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Can temporary cessation of CBT really be therapeutic? A case study

Published online by Cambridge University Press:  14 September 2017

Paul E. Jenkins
Paul E. Jenkins*
Affiliation:
Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford OX3 7JX School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT
*
Correspondence to Paul E. Jenkins, Cotswold House Eating Disorders Service, Warneford Hospital, Warneford Lane, Headington, Oxford OX3 7JX, UK. E-mail: [email protected]
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Abstract

Anorexia nervosa (AN) is a notoriously costly and challenging psychiatric illness to treat. Despite an accumulating evidence base, psychological treatment fails to achieve symptom abstinence in many patients with eating disorders, a shortcoming that is likely to be further pronounced in AN. The case study reported here describes how a mutually agreed break in a course of psychotherapy following an initial lack of progress might have influenced outcome for a client with a severe eating disorder. The patient received 26 sessions of CBT and results, consistent with those of larger studies, showed significant improvement on primary symptom measures. These results are discussed in the context of relevant psychological theories and an exploration of the client's motivation. Consideration is also given to other factors that may have influenced outcome.

Keywords

case studyCBTCBT-Eanorexia nervosatherapeutic break
Type
Practice article
Information
the Cognitive Behaviour Therapist , Volume 10 , 2017 , e8
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Recommended follow-up reading

Fairburn, CG (2008). Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press.Google ScholarPubMed
Masson, PC, Sheeshka, JD (2009). Clinicians’ perspectives on the premature termination of treatment in patients with eating disorders. Eating Disorders 17, 109–125.CrossRefGoogle ScholarPubMed

