Webinar- Treatment of Obsessive Compulsive Spectrum Symptoms and Eating Disorders

Webinar Treatment of Obsessive Compulsive Spectrum Symptoms and Eating Disorders December 7 th , 2011 Erin McGinty, LPC, NCC Program Director, Anxiety Services Coordinator, and Primary Therapist Castlewood Treatment Center for Eating Disorders 800 Holland Road 636-386-6611, ext. 103 www.castlewoodtc.com

Prevalence of Co-Occurring Anxiety Disorders with Eating Disorders
Kaye et al. (2004) studied the co-morbidity of anxiety disorders in an eating disorder sample, and found the following:
Two-thirds of the subjects had one or more lifetime anxiety disorder
A majority of the subjects reported that their anxiety disorders preceded the onset of the eating disorder
The most common anxiety diagnoses were obsessive-compulsive disorder (OCD; 41%) and social phobia (20%)

Effects of a Co-Morbid Anxiety Disorder on Eating Disorder Symptomology
Clients with co-morbidity experience both a longer length of stay and an exacerbation of eating disorder symptoms such as:
Perfectionism
Obsessionality
Harm avoidance, including:
Higher degrees of worry, or anticipatory anxiety
Higher degrees of intolerance of uncertainty
Higher degrees of fatigue
Higher degrees of pessimism
Body image dissatisfaction
Higher scores on depression inventories

The Importance of Treating Co-Morbid Anxiety Disorders (Steinglass et al., 2010)
“ Studies report that individuals with anorexia nervosa endorse significantly higher levels of anxiety than healthy controls both while underweight and after weight restoration”
Trait anxiety has been identified as a differentiating factor between patients who remitted from anorexia nervosa
Trait anxiety as measured by the State-Trait Anxiety Inventory (STAI; Speilberger)
Symptom substitution

Elements of Clinical Anxiety
Fear Cues: Stimuli and situations that elicit anxiety
Maladaptive Beliefs: Exaggerated estimates of threat
Catastrophizing
Probability Overestimation
Safety Behaviors: “Actions intended to detect, avoid, or escape a negative or feared outcome” (Abramowitz, 2011)

Safety Behaviors (continued; Abramowitz, 2011)
Passive avoidance
Checking and reassurance seeking
Checking locks, doors, outlets
Information seeking
Reassurance seeking
Visual checking
Compulsive rituals
Handwashing
Repetition of standing up, sitting down
Praying

Safety Behaviors (continued; Abramowitz, 2011)
Brief, covert (mini) rituals
Safety signals
Cell phone when leaving house
Anti-anxiety medication
Keys
“ Safe” person

Eating Disorders as Obsessive-Compulsive Spectrum Disorders
Fear Cue: “Fear of fat” (Steinglass et al., 2010)
Maladaptive Beliefs: Irrational thoughts regarding food, weight, and shape; overestimation of the likelihood and consequences associated with the threat
Safety Behaviors: Passive avoidance, body checking, restriction, purging, compulsive exercise, calorie counting, food rituals

The Application of Anxiety Treatments to Eating Disorders
Outcome studies suggest that Exposure and Response Prevention Therapy (ERP) is an effective form of treatment for co-morbid eating and anxiety disorders:
“ Results indicate that CBT with a primary focus on ERP is a successful treatment approach for treating persons with both obsessive-compulsive disorder and an eating disorder. Significant changes in the severity of obsessive-compulsive symptoms, depressive symptoms, and eating disorder symptoms were noted (Adams, Riemann, Weltzin, & McGinty, 2007) .”

Exposure and Response Prevention Therapy
Exposure
Graduated, repetitive, and consistent exposure to situations and thoughts that provoke anxiety and distress
Situational/In vivo exposure
Imaginal exposure
While performing the exposure, the client imagines the feared consequence(s) of the exposure
The client remains exposed to the cue until the associated anxiety decreases
Goal is to achieve habituation, or the decrease in anxiety due only to the passing of time
Within-trial habituation
Between-trial habituation

Response Prevention
Refraining from behaviors that are meant to reduce anxiety
Behavioral rituals
Mental rituals
Avoidance
Clients learn that feared consequences of exposure are irrational
Example: Eat a feared food such as potato chips( exposure ), no purging/binging/exercise/restriction ( response prevention ).

Fear Hierarchy Formation
Generate a list of external and internal triggers that provoke anxiety and induce urges to engage in behaviors
Assess feared consequences if client was exposed to a trigger
Assess responses to feared situations:
Passive avoidance
Behavioral rituals
Mental rituals
Generate a list of feared situations
Ask the client to provide a subjective unit of distress (SUDS) rating for each situation

Examples of assignments to generate data:
Assign clients to create a list of the following:
“ Good/bad” foods
Avoided foods
Binge foods
Assign clients to complete a an exhaustive list of their ritual behaviors at the table, and to identify what purpose these rituals serve
Assign clients to write “A Typical Day…
… in my eating disorder.”
… in my exercise addiction.”
… in my OCD.”

Assign clients to write “The Worst Day of My Eating Disorder”
Assign clients to write out their exercise routine in exhaustive detail

Target Symptoms in the Treatment of Obsessive-Compulsive Symptoms and Eating Disorders
Body Image
Clothing avoidance
Mirror avoidance
Body checking
Femininity and sexuality
Food Rituals
Cutting of food
Mixing of food
Ordering and arranging of food on plate
Eating foods in a certain order
Counting rituals

Exercise Rituals
Ordering of exercises in a particular fashion
Specific number of calories burned, miles run, time exercised, repetition of weight exercises, etc.
Rigidity around exercise
Perfectionism
Need for symmetry and exactness
Ordering and arranging compulsions
Concern over mistakes and the interpretation of mistakes as failures
Doubts about the ability to accomplish tasks

Other Eating Disorder Rituals
Calorie counting
Avoidance
Feared foods
Binging
Purging
Rumination
Chewing/spitting
Laxative, diet pills, diuretic, ipecac abuse
Restriction

Psychoeducation
Providing a rationale for the model
Educating the client on the importance of follow-through with self-monitoring and exposure assignments
Self-Monitoring
Ban books
Exposure and thought records
Cognitive Therapy
Identify cognitive distortions and feared consequences of exposure
Based on the outcome, identify evidence for/against irrational belief
Reframing of irrational beliefs

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Webinar- Treatment of Obsessive Compulsive Spectrum Symptoms and Eating Disorders

by Castlewood Treatment Center on Dec 06, 2011

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