EDUCATIONAL THERAPY FOR EATING DISORDERS
Educational therapy, sometimes known as psycho-educational therapy, involves teaching people the facts they need to overcome their disorder. It is not always a substitute for psychotherapy but can be a very helpful adjunct to it.
Some of the best work in this field has come from eating disorder specialists at the University of Toronto. They recently conducted an important piece of research comparing the effectiveness of different treatments in reducing the symptoms of bulimia. Amazingly enough, they found that for the healthiest 40 percent of the bulimia patients, educational therapy-in the form of a short lecture course-was as effective as a much longer treatment involving individual cognitive-behavioral therapy. The lecture course gave information about bulimia as well as self-care strategies to help the patients learn how to return to normal eating habits. The findings of this research suggest that it makes sense to begin treating bulimia patients with educational therapy and reserve costly, time-consuming individual therapy for those who don’t get better after learning the facts about their disease.
I can think of few other illnesses in which there can be such a dramatic therapeutic response after taking the simple step of learning the facts. In the next few pages, let’s review some of these facts as they might be covered in a course of educational therapy.
Our society keeps turning up the pressure to be thin. As a result many women resort to severe dieting. Our bodies, however, operate under biological rules. Each of us has a certain predetermined weight range-the set point range-that our bodies fight to maintain. For many people, this range is higher than what society says is the “ideal standard” for beauty.
Excessive or constant dieting robs the body of the food it needs to maintain the weight it prefers. The body then turns up the volume on the “hunger” signals. The result: bingeing.
Some people then try to undo the damage by purging, which leads to a vicious cycle. The woman binges with less guilt, since she knows purging will protect her from gaining weight. And she binges because it’s easier to vomit with a full stomach. Purging also keeps the body in a constant state of semi-starvation and dehydration. The cycle leads to anxiety and depression, which the woman then attempts to relieve through further eating.
After prolonged disruption, a person’s body may lose its ability to control eating. A woman must then relearn what it means to feel hungry, how to eat properly, and when to stop eating. She also has to learn to feel comfortable and not feel anxious when her body returns to its natural set point weight range.
But how does she know what that range is? In other words, what should her “goal,” or target weight, be? That’s something educational therapy can show her. First, the weight should be such that she can maintain it easily. She should be able to stay at that weight without resorting to extreme dieting, which as we have seen promotes bingeing. Secondly, the goal should be an individualized weight, not one derived from statistical charts.
Actually, the best goal is really a “no-goal.” By that I mean the woman should stop thinking in terms of weights and numbers and concentrate instead on learning better habits. Through psycho-education, she learns how to eat reasonably, exercise regularly, and develop ways of coping with stressful feelings without using food as self-medication.
Reaching this no-goal, however, usually occurs at the end of therapy. There are lots of steps in between, some of which involve setting up concrete objectives and working to achieve them. For example, an anorexic needs to know how much weight she has to regain. Her target should be neither too high nor too low, and should be a range rather than a precise number. As a rule, I ask patients to reach roughly 90 percent of the stable highest weight they had prior to the onset of their disorder. Each patient is different, but many find they can reverse starvation and maintain a reasonable weight without subsequently feeling the urge to binge and purge.
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Tags: Weight Loss