupid

Day&DateMonday29th April

Time Food&Drinkconsumed Where/withwhom

* V/L/E Context,thoughtsfeelings

710.301112.30122.303.3047.309102.30

YoghurtCookiesCakeSandwichYoghurtCookiesSandwichApplesSweetsSaladCerealToastCereal

HomeWorkWorkWorkWorkWorkWorkWorkWorkHomeHomeHomeHome

**

****

***

V

V

V

V

StructuredEating

• Psychoeducation– starvationsyndrome/hunger-satietydisturbance/binge-purgecycle

• 3mealsand3snacksperday• Planinadvance• Eatallplannedfood• Nomorethan4hoursbetweenfood• Canswitchbutcannotskip• Emphasisonhow youeatnotwhat youeat

Structuredeating(continued)

• Collaborative• Pragmatic• Realistic• Encouraging

Assessmood

• CompleteHam-D• Diagnosedepressionifpresent• ReviewHam-Datsession8andsession15• IfnodepressiondonotcontinueHam-D• Discusssickrole

SickRole

• AswithIPTfordepression– validateillness,allowtimeofffromsometasks/motivatetostarttasks,withtheaimofrestoringnormalfunctioning

• EDpatientsareoftendriven,perfectionistsorwithatendencytooverwork

• Focusisoftenonlookingafterself,lettingthingsgo• Guilt

Linkmoodandeatingproblemstointerpersonalworld

• Context• Vulnerabilityfactors• Triggers• Consequences

Session2

• Reviewfooddiaries• Reviewdepressivesymptoms• Linksymptomchangetointerpersonalworld• Reviewsickrole• Psychoeducationasneeded• CompleteTimeline

Session3

• Reviewfooddiaries• Reviewdepressivesymptoms• Linksymptomchangetointerpersonalworld• Reviewsickrole• Psychoeducationasneeded• CompleteInterpersonalInventory

Session4

• Reviewfooddiaries• Reviewdepressivesymptoms• Linksymptomchangetointerpersonalworld• Reviewsickrole• Interpersonalformulation• Choosingafocus• Markendofearlysessionsandmovetomiddlesessions

Choosingafocus

Same4focusareas:

InterpersonaldeficitsInterpersonalroletransitionsInterpersonalroledisputesComplicatedgrief

MiddleSessions

• TrackEDsymptomsalongsidedepressionsymptoms• Relatethesetothefocalarea.• Reviewdiariesandencourageuseofstructuredeatingplan

• Problemsolving• ThemainfocusofsessionsisInterpersonal- staywiththefocusstrategiesaswithIPTDepression

• Allthefocalareasandstrategiesremainthesame• Reviewatsession8(Ham-D)

TowardstheEnd

• ThesameaswithIPTforDepression• Endwhenagreed• Encourageregulareatingforthehunger/satietymechanismsmaystillbedisregulated

• Contingencyplanning• Continuedimprovementaftertherapy• RepeatHam-Difusing

IPTBNm &CBT-E

PreviousFindings

• 3RCTs

• IPTBNslowertoshowresults

• Legitimatealternative

IPTBNm &CBT-EOutcomesinaclinicalsetting

LeicestershireAdultEatingDisorderService

BulimicSpectrumDisorders

IPTBNm&CBT-EOutcomesinaclinicalsetting

Slideredacted– unpublisheddata

IPTBNm &CBT-EOutcomesinaclinicalsetting

Slideredacted– unpublisheddata

IPTBNm &CBT-EOutcomesinaclinicalsetting

Slideredacted– unpublisheddata

IPTBNm &CBT-EOutcomesinaclinicalsetting

Slideredacted– unpublisheddata

Anyquestions?

THEDEVELOPMENTOFASHORTERFORMOFTHERAPYFORBULIMIANERVOSA:

IPTBN10

WE FOUND THAT

• OurIPTwaseffectiveforthetreatmentofpatientswithBN.

• Changesineatingdisordersymptomatologyoccursfast,withinthefirst8sessions.

Eur.Eat.Disorders Rev.17 (2009) 260-268

§ The manual for IPT-BN10 was collaboratively developed by collecting the views of the 6 level D (supervisory level) IPT therapists working at the Leicester IPT team.

§ Feedback was also collected from 14 patients with bulimic disorderswho participated in semi-structured interviews concerning their experience with this treatment.

§ Interviews were transcribed verbatim and analysed using thematic analysis for emergent themes (Haslam et al, 2011).

