Applying emotion-focused therapy to work with the “anorexic voice” within anorexia nervosa: A brief intervention.

Abstract

Existent treatments for anorexia nervosa (AN) have produced dissatisfactory outcomes.Research suggests that many people with AN experience an internal 'voice' which is related to eating disorder symptoms and relapse. This study was designed to consider the feasibility and acceptability of a new emotion-focused treatment of AN, which is designed to work directly with the anorexic voice (AV) ('EFT-AV'). Six adult clients diagnosed with AN who were experiencing an AV and awaiting psychological treatment were recruited from an adult outpatient service. Informed by EFT and previous AV research, the intervention involved six weekly individual sessions which focused on transforming AV experiences and promoting self-compassion. Participants completed standardised measures of eating disorder symptoms, relating to the AV, illness beliefs, motivation to change, and hope of recovery. Participants were also interviewed at the conclusion of the intervention to ascertain their views of on its acceptability. Findings suggested good recruitment, retention, and treatment adherence which supported the feasibility of the EFT-AV intervention. Thematic analysis of participant interviews indicated the intervention was acceptable and tolerable. Future directions for the treatment of AN, including the potential value of EFT-AV as an adjunct to existing therapies, are discussed.

Interviewing anorexia: How do individuals given a diagnosis of anorexia nervosa experience Voice Dialogue with their eating disorder voice? A qualitative analysis

“…Accordingly, changing the ways individuals relate, respond to, and understand the EDV may support recovery and prevent relapse (Jenkins & Ogden, 2012; Tierney & Fox, 2010). Given that studies examining EDV interventions have reported promising outcomes (e.g., Dolhanty & Greenberg, 2007; Hibbs et al, in press; Mountford & Waller, 2006), developing voice‐related interventions may be an important direction for working with individuals with eating disorders.…”

A qualitative meta‐analysis of the clients' experiences of emotion‐focused therapy

“…All 11 studies examined clients' experiences of helpful aspects of EFT, while seven studies featured difficult but helpful aspects of EFT (Angus & Kagan, 2013; Elliott, 2013; Hibbs et al, 2020; Nødtvedt et al, 2019/ Stiegler et al, 2018/Stige et al, 2021; O'Connell Kent et al, 2020; Steinmann et al, 2017; Timulak et al, 2017), and six studies featured experiences of unhelpful aspects of EFT (Hibbs et al, 2020; MacLeod et al, 2012; Nødtvedt et al, 2019; O'Connell Kent et al, 2020; Steinmann et al, 2017; Stiegler et al, 2018; Stige et al, 2021; Timulak et al, 2017).…”

“…This meta‐category differs from the previous meta‐category in that it covers experiences that do not refer explicitly to the experiential techniques/nature of EFT. One client reported “I found it useful because it kind of gave you a way… of boxing up thoughts and feelings and starting to untangle some, yeah, the untangling process” (Hibbs et al, 2020, p. 14).…”

“…One client stated “… I want to go back and like do sessions…; I want to be like a guest speaker… I think everybody should go through this therapy…” (Angus & Kagan, 2013; p. 531) while another noted “I really believe that this treatment would benefit lots of people should this be rolled out. I would highly recommend it to anyone struggling to move forward” (Hibbs et al, 2020, p. 15).…”

“…This meta‐category was based on findings reported in four out of six meta‐analysed studies and referred to the clients' experiences of in‐session experiential work, especially chair work, as being difficult to engage with or unhelpful. Clients described how using empty chairs in‐session was not something they could engage with, and one client reported “I don't actually know how much of a difference it makes to be moving chair to chair” (Hibbs et al, 2020; p. 14), while another described their experience externalizing the inner critic as “I found that really, really hard because it does feel as though it's part of me most of the time so externalizing it was hard” (Hibbs et al, 2020; p. 14).…”