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Mod5 Art6 - Module 5 Article 6 TREATMENT HIGHLIGHTS EATING...

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Unformatted text preview: Module 5 --- Article 6 TREATMENT HIGHLIGHTS EATING DISORDERS Appetite Awareness Training (AAT) is found to be effective in the treatment of binge-eating disorder. In a preliminary study, 29 women with binge-eating disorder* were randomly assigned to 8 weeks of either AAT (see box below) or a waiting-list control group. The following were assessed prior to and following the 8-week study period: (1) frequency of binge-eating episodes, (2) incidences of undereating and overeating, (3) severity of bingeeating symptoms, (4) presence and frequency of urges to overeat in response to 5 different situations (relaxation, food present, hunger, reward, and negative feelings), (5) difficulty controlling eating in response to negative affect and in socially acceptable situations, (6) depression, (7) social anxiety, and (8) self-esteem. Patients receiving AAT reported greater reductions in both binge-eating episodes and overeating episodes than did those on the waiting list. For the 1-week period following treatment, 64% of patients receiving AAT reported no binges compared to 11% of those on the waiting list. Overall, AAT participants averaged 0.7 binge episodes during that week compared to an average of 5 binge episodes for patients on the waiting list. AAT participants (compared to patients on the waiting list) also reported greater reductions in urges to eat when food was present, when experiencing negative feelings, and when food was used as a reward. In addition, AAT participants experienced greater reductions in depressive and social anxiety symptoms. The authors note that, although weight loss is not a goal in this program, the significant reduction in overeating episodes indicates that AAT may be “particularly effective as a lead-in to a subsequent weight loss intervention for those participants who want to focus on weight loss once binges are under control.” The authors conclude that these results “provide initial support for the effectiveness of a form of cognitive behavior therapy utilizing appetite monitoring.” *Binge-eating disorder is not an official diagnosis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington DC: American Psychiatric Association, 1994). However, its inclusion as an official diagnosis has been proposed and research diagnostic criteria appear in Appendix B (p.731) of DSM-IV. Binge-eating disorder is characterized by recurrent episodes of binge eating, which DSM-IV defines as “eating in a discrete period of time an amount of food that is definitely larger than most individuals would eat under similar circumstances.” The episodes are accompanied by a sense of loss of control and distress over the behavior. In binge-eating disorder, compensatory behaviors (eg, fasting, purging, excessive exercise), if they occur, are not as frequent as they are in bulimia nervosa. Allen HN & Craighead LW. Appetite monitoring in the treatment of binge eating disorder. Behavior Therapy, 30:253-272, 1999. Appetite Awareness Training Appetite Awareness Training (AAT) is based on the assumption that binge-eating disorder results from losing touch with internal appetite cues (ie, hunger and fullness). In such cases, eating occurs in response to nonappetite cues (eg, being upset and/or following strict dietary guidelines) or in response to very strong appetite cues (ie, being very hungry before starting to eat and/or being very full before stopping). AAT is designed “to establish an eating pattern in which: (a) the individual responds primarily to moderate (rather than strong) hunger and fullness cues, and (b) eating in response to nonappetite cues is minimized.” Rather than focusing on food intake, AAT focuses on sensations of hunger and fullness, while noting the cues associated with starting and stopping eating. AAT focuses on four components and consists of eight 50-minute group sessions. Participants are given handouts describing these components and are encouraged to practice skills outside of the sessions. The four components are summarized below: (1) Education includes a description of cycles of maladaptive behavior associated with the development and maintenance of binge eating. These maladaptive cycles entail eating in response to factors other than appropriate internal hunger and fullness cues. (2) Self-monitoring is used to note sensations of hunger and fullness during eating episodes, and to note the cues associated with the onset and termination of each eating episode. Patients are given a self-monitoring form to keep with them at all times and to fill out as soon as possible following an eating episode. The goal is to increase awareness of moderate hunger and moderate fullness cues, and to prompt starting and stopping eating in response to those cues. (3) Problem-solving (identifying the problem, generating alternative solutions to the problem, and selecting the best alternative) is used to reduce episodes of binge eating and overeating. (4) Relapse-prevention education includes helping the individual to recognize that overeating or even binge eating may occur occasionally “given the role food plays in our social culture,” and to prepare for these occurrences. High-risk situations for overeating or binge eating are identified, and problem-solving skills are used to plan how to avoid or cope with those situations. Relapse prevention also focuses on minimizing reactions to lapses (eg, not skipping a meal to compensate for overeating) and replacing maladaptive thoughts (eg, “I’ve already messed up, so it doesn’t matter what I do now”) with adaptive problem-solving for the future. The Complete Practitioner wishes to thank author Linda Craighead PhD for providing additional information used in the preparation of this description. To obtain AAT materials (including client handouts, and forms for self-monitoring, problem-solving, and cognitive restructuring), write to Dr. Craighead (see address in article reference, above) and enclose $5 to cover costs. Dr. Craighead will be presenting a post-doctoral workshop on AAT at the American Psychological Association Convention in August 2000. © Copyright 2011 MWK Publishing LLC; from The Complete Practitioner: Mental Health Applications (Vol. 3, No. 1 -- January 2000) For next article, go to next page. ...
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