Posted by Mark Warren on Fri, Oct 23, 2009 @ 10:14 AM
One of the great tragedies of the mental health system is its labeling of those who have not responded to care as "treatment failures." The truth is the therapy may have failed, but the patient does not. This is obvious in all other areas of health care. When someone has cancer and is given chemotherapy that does not work we do not say they have "failed chemotherapy." Rather, we understand that the chemotherapy was wrong for this patient and their type/progression of cancer. This is also true with eating disorders. If you are not getting better, the problem is not that you are failing therapy; it is that the therapy is wrong for you. This is a central tenant of DBT that “therapy fails patients, patients do not fail therapy”.
One of the complications with treating eating disorders is that the illness itself causes distortions and difficulties with accepting the need for treatment. Effective therapy for eating disorders involves finding the motivation for change and working with your treatment team to make change happen. If you are in therapy for an eating disorder and have not yet found the reasons and motivations you need to get healthy, then it is unlikely that you will get better. Effective therapy therefore begins with developing the motivation to change, the commitment to doing the extraordinarily hard work ahead, and the orientation to what effective care will be for you. For treatment to be successful, these pieces must be in place.
Next week: The relationship between motivation and commitment and eating disorder therapy
Contributions by Sarah Emerman
Posted by Mark Warren on Fri, Sep 11, 2009 @ 11:53 AM
The term “evidence-based treatment” refers to therapy that has demonstrated statistically significant improvements or changes in behavior. In most kinds of healthcare, the only kind of treatment a person would accept is something that is evidence based. If someone was getting treatment for cancer, diabetes, or another life threatening illness, they would seek out care that had significant evidence that it worked. Unfortunately, the history of psychiatric treatment is filled with ineffective care used because it was marketed well or because there was nothing else available. Luckily this is no longer true.
Evidence-based therapy for the treatment of eating disorders has only existed for the past 15 years. Although various types of therapy have been proven to show progress in some clients, evidence to support any given treatment is not as good as we would like it to be. It is, however, better than it used to be. The major limitations to research are the short length of many trials in what we now know are long term illnesses, and the difficulty of doing randomized controlled clinical trials. Nonetheless, given that there was no effective treatment prior to 15 years ago, what we know now is a significant improvement.
For adults, evidence-based treatments include Cognitive-behavioral therapy, Dialectical-behavioral therapy,and Interpersonal therapy. If you are 18 years or older and are currently suffering from an eating disorder, these are the therapies to try first. If you are under the age of 18 and have anorexia, the Maudsley method is the only treatment that is evidence-based and should therefore be tried prior to any other treatment. We will cover each of these treatments separately over the next few weeks.
Next week: How can I tell if my therapy is working?
Contributions by Sarah Emerman