§ IPT BNm was analysed in detail, with particular reference to aspects of therapy identified as most helpful by patients and therapists as well as the areas felt to be intrinsic to IPT.

The Development of IPT BN10

It was felt important that aspects of treatment that were inherently IPT were maintained, whereas some of the areas could be reduced or removed.

A patient psychoeducational booklet plus homework activities were designed which allowed the patient to be placed in charge of their own recovery.

IPT-BN10 consists of 10 weekly sessions, each of 45 minutes duration.

The first 3 sessions are for the assessment of current difficulties and the interpersonal context of these, then formulate the focus area to be work through the middle 6 sessions

The final session focuses on ending and how the patient moves on from therapy to continue putting into practice what they have learned.

IPTBN(m)

• 16sessions• 4assessmentsessions• 10middlesessions• 2terminationsessions• 4focusareas• Midwayreview• Ham-Dcompleted

beginning,middle,end• Followupat3monthsby

assessor

IPTBN10

• 10sessions• 3assessmentsessions• 6middlesessions• 1terminationsession• 4focusareas• Noreview• BDIcompletedbefore

sessions1and9• Followupat3monthsby

therapist

IPTBN10PILOTSTUDY:AIM

• Tomeasureeatingdisorderspsychopathologychangesinasmallcaseseries

IPTBN10PILOTMEASUREMENTS

• EDE-Q• BDI• BITE

PretreatmentPosttreatment

T0 T1

PARTICIPANTSAll Females

Age range 18-43

Mean = 28.20

5 – EDNOS 2 – BED 3 - BN

OUTCOME DATA

IPT BN10 Start and End Therapy

05

101520253035

Start Therapy End Therapy

EDEQBDIBITE

All 3 measures were significant (p<0.05)

EDEQ scores start & end therapy for 3 treatment groups

0

1

2

3

4

5

Start Therapy End Therapy

IPT BN10IPT BN16Controls

IPT BN10 vs Control significant p(<0.05)

OUTCOME DATA

CONCLUSIONS

• Todate,thenewtreatmenthasbeeneffectivealthoughitrequiresaresearchprojecttovalidatethis.

• OnesessionofIPTcosts£202:Areductionof6sessionsin10patientshassavedtheNHS£12120

Arcelus, J., Whight, D., Brewin, N and McGrain L. (2012) A Brief form of Interpersonal Psychotherapy for adult patients with Bulimic Disorders: a pilot study. European Eating Disorders Review, 20(4), 326-30

OUTCOME DATA

IPT BN10 Start and End Therapy

05

101520253035

Start Therapy End Therapy

EDEQBDIBITE

All 3 measures were significant (p<0.05)

IPTinaCAMHSEatingDisorderTeam

ZoeThistlewood

IPTA

• 12weeksduration• SamefocalareasatIPTforDepressioninAdults

• Parent/Carerinvolvementisadvisableandcriticalinpromotingwellbeingandsuccessoftreatment,thiscanbebetween0toseveralsessions,e.g.3sessions,1ineachphase

AdaptationsforIPTA-BN

• 16sessions+parentsessions

• Rationale- increasedcontentduetoextratasksrequiredtoaddresstheeatingdisorder

ConsiderationsforIPTA-BN

Treatingco-morbidities Suicidalityandself-harm Non-medicalprescribing

CAMHSAssessmentandDiagnosis

Feedbacktofamily/youngperson,optionsexploredandtreatmentplandevised

MDTdiscussionandformulation

MDTassessment[within1-4weeks]

Phoneassessment[within24hours]

ReferralfromGP/SchoolNurse/CAMHS

Phases

PhaseOne•Sessions0-4

PhaseTwo•Sessions5-14

PhaseThree•Sessions15-16

PhaseOne

Session0• Assessingsuitabilitywiththeyoungpersonandparent/carer

• Physicalchecksincludingbloodtests• ExplainIPTandexpectationsi.e.fooddiary,cancellationsandlateness

• Nodieting• Schoolandmulti-agencyliaison• Confidentiality

PhaseOne

Session1• Reviewofrisks• Psychoeducation• HamiltonD(otherROMScompletedpre- andpost-treatment)

• Limitedsickrole• Regulareating• Begintoidentifymood-foodlink

PhaseOne

Session2• Reviewofrisks• Reviewofdiary,includingregulareating• Introducestrategiestomanagebinge-purgeurges

• Interpersonalnetwork

PhaseOne

Session3• Reviewofrisks• Reviewofdiary,regulareating,binge-purges• Timeline,includingepisodesofbullyinganddisappointments