References

Abbate-Daga, G, Amianto, F, Delsedime, N, De-Bacco, C, Fassino, S (2013). Resistance to treatment and change in anorexia nervosa: a clinical overview. BMC Psychiatry 13, 294. doi: 10.1186/1471-244X-13-294 Google Scholar
Accurso, EC, Ciao, AC, Fitzsimmons-Craft, EE, Lock, JD, Le Grange, D (2014). Is weight gain really a catalyst for broader recovery? The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa. Behaviour Research and Therapy 56, 1–6. doi: 10.1016/j.brat.2014.02.006 CrossRefGoogle ScholarPubMed
Amdur, MJ, Tucker, GJ, Detre, T, Markhus, K (1969). Anorexia nervosa: an interactional study. Journal of Nervous and Mental Disease 148, 559–566.Google Scholar
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC.Google Scholar
Barkham, M, Margison, F, Leach, C, Lucock, M, Mellor-Clark, J, Evans, C, Benson, L, Connell, J, Audin, K, McGrath, G (2001). Service profiling and outcomes benchmarking using the CORE-OM: toward practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology 69, 184–196.Google Scholar
Birmingham, CL, Stigant, C, Goldner, EM (1999). Chest pain in anorexia nervosa. International Journal of Eating Disorders 25, 219–222.Google Scholar
Bohn, K, Fairburn, CG (2008). The Clinical Impairment Assessment questionnaire (CIA). In Cognitive Behaviour Therapy and Eating Disorders (ed. Fairburn, C.G.), pp. 315–316. New York: Guilford Press.Google Scholar
Bohn, K, Doll, HA, Cooper, Z, O'Connor, M, Palmer, RL, Fairburn, CG (2008). The measurement of impairment due to eating disorder psychopathology. Behaviour Research and Therapy 46, 1105–1110.Google Scholar
Bruch, H (1978). The Golden Cage: The Enigma of Anorexia Nervosa. Cambridge, MA: Harvard University Press.Google Scholar
Connell, J, Barkham, M, Stiles, WB, Twigg, E, Singleton, N, Evans, O, Miles, JNV (2006). Distribution of CORE-OM scores in a general population, clinical cut-off points and comparison with the CIS-R. British Journal of Psychiatry 190, 69–74.Google Scholar
Dalle Grave R (2013). Multistep Cognitive Behavioral Therapy for Eating Disorders. Lanham, MD: Jason Aronson.Google Scholar
Dalle Grave, R, Pasqualoni, E, Calugi, S (2008). Intensive outpatient cognitive behaviour therapy for eating disorder. Psychological Topics 17, 313–327.Google Scholar
Deci, EL, Ryan, RM (2000). The ‘what’ and ‘why’ of goal pursuits: human needs and the self-determination of behavior. Psychological Inquiry 11, 227–268.Google Scholar
Elliott, R (2002). Hermeneutic single-case efficacy design. Psychotherapy Research 12, 1–21.CrossRefGoogle ScholarPubMed
Evans, C, Connell, J, Barkham, M, Margison, F, McGrath, G, Mellor-Clark, J, Audin, K (2002). Towards a standardised brief outcome measure: psychometric properties and utility of the CORE-OM. The British Journal of Psychiatry 180, 51–60.Google Scholar
Fairburn, CG (2008). Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press.Google Scholar
Fairburn, CG, Beglin, SJ (1994). Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders 16, 363–370.Google Scholar
Fairburn, CG, Cooper, Z, Doll, HA, O'Connor, ME, Bohn, K, Hawker, DM, Wales, JA, Palmer, RL (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry 166, 311–319.Google Scholar
Fairburn, CG, Bailey-Straebler, S, Basden, S, Doll, HA, Jones, R, Murphy, R, O'Connor, ME, Cooper, Z (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour Research and Therapy 70, 64–71.CrossRefGoogle ScholarPubMed
Geller, J (2002). What a motivational approach is and what a motivational approach isn't: reflections and responses. European Eating Disorders Review 10, 155–160.Google Scholar
Geller, J, Drab, DL (1999). The Readiness and Motivation Interview: a symptom-specific measure of readiness to change in the eating disorders. European Eating Disorders Review 7, 259–278.3.0.CO;2-6>CrossRefGoogle Scholar
Guarda, AS (2008). Treatment of anorexia nervosa: insights and obstacles. Physiology and Behavior 94, 113–120.CrossRefGoogle ScholarPubMed
Halmi, KA, Agras, WS, Crow, S, Mitchell, J, Wilson, GT, Bryson, SW, Kraemer, HC (2005). Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Archives of General Psychiatry 62, 776–781.Google Scholar
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12–19.CrossRefGoogle ScholarPubMed
Jenkins, PE (2013). Using an OCD formulation in the treatment of anorexia nervosa: a useful way to understand the illness? the Cognitive Behaviour Therapist, 6, e8. doi:10.1017/S1754470X13000147 Google Scholar
Knott, S, Woodward, D, Hoefkens, A, Limbert, C (2015). Cognitive behaviour therapy for bulimia nervosa and eating disorders not otherwise specified: translation from randomized controlled trial to a clinical setting. Behavioural and Cognitive Psychotherapy 43, 641–654.Google Scholar
Lebow, J, Sim, LA, Erwin, PJ, Murad, MH (2013). The effect of atypical antipsychotic medications in individuals with anorexia nervosa: a systematic review and meta-analysis. International Journal of Eating Disorders 46, 332–339.Google Scholar
Linehan, MM (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, NY: Guilford Press.Google Scholar
Llewelyn, SP (1988). Psychological therapy as viewed by clients and therapists. British Journal of Clinical Psychology 27, 223–237.Google Scholar
Masson, PC, Sheeshka, JD (2009). Clinicians’ perspectives on the premature termination of treatment in patients with eating disorders. Eating Disorders 17, 109–125.CrossRefGoogle ScholarPubMed
Mehler, P, Gray, MC, Schulte, M (1997). Medical complications of anorexia nervosa. Journal of Women's Health 6, 533–541.Google Scholar
Mond, JM, Hay, PJ, Rodgers, B, Owen, C, Beumont, PJV (2004a). Temporal stability of the Eating Disorder Examination Questionnaire (EDE-Q). International Journal of Eating Disorders 36, 195–203.Google Scholar
Mond, JM, Hay, PJ, Rodgers, B, Owen, C, Beumont, PJV (2004b). Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy 42, 551–567.Google Scholar
Mond, JM, Hay, PJ, Rodgers, B, Owen, C (2006). Eating disorder examination questionnaire (EDE-Q): norms for young adult women. Behaviour Research and Therapy 44, 53–62.Google Scholar
Murphy, R, Straebler, S, Cooper, Z, Fairburn, CG (2010). Cognitive behavioral therapy for eating disorders. Psychiatric Clinics of North America 33, 611–627.Google Scholar
National Institute for Health Care and Excellence (NICE) (2017). Eating Disorders: Recognition and Treatment, Guideline NG69. London: NICE.Google Scholar
Reas, DL, Ø, Rø, Kapstad, H, Lask, B (2010). Psychometric properties of the Clinical Impairment Assessment: norms for young adult women. International Journal of Eating Disorders 43, 72–76.Google Scholar
Robins, RW, Hendin, HM, Trzesniewski, KH (2001). Measuring global self-esteem: construct validation of a single-item measure and the Rosenberg self-esteem scale. Personality and Social Psychology Bulletin 27, 151–161.CrossRefGoogle Scholar
Rosenberg, M (1989). Society and the Adolescent Self-image. Middletown, CT: Weslyan University Press.Google Scholar
Tozman, S, DeJesus, E (1981). The positive side of administrative discharge (in a drug program). Substance Use and Misuse 16, 135–139.Google Scholar
Turner, H, Marshall, E, Stopa, L, Waller, G (2015). Cognitive-behavioural therapy for outpatients with eating disorders: effectiveness for a transdiagnostic group in a routine clinical setting. Behaviour Research and Therapy 68, 70–75.CrossRefGoogle Scholar
Vansteenkiste, M, Soenens, B, Vandereycken, W (2005). Motivation to change in eating disorder patients: a conceptual clarification on the basis of self-determination theory. International Journal of Eating Disorders 37, 207–219.Google Scholar
Vitousek, K, Watson, S, Wilson, GT (1998). Enhancing motivation for change in treatment-resistant eating disorders. Clinical Psychology Review 18, 391–420.Google Scholar
Waller, G, Cordery, H, Corstorphine, E, Hinrichsen, H, Lawson, R, Mountford, V, Russell, K (2007). Cognitive Behavioural Therapy for the Eating Disorders: A Comprehensive Treatment Guide. Cambridge: Cambridge University Press.Google Scholar
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