Cognitions in Anorexia Nervosa: Changes at Discharge from a Cognitive Therapy Milieu Inpatient Treatment Program
Bowers, Wayne A., Ansher, Lynn S., Journal of Cognitive Psychotherapy
Cognitive-behavioral therapy (CBT) has been effective in the treatment of various disorders including bulimia nervosa. However, little is known about the effectiveness of CBT on treatment of anorexia nervosa. Thirty-two patients were treated for anorexia nervosa on an inpatient unit. They were evaluated before and after treatment by three measures assessing negative cognitions. The unit milieu was designed to use cognitive therapy principles with CBT being administered primarily in groups, supplemented with individual sessions. At discharge all patients had displayed significant cognitive change in their disorder. Also, at time of discharge, this group of patients had significant changes in their schemas and cognitive distortions consistent with a cognitive therapy perspective. Future research is needed to identify the effect of CBT on anorexia nervosa within a wide variety of treatment settings.
Cognitive-behavioral therapy (CBT) has been expanded to treat a wide variety of interpersonal problems (Freeman & Dattilio, 1992) including eating disorders. Using manualized interventions, CBT has consistently produced positive results in the treatment of bulimia nervosa (Agras, Schneider, Arnow, Raeburn, & Telch 1989; Wilson & Fairburn, 1993; Wilson, Fairburn, & Agras, 1997). However, much less is known about CBT as an intervention in the treatment of anorexia nervosa (Bowers & Andersen, 1994; Vitousek, 1996). Additionally, little empirical work has been done on change in cognitions based on a CBT model when treating anorexia nervosa. Lack of work in this area is related to the disorder's complex and often unyielding nature. Additionally, the longer duration of treatment and the necessity for inpatient care make this type of research difficult (Garner & Garfinkel, 1997).
A multidetermined model for anorexia nervosa has been developed that includes etiological factors related to biological, psychological, social, and cultural factors. Within this model, a cognitive-behavioral view of anorexia has been advanced (Garner, 1985; Garner &Bemis, 1982,1985; Garfinkel & Garner, 1982) and specific recommendations for treatment have been proposed (Garner, Vitousek, & Pike, 1997). The cognitive model views anorexia nervosa as a final common pathway of multiple events or experiences (Garfinkel & Garner, 1982). This model conceptualizes anorexia nervosa in a developmental framework with primacy on cognition mediating both distressed emotion and resultant abnormal behavior (Garner, 1985; Garner & Bemis, 1982, 1985; Garfinkel & Garner, 1982). Vulnerable individuals develop the idea that weight loss will somehow alleviate psychological distress and dysphoria (Garner & Bemis, 1982, 1985; Garfinkel & Garner, 1982). Dieting, weight loss, and attaining thinness become factors these individuals manipulate in an attempt to exercise control over their internal and external environments (Garner & Bemis, 1982, 1985). Continued weight loss becomes a sign of control leading to social criticism that is seen as threatening the patients' sense of internal and external control. Perceived criticism leads to increased social isolation that reinforces distorted cognitions and maladaptive behaviors of anorexia nervosa. The model focuses on developmental templates, such as schemas (Beck & Freeman, 1990, Freeman, 1993) and core beliefs (Beck, 1995) that consist of personalized idiosyncratic content and are activated during the disorder.
Vitousek (1996) notes that little research on the cognitive model for anorexia nervosa has been published. The current study specifically examined the cognitions of anorexia nervosa patients (automatic thoughts and schemas) before and after inpatient treatment on a specialized eating disorder unit. It was hypothesized that, upon discharge, there would be significant changes in the thoughts and beliefs of anorexia nervosa patients treated in this specialized eating disorder program. …