Lecture 1
CBT-E stages
1. (sessions 1-7) Intensive initial stage, 2x week appointments.
- Finding underlying maintaining factors (if you eliminate binges, you decrease the
chance of a purge quite a lot).
- Collaboration is critical
,- Standing on a scale once per week (making people less afraid of their weight, and
falsifying catastrophic beliefs, keeping a food diary (food + thoughts and feelings)).
- Normalize eating pattern (eating 6 times a day, 3 meals, 3 snacks eating every 3
hours) – doesn’t matter what you eat STRUCTURE more important than
CONTENT
2. (Sessions 8-9), weekly appointments
- Review progress, identify emerging barriers to change
- Modify the formulation and plan stage
- Treatment adjustment if needed, after this treatment is more personalized
3. (Sessions 10-17), main body of treatment, weekly appointments
- Address main maintenance mechanisms
- Personalized = paying attention to one or more factors at the time (often an
important one is the over-evaluation of shape and weight)
- Trying to find more things to put more value on (than body-image). Experiencing
other parts of life – big part of recovery
4. (sessions 18-20), final stage and focus shifts to the future, appointments at 2-week
intervals
- 2 aims: first one is to ensure that changes are maintained (therapy break – 20
weeks)
- Second aim is to minimize the risk of relapse in the long term (personalized
maintenance plan is made)
, Eating disorders in adolescent and young adult males: prevalence, diagnosis, and
treatment strategies (Limbers, 2018)
Eating Disorders group of illnesses marked by severe disturbances in eating behaviors.
Key feature – inappropriate weight control techniques
Prevalence:
- In US 5.5% of males manifested elevated ED risk
- In Canada 1.1% of teen males exhibited threshold ED (significant impairments in
psychosocial functioning)
- Significant increase in the prevalence of bulimia between the ages 14-20 years.
Male ED symptom presentation:
Adolescent and young adulthood are peak periods for development of EDs. 30% of males
report body dissatisfaction and utilization of unhealthy control behaviors.
Binge ED teen guys report less shape and weight concerns, drive for thinness and body
dissatisfaction than their females.
- white females desire to be thinner
- young adult males desire to be “bigger” more muscular (except for ED males)
Muscle dysmorphic disorder (DSM-5) individuals who have a preoccupation with
their appearance and are concerned that they are not sufficiently large and
muscular. Engaging in activities intended to enhance muscularity including dieting,
weightlifting, steroid drug use
Young adult males who present bulimic symptoms are less likely to engage in dieting,
laxative use, self-induced vomiting than females.
Males are also less likely to report eating emotional eating, and reporting a sense of loss of
control during a binge
Young male gays/bisexuals have higher rates of ED pathology.
, Mixed results/no support about that males are more likely than females to engage in
excessive exercises
ED Assessment:
- Contemporary measures were created for women, so a criticism is that items
capture stereotypically feminine indicators of ED pathology.
- Males score lower on EDE Global Score and Shape and Weight Concern subdomains.
Effect sizes – small to moderate.
Males less likely to endorse:
1. Wanting a flat/empty stomach
2. Being uncomfortable while eating in front of others
3. Eating in secret
4. Desire to lose weight
The domains of: Dietary Restraints and Eating Concern on EDE Global Score
EDAM (ED assessment for men) Stanford and Lemberg
5 domains: food issues, weight concerns, exercise issues, body image/appearance concerns,
disordered eating habits
EDAM has received early validation, but further research is needed to establish psychometric
properties .
Treatment Strategies:
1. Family-based behavioral treatment The only intervention that has been said to be a
well-established treatment for ED teens
Experimental:
1. Enhanced CBT
2. Dialectical behavioral therapy
