Introduction & Case Overview
The eating disorders are supposed to be the most widespread diseases of the modern world. In fact, they imply the behavioral disorders associated with food intake caused by the variety of the psychological factors. The eating disorders include a group of syndromes including anorexia nervosa, bulimia and other food intake disorders which may lead harmful outcomes for the health state of the individual. The eating disorders may follow as result of distress, such as the loss of the loved ones, accidents, surgery and emotional distress, especially in individuals predisposed to be overweight. The eating disorders belong to the complex psychological issues. Despite the variety of the scientific researches, the biological, behavioral and social foundations of these diseases remain elusive. Based on the Cognitive Behavioral Therapy, the following paper is aimed to provide the overview and treatment therapy of Lisa, a 40 year old divorced woman, who suffers from the eating disorder, leading to the overweight. Lisa consumes most of the calories night, making the particular preference to the sugar, carbohydrates and comfort food. The wrong nutrition pattern made Lisa to put over 20 lbs for the last month. Being the social worker of Wellness Weight loss Clinic, the key goal of the paper implies the creation of the action plan aimed to help Lisa to cope with stress and self-esteem issues in order to overcome the obesity and current eating disorder.
The Essence & Central Philosophy of Cognitive Behavioral Theory
The cognitive behavioral therapy belongs to the wide-spread form of complex therapy that combines the elements of the cognitive therapy with the achievements of the behavioral therapy. The cognitive approach assumes that psychological problems and disorders are caused by the inappropriate or illogical thoughts and beliefs of an individual as well as his dysfunctional stereotypes of thinking (Hofmann, 2011). The change of the abovementioned manner of thinking provides the background to the solution of the existing problems. In addition, the behavioral approach is based on the theory of changing human behavior through the promotion and reinforcement of desired behaviors and restriction of the undesirable forms of behavior. In other words, the cognitive behavioral theory is based on the notion that the human behavior is determined. It means that the inadequate forms are amenable to correction by usage of the induced processes of learning. Another important thesis of this theory implies the position that all forms of behavior can be observed, while the cognitive behavior obeys the laws of learning.
The key approaches of cognitive behavioral therapy include the following:
- The formation of skills to overcome the specific disorder, i.e. the therapy-based training aimed to cope with stress. It implies the process of training of the skills and actions which are recommended to perform in the stressful situations.
- The problem oriented approach. It views the human life as a process of the problems’ solution. The patients are trained to understand the problems occurred in the process of the social functioning and learn to develop effective ways of planning and evaluation of actions.
- The structural cognitive therapy, i.e. the therapy aimed to change the thinking and motor stereotypes trough the transformation of the patients’ behavior pattern.
The basic goals of cognitive behavioral therapy practice can be expressed as the following:
- The changing of the inappropriate behavior (for example, to increase social and assertive reactions etc.).
- The learning of decision-making (for example, drawing up a list of options);
- The development of effective social skills, particularly the ability to the personal assertion.
- The development of the ability to self-regulation.
- The removal of high anxiety through the development of the ability to relax.
- The development of capacity for self-regulation on the basis of changes in the surrounding environment.
The behavioral counseling is preceded by the diagnosis (the behavioral assessment) which involves a number of techniques and procedures. The behavioral assessment should clarify the problem issues, i.e. the psychological problems that cause the inappropriate behavior and disorders (Hofmann, 2011). Based on the behavioral assessment corresponding to the actual state of the client, the appropriate methods of correction and rehabilitation are determined and implemented.
The definition of the Client’s Identified Problems
At the moment Lisa suffers from the compulsive overeating. However, based on the information provided in the case, it can be stated that the current Lisa’s eaten disorder can become the result of the poorly healed bulimia in the patient’s history. Lisa had bulimia nervosa, i.e. the eating disorder, which is characterized by two main features such as an irresistible urge to overeat and vomiting, deliberately caused by the sick person (sometimes in conjunction with the abuse of laxatives) to prevent an increase in body weight.
Bulimia occurs as the result of certain diseases of the central nervous system, endocrine system or mental disorders. The desire to overeating may be manifested as one of the following forms:
- The absorption of large quantities of food due to the suddenly occurred appetite.
- The constant desire to eat without stopping.
- The night food hunger attacks.
It should be mentioned that the bouts of overeating are accompanied by a sense of agonizing hunger, general weakness as well as the pain in the epigastric area. Combined with the weakness of the nervous system, the excessive eating and forced cleaning of the stomach may lead to the serious complications from neurasthenia, destruction of relationships with the family and the loss of interest to the life.
