Posts tagged with "cbt"

The app teaching anorexics to eat

More patients go into long-term remission by re-learning how to eat,
than through CBT or drugs

The Mandometer app connects to a weighing scale, and guides patients’ eating behavior by providing visual feedback. Redistributed under CC BY-NC-ND 3.0 from J Vis Exp. 2018; (135): 57432.

Swedish scientists say that eating disorders should be considered just that – eating disorders, rather than mental disorders. The proof, they say, is in the eating.

“Anorexic patients can learn to eat at a normal rate by adjusting food intake to feedback from a smartphone app,” says Per Södersten, Professor at the Karolinska Institute and lead author of an article in Frontiers in Neuroscience defending his pioneering method. “And in contrast to failing standard treatments, most regain a normal body weight, their health improves, and few relapse.”

The approach is based on the theory that slow eating and excessive physical exertion, both hallmarks of anorexia, are evolutionarily conserved responses to short food supply that can be triggered by dieting – and reversed by practicing normal eating.

Which came first: the diet or the anorexia?

Attempts to treat anorexia as a mental illness have largely failed, claim the authors.

“The standard treatment worldwide, cognitive behavioral therapy (CBT), targets cognitive processes thought to maintain the disorder,” explains Södersten. “The rate of remission from eating disorders is at most 25% one year after CBT, with unknown outcomes in the long-term. Psychoactive drugs have proven even less effective.”

Instead, they say, we need to flip our perspective: to target eating behaviors that maintain dysfunctional cognitive processes.

“This new perspective is not so new: nearly 40 years ago, it was realized that the conspicuous high physical activity of anorexia is a normal, evolutionarily conserved response – i.e., foraging for food when it is in short supply – that can be triggered dietary restriction.

“In striking similarity to human anorexics, rats and mice given food only once a day begin to increase their running activity and decrease their food intake further to the point at which they lose a great deal of body weight and can eventually die.”

More recently, the theory has been elaborated and validated by studies of brain function.

“We find that chemical signaling in the starved brain supports the search for food, rather than eating itself,” reports Södersten.

How to eat

To prove that the evolutionary perspective works in practice, Södersten and his team have put their money where their (patient’s) mouth is. Their private clinics – which reinvest 100% of profits into research and development – are now the largest provider of eating disorders services in Sweden.

“We first proposed teaching anorexics to eat back in 1996. At the time, it was thought that this was misplaced and even dangerous; today, no-one can treat patients with eating disorders in the Region of Stockholm without a program for restoring their eating behavior.”

At the Mandometer clinics, the control of eating behavior is outsourced to a machine that provides feedback on how quickly to eat.

“Subjects eat food from a plate that sits on a scale connected to their smartphone. The scale records the weight loss of the plate during the meal, and via an app creates a curve of food intake, meal duration and rate of eating,” explains Södersten. “At regular intervals, a rating scale appears on the screen and the subject is asked to rate their feeling of fullness.”

“A reference curve for eating rate and a reference curve for the feeling of fullness are also displayed on the screen of the smartphone. The subject can thus adapt their own curves in real time to the reference curves, which are based on eating behavior recorded in healthy controls.”

Through this feedback, patients learn to visualize what normal portions of food look like and how to eat at a normal rate.

Satisfying results

The method has now been used to treat over 1500 patients to remission by practicing eating.

“The rate of remission is 75% in on average one year of treatment, the rate of relapse is 10% over five years of follow-up and no patient has died.”

This appears to be a vast improvement compared to the current best standard treatment of CBT. All the more so, considering that overall Södersten’s patients started off sicker than average.

“The difference in outcome is so big that, according to our medical statistician, a randomized control trial [RCT] is now redundant. Nevertheless, we invite a head-to-head RCT by independent researchers – so far, there are no takers.”