PhaseOne

Session4• Reviewofrisks• Reviewofdiary,etc.• Choosefocalarea• Setgoals• PreparationforPhaseTwo

• Parentliaison(optional)

PhaseTwo

Sessions5-14• AimistoresolvesymptomsofBulimiaorBingeEatingDisorder

• IPTstrategies:CommunicationAnalysis

RolePlay

EmotionalLiteracyandExpression

Problem-Solving

PhaseTwo

Sessions5-14• Specificadolescentissues

Newtotherapyandtalking

Intenseexperienceofaffectandoftenfeeltheyarenotincontrolandnotsure

whereemotionsarecomingfrom

Importanceofbehaviouralchange,oftenrequiressupportofothersand

parent/carerinvolvement,e.g.buyingfoodand

mealtimes

CognitiveCapacity

ASD Bodyimageissues ParentalMentalHealth

PhaseTwo

Sessions5-14FocalArea:Disputes

Bullying

Parents/step-parentscanrequireconjointcoaching;assessparentswillingnessfirst

PhaseTwo

Sessions5-14FocalArea:InterpersonalSensitivities/Deficits

Networkofeatingdisorderpeers?

Developmentalaspects

NEET

Parents/step-parentscanrequireconjointcoaching;assessparentswillingnessfirst

PhaseTwo

Sessions5-14FocalArea:Transitions

Bullying

Familystructuralchange

Changeofschool

Puberty

PhaseTwo

Sessions5-14FocalArea:Grief

Potentiallyfirstsignificantloss

Impactsonfamily

Griefinadolescentsmaybemoreepisodicthanpervasive

Griefcanbeexpressedinpsychosomaticsymptoms

Socioeconomicimpactfromdeathofaparent

Developmentalstagee.g.youngerchildmoredependentonparents

PhaseThree

Sessions15-16• TerminationPhase• Liaisonwithparentsre.relapsepreventionplan

• Particularfocusonfutureevents,e.g.Christmas,Eid,etc.

• Continuationofdiary?• Supportfromnetworke.g.BEAT• Diets

CaseStudy

IPTA/AN

• Trialusedinabsenceofothersuitableindividualtherapies

• 2caseswerecompleted• IPTANAdultmodelfollowed

AFT:IsthisIPTindisguise?

• NICEGuidelinerecommendedtreatmentforAnorexiainAdolescents,whenFBTisnotappropriateorsuitable

AFT:IsthisIPTindisguise?

• AFThas3Phases• 10sessions• Addressweightgain• Developtherapeuticalliance• Developformulation

PhaseOne

•5sessions• Targetmaintainingfactors• Developnewskills• Continuetogainweight

PhaseTwo

•8sessions• Relapseprevention• Identifyingfuturedifficulties

PhaseThree

AFT:IsthisIPTindisguise?

Caseconceptualisation

themes

Depressivecharacteristics

Anger/Controlissues

Deficitsinself-esteem

Regressiveneeds/

independenceneeds

AFT:IsthisIPTindisguise?

• AFTstrategies– Problem-solvingskills– FirmandNurturingstance– Self-disclosure– ParentCollaterals– Skilldevelopment

IPTforAnorexiaNervosa

Why?

• RCTMcIntoshetal2005• ComparedIPT,CBTandSSCM• SSCMmoreeffectiveatend,butnodifferenceat5yearfollow-up(2011)

• InsufficientadaptationtoAN

• ‘SeveredifficultiesseeninIPfunctioninginpatientswithAN,whicharecentraltodevelopmentandmaintenanceofthisdisorder’EvansandWertheim1998

• OverlapofcorepsychopathologyofBNandAN

• CouldtreatmentforBNbeusedforAN?

PartialsyndromeAN

• 20weeklysessions• Fortnightlyfor6months• Fortnightly/Monthlyforfurther6monthsifclinicallyindicated

Anorexianervosa

• Usually1-2yearsweeklytherapyforAN–couldthisbeIPT?

• Recognisedneededfurtheradaptation

How?