The Influence of the Practice Model onto the Problems Definition
& The Identification of the Issues in the Assessment of the Client’s Situation
The abovementioned proves that Lisa’s bulimia has developed into the compulsive overeating, i.e. the eating disorder characterized by recurrent episodes of binge eating during which a person feels a loss of control and the process of eating. Unlike bulimia, the binge eating episodes caused by the compulsive overeating are not followed by the stomach cleaning, such as vomiting, inadequate physical activity or starvation. As a result, people suffering from binge eating are often overweight or obese. They also feel a sense of guilt and / or shame, which can lead to more bouts of overeating. The obese people, suffering from compulsive overeating, often have co morbid psychiatric disorders such as anxiety, depression and personality disorders. In addition, there is no doubt in the direct link between obesity, cardiovascular disease and hypertension.
The cognitive behavioral therapy is supposed to be the efficient tool to overcome Lisa’s eating disorders caused by the psychological factors. It can be stated that the modification of behavior is aimed at helping individuals to obtain their patterns of behavior, enabling to successfully operation in the environment. This is achieved through the implementation of socialization and educational programs, including the experience of the current situation of the patient’s life, which tend to turn into the positive learning experience. Such practice brings the patients the new knowledge of the situation, competence in the behavioral patterns and social roles in the various life situations.
The Hypothetical Plan of Actions & the Cognitive Behavioral Therapy
The treatment options to overeating or binge eating are similar to those used for the treatment of bulimia. The individual psychotherapy, especially psychoanalysis, is effectively used for the treatment of the major psychological problems associated with over-eating. The group therapy can also be recommended to Lisa as the tool to overcome the psychological stress and socialize (Foa, 2009). The usage of medications such as antidepressants, antipsychotics or mood stabilizers may help in Lisa’s treatment, eliminating depressed mood and anxiety as the symptoms often associated with the eating disorders. However, it should be mentioned that antidepressants do not help to combat some patients with possible relapse of eating disorders (Foa, 2009). Thus, Lisa is recommended the limited usage of the medications. In addition, the various forms of psychotherapy, including individual, group and family, can help to deal with the psychological causes of the disease. It should be noted that an integrated approach in the treatment of Lisa’s compulsive overeating involving the medical care and supportive psychotherapy is supposed to be the most effective. However, the result of treatment depends on the patient’s interest in the correction of the situation.
The Plan Implementation & Theory Challenges
The abovementioned plan of Lisa’s treatment proves that the key goals of social workers is aimed at building systems of reinforcement in the environment and assure the social support systems for the certain adaptive behaviors. In fact, the behavioral model of a social worker imply the action as an expert, teacher and guide, covering a wide range of adaptive, socializing, therapeutic functions.
The practice of social and cognitive therapy is presumably focused on learning disabilities through the observation and modeling through participation. It is important the real life performance of tasks that cause the patient’s fear (Dattilio & Freeman, 2007). The successful completion of these tasks serves as the mean necessary for the psychological changes. The simulation through participation includes the following steps:
- The consultant repeatedly simulates the action of causing fear. For example, if Lisa fears of being lonely or stressed, a consultant should make her stressed to cause the binge eaters episodes.
- The patients should produce the stressful action.
- The consultant helps the patient to overcome the stressful situation.
- The patient learns how to overcome the stressful situation without the assistance of the consultant. As a result, the behavioral disorder can be gradually reduced and removed.
3 Major Concepts of Cognitive Behavioral Therapy Theory
The set of the abovementioned recommendations to Lisa’s treatment proves that the major concepts of the cognitive behavioral therapy imply the following:
- The formation of skills to overcome the specific disorder through the process of training of the skills and actions necessary to perform in the stressful situations.
- The problem oriented approach based on the understanding of the problems occurred in the process of the social functioning.
- The structural cognitive therapy aimed to change the thinking and transform the patients’ behavior pattern.
The concept of the cognitive behavioral therapy is focused on the identification of the problematic thoughts occurred in the patient’s consciousness in the forms of negative automatic rules, thoughts and schemas. The usage of the cognitive and behavioral techniques in the process of treatment helps to reduce the patient’s problematic thoughts, helping to confront stressful factors as well as guiding Lisa in the process of learning of the new behavior pattern. Based on the Cognitive Behavioral Therapy, the paper provided the recommendations to treatment therapy of Lisa, a 40 year old divorced woman, suffering from the eating disorder, leading to the overweight. The proposed action plan will help Lisa to cope with stress and self-esteem issues in order to overcome the obesity and current compulsive overeating.