Hendrik Hinrichsen

Social anxiety and coping strategies in the eating disorders.

Studies of social phobia in the eating disorders have demonstrated high comorbidity with both anorexia and bulimia nervosa. This study examined levels of social anxiety across different types of eating disorders, and determined the association of such anxiety with specific forms of emotional regulation. One hundred fourteen females who met DSM-IV criteria for an eating disorder and a comparison group of 50 nonclinical women completed three self-report questionnaires, which measured bulimic behaviours, dissociation, and social anxiety. The clinical groups reported higher levels of social anxiety than the nonclinical group. In both the nonclinical individuals and the bulimia nervosa patients, social anxiety was found to be associated with higher levels of bulimic psychopathology. By contrast, social anxiety in the restrictive anorexic group was linked to higher levels of dissociation. The present findings highlight the clinical importance of addressing social anxiety in eating-disordered individuals, and suggestions are made for the treatment of different forms of emotional regulation in such cases. Implications for future research are also discussed.

Social Anxiety and agoraphobia in the eating disorders: Associations with core beliefs

The eating disorders have a high comorbidity with anxiety disorders, but it is not clear what cognitions underpin those anxiety symptoms. The present study investigated whether social anxiety and agoraphobia in eating-disordered individuals are associated with different types of unconditional core beliefs. The participants were 70 women meeting DSM-IV criteria for an eating disorder. The short version of Young’s Schema Questionnaire (YSQ-S) was used as a measure of core beliefs, while the Social Phobia and Anxiety Inventory was used as a measure of levels of social anxiety and agoraphobia. Eating-disordered individuals reporting high levels of comorbid social anxiety had higher abandoment and emotional inhibition core beliefs. In contrast, patients with high levels of agoraphobia had higher vulnerability to harm beliefs. The findings highlight the importance of identifying and addressing core beliefs in subgroups of eating-disordered individuals presenting with comorbid anxiety. Implications for future research are discussed, including the need for longitudinal studies to elaborate on the specificity of the cognition-anxiety link in the eating disorders.

Triggers of Self-Induced Vomiting in Bulimic Disorders: The Roles of Core Beliefs and Imagery

Recent evidence has suggested a specific role for core beliefs in the triggering of bulimic behaviors. However, less is known about the role of imagery in this link despite its role in other disorders. The present study aimed to investigate the potential roles of core beliefs and imagery in triggering self-induced vomiting. Thirty bulimic women took part in a semistructured interview focusing on their mental processes prior to vomiting and completed a self-report measure of core beliefs. The results showed that prior to vomiting, a clinically significant proportion of bulimic patients reported thoughts relating to defectiveness/shame, failure, and social isolation core beliefs and associated feelings of shame and anxiety. Most patients perceived these feelings as triggers to their vomiting. A large number of bulimic patients also reported experiencing visual images prior to vomiting, and those images tended to be recurrent and linked to adverse life experiences. Overall, the findings suggest that defectiveness/shame, failure, and social isolation core beliefs and recurrent negative images (linked to adverse life experiences) may play important roles in the triggering of self-induced vomiting in bulimic disorders.

Core beliefs and social anxiety in the eating disorders

Social anxiety is a common comorbid problem in the eating disorders. The present study investigated whether specific types of core beliefs are common in eating-disordered individuals presenting with high levels of social anxiety. The participants were a group of 191 women meeting Diagnostic and Statistical Manual-IV (DSM-IV) criteria for an eating disorder. Young’s Schema Questionnaire (YSQ-S) was used as a measure of core beliefs, while a brief version of the Fear of Negative Evaluation scale (Brief FNE) was used as a measure of social anxiety. The results showed that eating-disordered individuals with high levels of comorbid social anxiety report higher levels of socially-oriented core beliefs (abandonment; defectiveness/shame) than those who experience low levels of social anxiety. The findings highlight the potential importance of addressing core beliefs in specific groups of eating-disordered individuals. Implications for future research and clinical practice are discussed.

Clinical and psychometric validation of an extended version of the Testable Assumptions Questionnaire (TAQ-ED-R).

