This book describes the application of cognitive behavioural principles to patients with a wide range of eating disorders - it covers those with straightforward problems and those with more complex conditions or co-morbid states. The book takes a highly pragmatic view. It is based on the published evidence, but stresses the importance of individualized, principle-based clinical work. It describes the techniques within the widest clinical context, for use across the age range and from referral to discharge. Throughout the text, the links between theory and practice are highlighted in order to stress the importance of the flexible application of skills to each new situation. Case studies and sample dialogs are employed to demonstrate the principles in action and the book concludes with a set of useful handouts for patients and other tools. This book will be essential reading for all those working with eating-disordered patients including psychologists, psychiatrists, nurses, counsellors, dieticians, and occupational therapists.
Discussion:The improvements in this 'real-world' trial of CBT for adults with bulimic disorders mirrored those from large, funded research trials, though the conclusions that can be reached are inevitably limited by the nature of the trial (e.g., lack of control group and therapy validation).
Previous research has shown that patients with eating disorders have a characteristic cognitive bias, making internal attributions when evaluating negative events. However, there is less clarity about their attributions for positive events. There are suggestions that this cognitive style might be influenced by depressed mood. This study examines attributional style in the eating disorders for positive and negative events, independent of covariant effects of depression. Twenty-five eating-disordered women and 26 nonclinical women each completed measures of attributional style, depressed mood, and eating pathology. They also completed a measure of verbal intelligence (to ensure comparability of groups). Women with an eating disorder had a greater tendency to attribute negative situations to the self when compared with nonclinical women, even when differences in depressed mood were controlled for. There were no comparable differences in positive attributional biases. Women with an eating disorder adopt a self-blaming style when evaluating negative events, and such self-blame is likely to contribute to the maintenance of an eating disorder. This suggests that therapy for the eating disorders should include an element that focuses on highlighting and re-evaluating such interpretations.
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