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

Abstract

A proportion of individuals given an eating disorder diagnosis describe the experience of an eating disorder 'voice' (EDV). However, methods for working with this experience are currently lacking. Voice Dialogue (Stone & Stone, 1989) involves direct communication between a facilitator and parts of the self to increase awareness, understanding, and separation from inner voices. Adapted forms of this method have shown promise in working with voices in psychosis. This study aimed to explore the experience and acceptability of Voice Dialogue amongst individuals with anorexia nervosa who experience an EDV. Nine women participated in a semistructured interview following a single Voice Dialogue session. Interview transcripts were analysed using interpretative phenomenological analysis (IPA). Three overarching themes were identified as follows: (i) "separating from the EDV";(ii) "better understanding of the EDV"; and (iii) "hopeful, motivated, and afraid of recovery". The majority of participants found Voice Dialogue acceptable and helpful for exploring their EDV. Whilst preliminary, the results suggest that Voice Dialogue has potential in terms of helping individuals establish a more constructive relationship with their EDV and motivating change. Further research is needed to build upon these findings. Implications for addressing the EDV using voice-focused interventions are explored.

Changes in the eating disorder voice over time and the association of voice characteristics at baseline with clinical symptoms in patients with anorexia nervosa

“…A possible explanation for the finding that greater malevolence (and lower benevolence) and severity of the eating disorder voice were associated with greater symptomatic change is that perceiving the eating disorder voice as invalidating, malevolent and as less benevolent might fuel a stronger motivation to challenge the eating eating disorder and achieve clinical change. This is in line with patients' narratives that realising the costs of the illness on themselves, and their lives motivates them to strive for recovery (Chua et al, 2022;Gregertsen et al, 2017).…”

“…Voice Dialogue is a particular type of chairwork which has been recently piloted in a case series of women with anorexia nervosa. Qualitative feedback from participants was encouraging; the dialogue was acceptable and helpful to explore the eating disorder voice (Chua et al, 2022).…”

“…It was also found that greater levels of perceived power, omnipotence and benevolence of the voice at the beginning of treatment predicted greater reductions in eating disorder symptoms; however, the sample size was small (14 patients). Findings add to cross-sectional and qualitative studies which document that patients' beliefs, attitudes and behavioural responses towards the voice might contribute to illness maintenance and/or recovery (Chua et al, 2022;Forsén Mantilla et al, 2018;Morrison et al, 2022;Pugh, 2016Pugh, , 2020, through the association of the voice's characteristics with core symptoms of the illness, such as negative eating cognitions, body mass index (BMI), illness duration and compensatory behaviours (Aya et al, 2019;Noordenbos & Van Geest, 2017).…”

Chairwork and the therapeutic relationship: Can the cart join the horse?

“…Other studies indicate that dramatizations are an effective way to modify distressing thoughts and beliefs (e.g., de Oliviera et al, 2012) and develop behavioral skills such as assertiveness (Lazarus, 1966). Interview methods have received comparatively less attention but have produced promising results such as increased insight, motivation, self‐compassion, and positive relationships with distressing inner voices (Chua et al 2021; Longden et al, 2022). Finally, studies suggest that interventions using chairwork are not only effective in the context of psychotherapy but also as a stand‐alone intervention (e.g., Trachsel et al, 2012).…”

Can We Predict Dissociative Experiences Based on Inner Speech in Nonclinical Population by Mediating Role of Sleep Disturbance?

“…Interestingly, the source of the experience in which the person feels they know and are analyzed by others may result from feeling and exploring ego elements that are quite different and more complicated than the self for a variety of reasons (Kate et al, 2021). In some cases, where the connection with the self is highly emotionally charged, this should promote the growth of some associated analytic experiences and alter the distance from some ego positions (Ling et al, 2022).…”