Prevalence & Features of Eating Disorders in Males – Part 8

As I mentioned before, behavioral activation is a very effective treatment for depression and other related mood problems.

Now, let’s talk about why we know that behavioral activation is a particularly good fit in the context of eating disorders.

First of all, we talked before about the significant overlap and comorbidity between depression and eating disorders.

We also know that, even if an individual who is struggling with an eating disorder isn’t experiencing mood-related difficulties that meet the diagnostic threshold for major depressive disorder or a different mood disorder, there’s still often very pronounced, mood-related disturbances.

In the context of eating disorders, we haven’t talked about this feature, but how we can go about addressing the extreme degree of overemphasis that we often see in terms of body shape and weight and eating disorders is to help one diversify their engagement in a good variety of different life activities such that their array of activities do not all center around the topic of body image.

It can also be helpful to counteract a lot of the significant functional impairment that we see as a common consequence of one being preoccupied with eating disorder related thoughts and worries as well as the engagement and a lot of those rituals or safety behaviors around eating.

We see that behavioral activation can be helpful in addressing that functional impairment finally and this is particularly helpful with our male patients.

When we see higher rates of excessive or compulsive exercising, behavioral activation can be a nice framework to go about trying to establish a more moderate healthy routine with regard to exercise and other forms of physical activity.

Behavioral Activation Treatment Steps

For treatment steps, we’ll start with a functional assessment, talk about some different ways that patients can engage in self-monitoring, and then move on to how we go about developing an activity hierarchy. We then progress through that hierarchy.

This process is similar to how we begin exposure-based therapy behavioral activation and, as such, again begins with a very careful functional assessment where we look at a couple of important different domains.

First, we want to look at how the patient may avoid, so, we want to ask questions such as:

• How do you respond to negative emotions when you’re experiencing them?
• How do you go about coping with negative life events when they occur?
• What types of ways do you avoid?

We also look at what types of important life activities the patient was more consistently engaged in prior to the onset of the difficulties that they’re having. To do this, we ask questions such as:

• Before you began to struggle with your depression or developed difficulties with your eating disorder what kind of life activities, what things, or what people were important to you?
• What were you doing more often prior to the onset of these difficulties?
• What kind of things add meaning to your life?
• What is it that really matters to you?
• In what direction do you want your life to be headed?

Finally, we want to assess any kind of current life stressors that may require some problem-solving. Essentially, what we’re looking for are current problems that may be standing in the way of the patient being able to activate himself more.

We’re encouraging them to engage in more enjoyable activities that current life stressors might prevent the patient from doing.

This is, consequently, how we can go about helping the patient in circumventing those stressors in the future.

Self-monitoring on the part of the patient is a very important component of behavioral activation. Our overarching goal is to help patients gain an improved awareness and understanding of a couple of important features.

First of all, we want patients to gain a better awareness of some of the avoidant patterns that they notice.

Another thing that can be really helpful that self-monitoring helps to facilitate is a better understanding of the relationship between the patient’s level of activity and the subsequent effect that this has on their mood.

There are a few different forms of self-monitoring and this gets back to the TRAP-TRAC Model that I described before.

There’s specific TRAP-TRAC monitoring that can be done with patients to help them understand how they might avoid different patterns.

Let’s talk about a log of what this might look like. The patient is asked to maintain a daily log where they identify different TRAP patterns. That is, instances wherein a Trigger occurs, and the individual engages in an Avoidance Pattern of coping.

This can also help the patient brainstorm where there may be more helpful TRAC responding that they could engage in as an alternative. This is where some of the more active forms of coping may come in handy

Let’s consider an example of this.

The triggering negative life event could be failing an exam, and it’s natural that one’s emotional response was feeling sad and somewhat hopeless about doing well on future exams.

One might respond to this negative life event by engaging in an Avoidant Pattern such as staying in one’s room, sleeping a lot more often, giving up on studying, not answering the phone, not getting together with friends

Now let’s consider the TRAC response in which the individual could engage.

Using Active Coping, the individual could respond to the same negative life event, failing an exam, and, though they feel sad and hopeless about doing well on future exams, they could work one-on-one with a tutor, go and speak with the professor about what was missed or what areas of the exam this individual really struggled with or finding a study partner.

This form of active coping might lead to a different response in the individual. By virtue of engaging in this more active form of coping, they might feel less depressed, might experience a greater sense of mastery over their behaviors, and ultimately might lead to a very different outcome next time.

As such, the next outcome might be that the individual improves and gets a better grade on the next exam. This is likely to be met with a very different emotional response, perhaps one of joy and mastery.

That emotional response, in-and-of-itself, is going to be reinforcing of the more active coping strategies, thereby making active coping much more likely and a more go-to response in the future.

A second type of patient self-monitoring, which we frequently use in the context of behavioral activation, involves activity monitoring.