Handling Your Anger

5 STEPS TO UNDERSTANDING YOUR ANGER AND HANDLING IT EFFECTIVELY IN INTERPERSONAL RELATIONSHIPS

Anger can be a normal and healthy emotion. So why is it often so problematic? Here are a few signs that your anger may be harmful rather than helpful:

  • I’m often told I have a “bad temper”
  • Others distance themselves from me when I’m angry
  • Expressing anger leads to fighting
  • I don’t feel understood when I’m angry

Let’s take some time to understand anger in a different way.

As normal and as common as anger is, the emotion is frequently misunderstood and mishandled. In today’s day and age, we are taught that we are supposed to let others know exactly how we feel, which can be helpful at times; however, expressing anger is complicated for two main reasons. First, because it is often a secondary emotion, meaning that people often use anger to mask more vulnerable feelings such as hurt disappointment or fear. These feelings may be frightening because they can leave us feeling weak and helpless. This may cause us to resort to showing anger instead so that we can maintain a sense of control. Second, anger can be problematic because expressing anger, in the wrong way, can trigger fear, defensiveness and anger in the recipient. This may cause the other person to begin to protect him or herself instead of trying to understand you.

So What Is Anger?

In its purest form, anger can be a natural response to feeling purposely violated or wronged in some way. When we believe that someone has intentionally violated us, anger can give us the energy to stand up for ourselves. However, the way in which we understand and express our anger can either cause constructive or destructive results.

If expressing anger leaves you feeling misunderstood, or others feeling hurt, angry or shut down, these tips may help.

1. TAKE A MOMENT TO BREATHE

When you notice that you are feeling angry, slowing down your breath can give you a sense of self-control and peace. This will give you time and space to think about your process so that you don’t go on autopilot. If you feel tension in a particular part of your body, breathe relaxation into it.    

2. NOTICE WHAT YOU ARE FEELING

Notice the thoughts that are passing through your mind and the emotions in your body. Is there a tinge of sadness or fear? Are you longing for something? Do you need reassurance? Because many people fear that the other person won’t be there for them in the way they need, these softer feelings often get ignored.  

3. DISCUSS YOUR CONCERNS

Let the other person know that you have some apprehension about sharing your feelings because you fear that he or she won’t be receptive. For example, you may say something like “It’s hard for me to tell you what I need because I think you will judge me.” Once this is in the open, discuss this with the other person until you feel safe enough to share your more vulnerable feelings.

4. BE WILLING TO ADDRESS THE SOFTER FEELINGS

Acknowledging feelings such as loneliness and the desire for acceptance and appreciation can trigger feelings of vulnerability. However, expressing these feelings can connect you to others. When you let someone know your needs, if the dynamic is healthy, the other person will likely try to understand them and help search for a viable solution.

5. BE SOLUTION ORIENTED

Think about your intentions. What are you trying to accomplish by addressing your anger with others? Are you trying to hurt them in the same way you believe they hurt you? If so, this can feed into a destructive pattern of fractured relationships. On the other hand, if your goal is to resolve the issue so that you can build trust and harmony with the other person, then addressing your anger can be helpful. See my blog on Conflict Resolution for detailed steps on how to address conflict.

Understanding and addressing your anger in a way that restores harmony in your relationships can be easy when we focus on the right thing. Call me today for a free consultation so that I can help you change your relationship with anger from one that is harmful to one that creates peace.

 

About Dr. Crystal Clements:

Dr. Crystal Clements is an adjunct professor and registered psychological assistant who practices in Downtown Los Angeles at Sync Counseling Center. She works with adults, adolescents, couples and families to treat depression, anxiety, grief, trauma, and relational issues. She loves what she does and is passionate about helping people feel good about themselves and life. Dr. Crystal earned a PhD in Clinical Psychology with an emphasis in Family Studies and MAs in Psychology and Christian Leadership from the Fuller Graduate School of Psychology. She earned a BA in Communications from the University of Pennsylvania. As part of her training, she completed an APA accredited internship in Health Service Psychology at California State University, Fullerton.

Contact her today for a free 15 minute consultation!