OBJECTIVE Testable dysfunctional assumptions are a central aspect of the cognitive profile of patients with eating disorders. These are conditional beliefs that can be challenged directly using techniques such as behavioural experiments and surveys. Recent research has suggested that such assumptions fall into three classes (assumptions about ones body, ones feelings and the world), but the emerging scale had only relatively few items. The present study examines the clinical and psychometric utility of an extended version of that scale--the Testable Assumptions Questionnaire-Eating Disorders-Revised (TAQ-ED-R). METHOD The TAQ-ED-R and the Eating Disorders Examination-Questionnaire (EDE-Q) were administered to 200 women--72 with eating disorders, and 128 with no eating disorder. Differences between anorexic, bulimic and non-clinical women were examined, and associations with EDE-Q scores were tested. RESULTS The three subscales had adequate to good internal consistency across all three samples. The two clinical groups reported relatively high levels of testable assumptions, but there was no difference between the anorexic and bulimic women on the overall scale. Although all three forms of testable assumption were associated with levels of eating pathology, assumptions relating to ones body were the key correlate. DISCUSSION The TAQ-ED-R is a clinically useful measure of dysfunctional assumptions that can be tested with the help of behavioural experiments and surveys. It will be important to test the predictive validity of the new measure, as well as its capacity to drive treatment for comorbid states, such as alexithymia and social anxiety.

Beating Your Eating Disorder: a Cognitive-Behavioral Self-Help Guide for Adult Sufferers and their Carers: General points to help normalize your food intake

academic work 175; see also cognitive changes acceptance, of body image 84, 87, 91 accreditation of clinicians 121 achievement, sense of 26 action (starting to change) 25; see also time for action active listening 104–5 advantages of eating disorders see pros and cons Aesop’s fable 104 alcohol 2, 60, 69 alertness 151; see also cognitive changes anorexia; see also eating disorders complications 156–8 physiology (biology) 54 Anorexics and Bulimics Anonymous 149 anticipating obstacles 35–6 anti-contemplation 24, 104 anxiety 34, 48, 141 carers 102 CBT self-help program 49–50 challenging 71 exposure 78–9 apathy 151; see also cognitive changes application to self-help program xii–xiii, 13, 48, 59, 106; see also making time for therapy approaching the sufferer 100 assertiveness 38 assessment, preparation for forma 115–16 assumptions, dysfunctional see beliefs atypical cases 6, 12, 19 Australian organizations, eating disorder support 149 automatic thoughts/behavior 60, 71, 72, 75 avoidance 49, 88, 99; see also safety behaviors

Beating Your Eating Disorder: a Cognitive-Behavioral Self-Help Guide for Adult Sufferers and their Carers: Have I done myself permanent damage?

Preface: read this bit first Part I. Getting Started: 1. Who is this book for? 2. The key elements of cognitive-behavioural therapy and the self-help approach 3. How to use this book Part II. For the Sufferer: 4. Am I making a fuss about nothing? 5. Motivating yourself to treat your eating disorder 6. Is now the time to act? 7. Getting started with CBT Part III. The CBT Self-Help Programme: 8. Start here: how to use this programme 9. The practical steps of CBT for your eating disorder Part IV. For Carers: 10. Am I to blame for the eating problem? 11. What can I do to support the sufferer? Part V. Transitions into More Formal Help: 12. Thinking about getting more formal therapeutic help 13. Starting the process of getting formal therapeutic help 14. What to look for in a good CBT practitioner 15. The role of carers in the transition to more formal help Part VI. Letting Go of the Eating Disorder: 16. The journey of recovery 17. Relapse prevention 18. Have I done myself permanent damage? 19. Carers need to move on too Conclusion: eating normally again References and further reading Appendices Index.

Cognitive Behavioral Therapy for Eating Disorders: Acknowledgments

This book describes the application of cognitive behavioral principles to patients with a wide range of eating disorders: it covers those with straightforward problems and those with more complex conditions or comorbid states. The book takes a highly pragmatic view. It is based on evidence published, 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 dialogues 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, occupational therapists, counsellors and dietitians.

Cognitive Behavioral Therapy for Eating Disorders: Frontmatter

This book describes the application of cognitive behavioral principles to patients with a wide range of eating disorders: it covers those with straightforward problems and those with more complex conditions or comorbid states. The book takes a highly pragmatic view. It is based on evidence published, 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 dialogues 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, occupational therapists, counsellors and dietitians.

Cognitive Behavioral Therapy for Eating Disorders by Glenn Waller

This book describes the application of cognitive behavioral principles to patients with a wide range of eating disorders: it covers those with straightforward problems and those with more complex conditions or comorbid states. The book takes a highly pragmatic view. It is based on evidence published, 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 dialogues 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, occupational therapists, counsellors and dietitians.