This is as straightforward as the patient keeping a daily and hourly log of the relationship between the activities that they’re engaging in and their subsequent mood

Again, this helps to accomplish the goal of a patient gaining a better awareness of when their mood improves and when this is a result of increased activation.

In one of these logs, the left-hand column lists the different hours of the day and the right-hand column lists two things: the activity that they were engaging in during that hour of the day and a mood rating on a 0 to 10 depression scale, with 0 being the least depressed that an individual could feel and 10 being the most depressed that an individual could feel.

Let’s consider an example of an individual’s day.

They may log that the first two hours, from 8 to 10 a.m., their primary activity was laying in bed they reported feeling a nine on that zero to 10 depression intensity scale.

Then, as this individual took steps to activate themselves from 10:00 to 11:00 a.m., they talked on the phone with a friend. From 11:00 to 12:00, they got up and showered and brushed their teeth and then spent some time from 12:00 to 1:00 reading a mystery novel.

In these activities, the intensity of the depression seemed to lessen. It went to a six then up a little bit to a 7.5 and then all the way down to a 5.

This is helpful on a number of fronts.

First of all, you can see that the first two hours of this day is where we see the baseline data. We want to look closely for avoidance behaviors. Laying in bed seemed to be one way that this l particular patient went about avoiding.

Secondly, this can serve, in-and-of-itself, as good motivation to increase the patient’s engagement in different in life activities.

Hopefully, from this five-hour span of time, the patient would have gathered that “the more I activate, the less depressed I feel.”

We can use this information to relate back to the Behavioral Activation Model. This experience shows that, the more that we activate ourselves and the more effort we put forth to stay engaged with activities that are personally relevant, meaningful, and fulfilling to us, the more that we experience a more consistent positive mood.

Similar to Exposure-Based Therapy, in doing Behavioral Activation, we develop and implement what we call an “activity hierarchy.”

Our major objective here is to create a rank-ordered list of activities that the individual will engage in throughout the course of treatment.

We try to begin with assignments or different behavioral activation tasks that are going to be appropriate for a patient’s current functional level.

Expecting too much or having the patient take on too much early in the course of treatment might backfire and the patient might become overwhelmed and just throw in the towel and give up.

Throughout the course of treatment, we try to gradually increase the difficulty of moving through the hierarchy, encouraging greater and greater levels of activation.

As we’re moving through the hierarchy, we try to ensure a relative balance between the activities from the three different domains that we spoke of before: routine life activities, pleasurable or enjoyable activities, and value-driven activities

Our core objective here is to facilitate an increasingly diverse and stable source of positive reinforcement.

We want the activities to be things that are good from a variety standpoint and things that a patient can have access to and can implement in a stable fashion over the course of time.

In a completed activity hierarchy, the patient will hypothetically provide ratings on a zero to seven scale, zero being the least anticipated difficulty or distress and seven being the most anticipated difficulty or distress.

Similar to how we work through the exposure hierarchy, we start lower in the hierarchy and work our way up.

So, with the individual we mentioned earlier, we may get the ball rolling with behavioral activation by encouraging them to take on the following assignments:

• Getting out of bed every day at 8:30 a.m.
• Having a shower every morning
• Calling his best friend once a week

As the individual experiences greater mastery of these activities throughout the course of treatment, greater and greater levels of activation are sprinkled in.

For example, the individual might be willing then to spend five minutes a day picking up the bedroom or be willing to get out of bed an hour earlier in the morning.

It naturally follows that we just work upward through the hierarchy.

Maybe the individual takes on tasks like working on a college application or watching some kind of sporting event with friends, gradually working through so that most, if not all, of the activity hierarchy, is completed throughout the course of treatment.

Please See Eating Disorders in Males

Prevalence & Features of Eating Disorders in Males – Part 1
Prevalence & Features of Eating Disorders in Males – Part 2
Prevalence & Features of Eating Disorders in Males – Part 3
Prevalence & Features of Eating Disorders in Males – Part 4
Prevalence & Features of Eating Disorders in Males – Part 5
Prevalence & Features of Eating Disorders in Males – Part 6
Prevalence & Features of Eating Disorders in Males – Part 7

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Source:

Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html

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About the Presenter: Dr. Nicholas R. Farrell, Ph.D. is a licensed clinical psychologist who directs and supervises the treatment of patients in eating disorder programs at Rogers Memorial Hospital. Dr. Farrell specializes in the use of empirically-supported cognitive behavioral therapy (CBT) treatment strategies that are used to help patients in our eating disorders programs.

Additionally, Dr. Farrell is a regular contributor to scientific research on the effectiveness and dissemination of CBT for eating, anxiety, and mood disorders and has published over 20 peer-reviewed journal articles and book chapters. Dr. Farrell has been the gracious recipient of federal grant funding to study the role of social stigma in the context of eating disorders.

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About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on June 18, 2018.
Reviewed on June 18, 2018 by Jacquelyn Ekern, MS, LPC

Published on EatingDisorderHope.com