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Introduction

Cognitive behavioral therapy (CBT) is the most commonly used therapy for individuals with eating disorders on account of the substantial focus of the cognitive and behavioral factors that contribute to the maintenance of an eating disorder (Murphy, Straebler, Cooper, & Fairburn, 2010). Due to the negative and dysmorphic view of their bodies, individuals with eating disorders benefit greatly from CBT. With the assistance of a therapist, individuals will analyze how their distorted cognition is maintaining their eating disorder and in turn, set goals that are addressed throughout the CBT process.

Theory

Cognitive behavioral theory was established on the principle that individuals develop and maintain emotional and behavioral responses that are dictated by their cognitive perceptions (Martin, 2016). Cognitive behavioral methods of treatment have three underlying assumptions: individuals’ are aware of their cognitive processes, an individual’s thinking controls the way they respond to the environment or life events, and lastly an individual’s cognition can be purposefully altered (Dobson & Dozois, 2001). While some individuals may not have full insight of their thoughts, certain training exercises may establish and support a more cognizant thought process. In addition, the way a person perceives their reality is essential to the way they behave. Therefore, the theory is grounded on the idea that when one’s cognition is changed towards a more reasonable, sensible and balanced way of thinking, symptoms of a disorder will be alleviated and thus the individual will become more functional.

Evidence

CBT is the treatment of choice for bulimia nervosa and recent research is found to be most effective when practicing CBT-E (Enhanced Cognitive Behavioral Therapy) which is directly aimed towards individuals with eating disorders. Previous research studies of CBT with individuals with bulimia have demonstrated low rates of relapse and relatively high amounts of positive outcomes (Murphy, et al., 2010).

Case Study

Miranda is a 26 year old woman that has been diagnosed with Anorexia Nervosa, one year ago. She is experiencing low confidence, distressed mood, anxiety and panic attacks and was self-harming on occasion. Miranda was frequently bullied as an adolescent and she received individual therapy for nearly a year which she found to be helpful at the time and would like to attempt cognitive behavioral interventions again. Her eating disorder has become a form of escape from her negative feelings and anxiety. Miranda is the middle child of her family and has always felt like the black sheep of the family along with a sense of overall competitiveness with her older sister Melissa. Miranda currently lives alone in New York City and her family resides in Upstate New York. She finds herself making excuses to avoid visiting her family for the holidays and other family celebrations but often feels guilty about it and would like to attempt to reconnect.

Intervention Plan

Problem Statement

Due to negative self worth, client is having difficulty in maintaining healthy family relationships.

Long Term Goals

1. Client will independently implement 2 coping techniques, in times of high stress, in order to increase family relationships by discharge.
2. Client will report 2 conversations with 2 different family members in order to maintain a healthy family relationship by discharge.

Short Term Goals

1. Client will write down 10 positive thoughts in her thought journal to maintain healthy family relationships by 2 weeks.
2. Client will disprove 2 negative thoughts about her family to improve her relationship with them by 2 weeks.
3. Client will demonstrate 5 positive coping strategies when experiencing negative thoughts at her family holiday parties in order to increase her relationship with her family in 2 weeks.

Intervention Format

Individual

Setting

The occupational therapist will meet with Miranda in her home for 60 minutes 1x a week, for 4 months.

Supplies

None

Agenda

Initial Session:

• • • Develop rapport with Miranda (5 min)
    • Complete the occupational profile (10 min)
    • Therapist and client create a problem list (10 min)
    • Create concrete and achievable goals (15 min)
    • Educate Miranda on cognitive behavioral therapy technique (10 min)
    • Assign homework to Miranda (5 min)
    • Summarize session (5 min)

Documentation

S:  “ I do not feel accepted by my family.”

O: After completing the COPM the client was able to create a list of problems such as: problems maintaining healthy relationship due to her negative thought about them. Client feels that her family prefers her older sister over her. Client identifies problems with family participation and lack of leisure activities. On the COPM, client scored performance 2 and satisfaction 1 in family participation; and performance 6 and satisfaction 7 in regards to engagement in leisure activities. Client created 3 goals focused on enhancing her relationship with her family and improving overall self thoughts. Client wrote down notes on CBT techniques and reviewed her notes with the therapist. For homework, client will use the thought journal and write down 10 positive thoughts. The therapist explained to Miranda the importance of completing the homework and next session they will be discussing it.

A: Miranda is not able to participate in family events due to her low self-confidence. Client’s problem list demonstrates her negative thoughts and opinions toward herself indicating the need for CBT. Scores on the COPM, indicate client’s desire to improve her performance and satisfaction in family relationships.  Client’s ability to construct 3 goals on enhancing her relationship with her family shows that she is willing to improve her self-thoughts. Client’s cooperation in learning new CBT techniques demonstrates an informed outlook on future therapy sessions. Client will benefit from further practice and implementation of coping strategies.

P: Next session, client will share what she has written in her thought journal and explore different coping strategies to use in situations of high stress. Client will practice role playing with therapist to implement coping strategies in a simulated situation.

References

Connecting feelings, thoughts and deeds: Cognitive Behavior Therapy and eating disorders. (n.d). Retrieved February 14, 2018, from https://eatingdisorder.org/treatment-and-support/therapeutic-modalities/cognitive-behavioral-therapy/

Dobson, K., & Dozois, D. (2001). Historical and philosophical basis of cognitive- behavioral therapy. In K. Dobson (Ed.), Handbook of cognitive-behavioral therapies (pp. 3–39). New York: Guilford.

Martin, B. (2016). In-Depth: Cognitive Behavioral Therapy. Psych Central. Retrieved on February 16, 2018, from https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/

Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. Psychiatric Clinics, 33(3), 611-627.