The Beautiful BodyCognitive Behavioral Therapy

Group Proposal

Anne Roach, Jenna Schmidt, Mai Thao, Leta Voigt

Purpose & Goals

• Modify underlying schemata in order to break self-perpetuating cycle of dieting, bingeing, and purging

• Monitor thinking and beliefs about food, body shape, and weight

• Repair maladaptive body image and self-esteem concepts

• Recognize connection between beliefs and behavioral consequences

Significance • Our culture tells people that their identity is defined by how they

look.

• Over 10 million people suffer from a form of eating disorder. – 90% of those who have eating disorders are women between the ages

of 12 and 25 (National Alliance for the Mentally Ill, 2003). – increasing number of older women and men suffering eating disorder. In

addition, hundreds of thousands of boys are affected by these disorders as well (U.S. DHHS Office on Women's Health, 2000).

• 42% of first to third grade girls want to be thinner

• 81% of ten-year-olds are afraid of being fat

• most kids with eating disorders began their eating disorder between the ages of eleven and thirteen.

NEDA, 2008

Treatment Overview

• Teaches– Illness and symptoms, predictions of occurrences– Monitoring

• Diary of eating episodes

• Binge eating

• Purging

• Events triggering episodes

– Handling daily problems– Exercises to reduce fears and concerns

Treatment Overview continue…

• Helps– Eat regularly– incorrect beliefs– self-defeating thoughts– behaviors

Why does group therapy work?

• Corrects poor eating habits• Prevents relapse• Change attitudes about food, eating and body image• Education• Universality• Support and acceptance• Interpersonal relations• friendship

Success Rate• CBT and Psychodynamic-interpersonal therapy (PIT) are comparable in results

– PIT: changes took longer to achieve full effect but after 1 yr comparable to CBT

– Behavioral therapy (BT): rapid in achieving change but short lived

• Drop out rate in 1-yr follow up – 48% of BT – 20% CBT but maintained their improvement and did not deteriorate

• Abstinence rate (Binge eating and purging): 5-yr follow-up– CBT 44%– PIT 52%– BT 18%

• CBT indicated higher success rate: 18-month follow-up– 68% ceased binging and purging– 22% showing improvement

(Schlundt & Johnson,1990).

Practical considerations

• Types of groups– Strictly anorexia nervosa

– Strictly bulimia nervosa

– Strictly binge eating disorder

– Mixture of all three or only two

Segregated/homogeneous group• Anorexics and binge eaters often complain about

being mixed in groups.

• They feel the cannot relate to each other

• They suffer from different illnesses

Types of Groups cont…Mixed/heterogeneous

• Anorexics and bulimics have many similarities that they seem to accept readily being mixed in a group setting (most common)

• Groups with anorexic, bulimics, and binge eaters are also prevalent

– Working premise: unnatural, self-destructive relationship with food and their bodies.

• Clients can look at each other’s strengths and weaknesses – See the many common themes or underlying psychological issues

they share

• Provide experiences that break through distortions in thinking that counselor or similar patient cannot

– Eg: Molly, a binge eater, said to Holly, an anorexic, “how could you sit there and say you are fat? I am fat. If you feel fat, that’s one thing, but to say you are fat is wrong.”

Considerations continued…

• Place, time, & size– 20 sessions, 1 x a week for 1.5 hours– 8-10 members (opt even number)

• Criteria for membership– Ages 11-14– Affected by eating disorder

Marketing Strategy

• Newsletters

• Radio

• Video clip– The True campaign

• http://www.youtube.com/watch?v=DvKOGKgboQo

– Reality• http://www.youtube.com/watch?v=94c43AlwLKo

– Anorexia bulimia contact• http://www.youtube.com/watch?v=qFbYW6bNViw

Referrals • School Nurse• School Counselor• Public Health Nurse• Social Services• Local Hospital or clinics• Social workers• Parents• Crisis Hotlines• Other service providers

Leader Statement

• This Group will be co-lead

• Leaders will be LPC with training in groups with an emphasis on adolescents

• Leaders will have an understanding of eating disorders

Resources for screeningResources for Eating Disorders and Weight Screening tools:Eating Attitude TestBody-ImageBody Image TestBody-Image Problem?Body and Self-Image RelationshipBody Mass Index CalculatorScoff Eating Disorders TestEating Disorder ScreeningEating Disorders: Is Your Child at Risk?Relative/Friend w/E.D?Friend at Risk of Eating DisorderCompulsive Overeaters TestSelf-Test for Compulsive OvereatingAre You Physically Fit?Nutrition AssessmentHealth and Fitness Calculator http://www.healthyplace.com/site/tests/

psychological.asp#eating_disorders

Scoff screening tool• 1. Do you make yourself sick because you feel uncomfortably full? • No Sometimes Often

• 2. Do you worry you have lost control over how much you eat? • No Sometimes Often

• 3. Have you recently lost more than 15 lbs. in a 3 month period? • No Yes• 4. Do you believe yourself to be fat when others say you are too

thin? • No Sometimes Often

• 5. Would you say that food dominates your life? • Not at all Somewhat Very much

Group Rules and Policies

• Confidentiality

• Respect for each other’s opinions

• No put-downs

• One person talks at a time

• Make a sign and post it that says:

“open, honest, loving, kind”

this is what is asked of each participant

Session 1: Introduction

• Purpose of the group• Introductions of members and leaders• Ground rules • An Icebreaker Activity

– encourages members to share personal information in a playful, nonthreatening way.

– inner/outer circle

Session 2: Control & Helplessness

• An Icebreaker Activity – encourage members that their questions are important. – Each member writes their name on a tag to wear and after

they say their name, they ask a question or make a comment.)• Confidentiality is re-defined and addressed to ensure

confidentiality in group and outside of group in school.• Dyads

– groups of 2: talk for 1 minute, then partners are asked to say something positive about the partner

• Comments / Homework Assignment– Each member is encouraged to write about their family story

and their place in the family to share in the following session.

Remaining Session topics• Session 3: Family and personal history regarding

food and weight• Session 4: Ability to nurture and be nurtured• Session 5: Expectations and Experiences with

Perfectionism• Session 6: Trust and Mistrust• Session 7: Introduce: Addiction and Disease• Session 8: “My feelings about Addiction & Disease”• Session 9: Anger and Assertiveness• Session 10: Healthy Eating

• Session 11: Separation and Individuation• Session 12: Body Mass Index (BMI)

Session Topics Cont.• Session 13: Changing Minds Not Bodies (Parents are

involved)• Session 14: Competition and Loneliness including

Guest Speaker (Parents are involved)• Session 15: Challenge by choice (Parents are involved)• Session 16: Relapse (Parents are involved)• Session 17: Body Image and Self (Parents are involved)• Session 18: Power of Language: to shape thought

patterns and actions (Parents are involved)• Session 19: Good thoughts, Good feelings, and

Goodbyes (Parents are involved)• Session 20: Final Termination (Parents are involved)

Evaluation Plan

• Participants will evaluate the group with personal interviews and/or written evaluations

• Parents and Teacher will complete a survey at the end of the 20 weeks

• 6 months and 1 year after termination, the group will meet again for 1.5 hours

References

• Corey, G. & Corey, M. S. (2006). Groups process and practice: 7th ed. Belmont, CA: Thomson Learning Inc. (pp. 293-360).

Healthy place. (2008). Retrieved October 19, 2008, from www.healthyplace.org

• Schlundt, D.G. & Johnson, W.G. (1990). Eating disorders: Assessment and treatment. Boston: Allyn and Bacon.