Therapeutic Interventions

1. Describe the history and current status of dysfunctional eating patterns. (1, 2)

2. Complete psychological testing or objective questionnaires for assessing eating disorders. (3)

3. List five occasions when the eating disorder has been triggered. (4, 5, 6)

1. Explore the client's history and current status of his/her eating disorder.

2. Confront client's minimization and denial of the eating disorder behavior and its related, distorted thinking.

3. Administer to the client psychological instruments designed to objectively assess eating disorders (e.g., Eating Inventory, Stirling Eating Disorders Scales, Eating Disorders Inventory [EDI]); give the client feedback regarding the results of the assessment.

4. Help the client see how negative feelings increase the probability of dysfunctional eating and addictive behavior.

4. Keep a daily feelings journal.

5. Identify distorted, negative thoughts that lead to eating-disordered behavior. (8, 9, 10)

6. Implement self-enhancing, realistic thoughts to replace distorted, self-defeated thinking. (11, 12)

7. Draw an outline of one's own body and ask for feedback about the accuracy of one's body image. (13)

5. Explore the specific circumstances that increase the probability of the client's eating disorder behaviors being triggered.

6. Review several eating disorder behaviors (e.g., gorging, purging, use of laxatives, excessive exercise) that occurred under stress, and help the client discover what he/ she could have done to cope more effectively, rather than to use food dysfunctionally in each situation.

7. Assign the client to write a daily journal of what emotions were experienced, why the feelings developed, and what actions resulted from the feelings.

8. Help the client to differentiate between distorted, self-defeating thoughts and self-enhancing, realistic thinking.

9. Use cognitive techniques to help the client identify his/her negative, self-defeating thoughts and how they lead to eating disorders and other addictive behavior.

10. Assign the client to keep a daily record of distorted, self-defeating thoughts.

11. Assist the client in building a list of 10 positive, reinforcing statements to use daily for self-enhancement.

12. Use cognitive techniques to help the client correct self-defeating thinking, and replace self-derogatory thinking with positive, self- enhancing statements.

13. Teach the client about his/her distorted, negative body image and ask him/her to draw an outline of his/her body; give feedback as to

Develop a written plan to decrease the frequency of impulsive eating or addiction behavior related to dysphoric moods. (4, 6, 14, 15, 16)

9. Verbalize an understanding of how fear of abandonment is expressed in eating disorders and addictive behavior. (17, 18)

10. Identify situations that easily trigger feelings of fear about weight and body image. (19)

the accuracy or distortion of the drawing.

4. Help the client see how negative feelings increase the probability of dysfunctional eating and addictive behavior.

6. Review several eating disorder behaviors (e.g., gorging, purging, use of laxatives, excessive exercise) that occurred under stress, and help the client discover what he/she could have done to cope more effectively, rather than to dysfunctionally use food or addictive behavior in each situation.

14. Help the client develop and practice coping skills to deal with dysphoric moods, rather than engaging in disordered eating or addiction behavior.

15. Teach the client how negative thinking, feeling, and acting lead to negative consequences; teach how positive thinking leads to positive consequences.

16. Teach the client self-control strategies (e.g., "stop, look, listen, and think") to control the impulse to engage in eating disorders and other addictive behavior.

17. Probe the relationship between the client's feelings of anger, sadness, or fear of abandonment and the eating disorder and other addictive behaviors.

18. Assist the client in identifying triggers for fear of abandonment, and possible historical causes for these feelings being so predominant.

19. Assist the client in identifying situations that trigger fear regarding weight and body image;

11. Verbalize five negative con- 20. sequences of eating disorder behavior. (20)

12. Verbalize alternative, construc- 12. tive ways to cope with feelings of anger, sadness, or fear. (12, 16, 21, 22, 23)

13. Five times this week, talk calmly to someone while feeling upset. (24)

process more adaptive messages to counteract the fear response.

Help the client understand the self-defeating, alienating consequences of being obsessed with weight.

Use cognitive techniques to help the client correct self-defeating thinking, and replace self-derogatory thinking with positive, self- enhancing statements.

16. Teach the client self-control strategies (e.g., "stop, look, listen, and think") to control the impulse to engage in eating disorders and other addictive behavior.

21. Develop with the client a list of constructive reactions to feelings of anger or fear (e.g., writing about feelings, talking to counselor, delaying expression for 24 hours, tracing feelings to one's own background, substituting physical exercise for outlet, practicing a relaxation exercise) that reduce impulsive acting out of feelings.

22. Use role-playing and modeling to teach the client to verbalize anger in a controlled, respectful manner, delaying the response, if necessary, to gain more control.

23. Help the client make a list of the people to call or visit when he/she becomes upset; role-play several situations where the client discusses a problem calmly.

24. Assign the client the task of talking to someone calmly while feeling sad, angry, fearful, or depressed.

14. Cooperate with a complete physical exam. (25, 26)

16. Cooperate with admission to inpatient treatment if a fragile medical condition necessitates such treatment. (28)

17. Attain and maintain balanced fluids and electrolytes, as well as resumption of reproductive functions. (29, 30, 31)

18. Meet with a physician to be evaluated for the need for pharmacological treatment. (32)

19. Take medications as prescribed and report any side effects to appropriate professionals.

20. Practice the healthy communication skills of listening to others, the use of "I statements," and sharing feelings. (35)

Refer the client to a physician for a complete physical exam.

Stay in close consultation with physician as to the client's medical condition and nutritional habits.

27. Refer the client to dentist for a dental exam.

28. Refer the client for hospitalization, as necessary, if his/her weight loss becomes severe and physical health is jeopardized.

29. Establish a minimum daily caloric intake for the client; solicit the client's agreement to consume these calories daily and to record this in a journal.

30. Assist the client in meal planning.

31. Refer the client back to physician at regular intervals if fluids and electrolytes need monitoring due to poor nutritional habits.

32. Refer the client to a physician to evaluate if psychopharmacologi-cal intervention is warranted.

33. Monitor the client's response as the physician prescribes and adjusts medication to maximize effectiveness and reduce side effects.

34. Direct the staff to administer medications to the client as ordered by physician and monitor for compliance, effectiveness, and side effects.

35. Teach the client how to listen, use "I statements," and share feelings; assign him/her to implement listening skills and "I message" communication in daily life, and then monitor, review, reinforce, and redirect as indicated.

21. Acknowledge how perfectionism leads to fear of rejection.

22. Make a list of 10 positive body characteristics. (38)

Practice relaxation techniques two times a day for 10 to 20 minutes per session. (39)

Complete a re-administration of objective tests of eating disorders as a means of assessing treatment outcome. (40)

Complete a survey to assess the degree of satisfaction with treatment. (41)

36. Assist the client in understanding how the need to be perfect leads to feelings of inadequacy; help him/her see positive and negative traits in himself/herself.

37. Challenge the extremes of the client's thinking about how he/she needs to be perfect to be loved.

38. Assign the client the task of listing 10 positive characteristics of his/her body; process the list.

39. Teach the client relaxation techniques (e.g., progressive relaxation, deep breathing, and/or guided imagery); urge implementation of relaxation techniques as a substitute for eating disorder or addictive behaviors during times of anxiety or stress.

40. Assess the outcome of treatment by re-administering to the client objective tests of eating disorders; evaluate the results and provide feedback to the client.

41. Administer a survey to assess the client's degree of satisfaction with treatment.

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