• Todevelopaframework– Initial8-16sessions– Middle20-40– Ending5-10

Initialstages

• Psychoeducation• Dietarydiary• Menuplanning• Weighingweekly• Physicalmonitoringifappropriate

• NoHam-D• Timeline• IPinventory• Sickrole

Targetedsymptomchecklist

• Intentionalrestriction• Weighingself• Vomiting• Chewandspit• Laxatives• Exercise• Bodychecking

• Weightgainisgoal• Piechartoflife

• Focus- sameasforIPTBNm• Transitionfrombeingunwelltowellness• Explorephysical,emotionalandrelationalaspectsofhavingANandwhatwouldchange

• Dealingwithambivalence

IPT-ANPilotCases

IPTAN- Outcomes

0 10 20 30 40 50

Patient1

Patient2

Patient3

LengthofTherapy(months)

No.ofSessions

IPTAN– OutcomesBMI

0

5

10

15

20

Start End

Patient1

Patient2

Patient3

IPTAN- Outcome

0

2

4

6

8

10

12

14

16

18

Patient1 Patient2 Patient3

EDE-QStart

EDE-QEnd

InterpersonalDistrustStart

InterpersonalDistrustEnd

Whatworked?• Someweightgain

• Interweavingassessmenttoolsthroughearliersessions

• Abletoutilise/buildnetworkmore

• LossofANseenaslossofrole

Whatdidn’twork?• Safeguardingissues• Comorbidity/Alcoholmisuse

• Changeoccursslowly

• OverlapwithothermodelsforAN,hardertostayonmodel

CaseStudy

• Divorced• Son20• Daughter15• Depressionwithhistoryofalcoholmisuse• AnorexiaNervosa

• ClearIPissues• Focusoftransition• WeightwentfromBMIof14to15.6

• Understoodimportanceofnetwork• Abletoestablishregulareating• Lackofsignificantweightgain• Usingalcohol?• LearningtolivewithAN

Questions?

N.I.C.E.Psychological treatment for bulimia nervosa in adults

• 1.5.2 Consider bulimia-nervosa-focused guided self-help for adults with bulimia nervosa.

• 1.5.4 If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED).

• 1.5.5 Individual CBT-ED for adults with bulimia nervosa should:– typically consist of up to 20 sessions over 20 weeks, and consider twice-weekly

sessions in the first phase– in the first phase focus on:– engagement and education– establishing a pattern of regular eating, and providing encouragement, advice and

support while people do this– follow by addressing the eating disorder psychopathology (for example, the extreme

dietary restraint, the concerns about body shape and weight, and the tendency to binge eat in response to difficult thoughts and feelings)

– towards the end of treatment, spread appointments further apart and focus on maintaining positive changes and minimising the risk of relapse

– if appropriate, involve significant others to help with one-to-one treatment.

NICEGuidelines

• AllpeoplewithanEDandtheirparents/carersmusthaveequalaccesstotreatments

NiceGuidelines,2017

NICEGuidelinesAnorexiaNervosa• Support&careshouldbeprovidedforall peoplewithANà

whetherornottheyarehavingaspecificintervention• Keygoalà helpingpeoplereachahealthybodyweightorBMI&

weightgainiskeyinsupportingotherpsychological,physicalandqualityoflifechangesthatareneededtoimprovementorrecovery.

• ConsiderFT-AN- withfamilyandseparatefamilytherapysessions• Covernutrition,relapseprevention,cognitiverestructuring,mood

regulation,socialskills,bodyimageconcernandself-esteem• Createapersonalisedtreatmentplanà basedonprocesses

maintainingtheeatingproblemNice,Guidelines,2017

NICEGuidelinesBulimiaNervosa• Explainthatpsychologicaltreatmentshavealimitedeffectonbodyweight

• OfferFT-BNtochildrenandYP- ifunacceptable,contraindicatedorineffectiveà considerCBT-ED

• InitiallyfocusonroleBNplaysandbuildingmotivationtochange

• ProvidepsychoeducationaboutED’s,howsymptomsaremaintainedandencouragementtoestablishregulareatinghabits

• Userelapsepreventionstrategiesà preparationforpotentialfuturesetbacks

NICEGuidelines,2017

NICEGuidelinesBingeEating• Medicationnottobeoffered asthesoletreatment• ForchildrenandYPà offersametreatmentsrecommendedfor

adults• Explainthatpsychologicaltreatmentsaimedattreatingbingeeating

havealimitedeffectsonbodyweightandthatweightlossisnotatherapytarget

• First,offerguidedself-help• Ifinappropriateorineffectiveafter4weeks,offergroupCBT-ED• Ifgroupisunavailableordeclined,considerindividualCBT-ED• Addressbodyimageissuesifrequired• Advisenottotrytoloseweighte.g.dietduringtreatmentàmay

triggerbingeeatingNiceGuidelines,2017