Introduction
Eating disorders are at increase in recent times and there are many interventions of researchers to assess and understand the recent steady growth of the incidences.
This paper presents the group proposal for the treatment of the adults who are affected by eating disorders. It has addressed various topics, such as the application of group therapy for eating disorders, rationale for the group proposal, literature review and design of a group proposal.
Application of group therapy for eating disorders
Eating Disorders can be defined as “Excessive concern or obsession with weight gain and a need for control are earmarks of eating disorders, which include anorexia nervosa, bulimia, under eating, and binging.” (Kienlen, 2008, Eating disorder, para.1). “Any eating disorder that does not fit the full diagnostic criteria for anorexia or bulimia is classed as NOS.” (Busko, 2007, Presence of unspecified eating disorders investigated, para.1).
In group therapy or group psychotherapy, one or more therapists interact with a group of clients in a group. Group therapy is one of the best treatment processes for eating disorders. There are different types of group therapeutic techniques that could be used for eating disorders.
They are, recognizing the connection between the cognition or beliefs and behavioral changes, recognizing the behavior paradigms and formulating strategies for behavioral change, assessing and developing the interpersonal relationship using the interpersonal therapeutic technique and psycho educational groups to impart information on the disorder, and question and answer session.
In cognitive therapeutic technique, the client will learn how to control the thought about food, body shape and weight and the client will realize maladaptive body image. The client will learn to plan meal, problem solving and self control. In interpersonal therapeutic technique, the client will learn to control tension, gain of self-esteem and to bring sense of stability.
Psycho education means developing other coping strategies instead of eating as coping, cultivating perfectionism and self esteem, enhancement of body image and setting of goal. Three of these therapeutic techniques can be used in the group therapy for eating disorders.
A variety of techniques are used in group therapy such as group feelings, lectures, art therapy, recreate therapy, cognitive therapy, guided imaginary relaxation, body image workshops, spirituality groups, twelve step group, relapse prevention, anger management, nutritional education, stress management, relationship group and dialectical behavioral therapy.
There are a number of benefits out of group therapy for eating disorders among adults, such as more information about the problem, normalizing which means the affected clients will think that they are not alone in this world affected by the disease, support and acceptance from group members, developing interpersonal relationships and avoiding unhealthy behaviors.
Rationale for the group proposal
More adults are recently diagnosed having anorexia nervosa and bulimia nervosa and a number of adults remain having various eating disorders without diagnosis. Today, dancers, entertainers and models are longing for reduction of body weight and thereby they address the issue of malnutrition. The eating disorders are mainly related to value system of the society.
It is reported that some of the ethnic groups in America cherish the value of making the body lean. The adults and children address various issues associated with eating disorders, such as anorexia nervosa, bulimia nervosa, binge eating disorder etc. Therefore, group therapy for the adults for eating disorders has an immense significance today.
Review of the literature
Binge eating disorder is characterized as more number of intake of food every day. They are clinically diagnosed as obese. People who are affected with this problem often have the habit of intake of food very rapidly, intake of large amount of food and guilt feeling after having large amount of food.
Binge eating disorder is “an eating disorder marked by repeated episodes of binge eating and a feeling of loss of control. The diagnosis may be based on a person’s having an average of at least two binge-eating episodes per week for six months.” (Eating disorder medical glossary, 2006, Binge eating disorder, para.1).
Anorexia nervosa is an eating disorder in which a person remains loath to take food thinking that he will become too much fat if he takes food. “An estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime.” (Anorexia nervosa, 2009, para.1).
The major symptoms shown by them are not letting the body to be fatter above the normal level, increased fear of getting too much fat and irregular and absence of menstrual episodes. The mortality rate of the people who are affected with anorexia nervosa is 0.56% annually. There is a connection between sexually abused females and development of anorexia nervosa.
“It is estimated that 2% of adults have binge eating disorder, or approximately 1 to 2 million Americans. Binge eating is more common among obese people and among adults who have experienced yo-yo dieting (a repeated cycle of weight loss followed by weight gain).” (Engel, Reiss & Dombeck, 2007, para.2).
It is reported that there is steady increase in the cases of anorexia nervosa and it is the prime time of making available the treatment for anorexia nervosa which has a great connection to the physical abuse of the client. “There has been a steady increase in the reported incidence of male anorectics, from approximately 5% in 1985 (DSM III) to as much as 10% in 1987 (NIMH, 1987).” (Felicia, 1994, para.1).
Bulimia nervosa is an eating disorder in which a person has recurrent periods of eating pattern of high amount of food. They use inappropriate methods to reduce their fat, like self-induced vomiting, excessive exercise and fasting. “An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime.” (Bulimia nervosa, 2009, para.1).
A research on the current knowledge about the psychotherapy in dealing with bulimia nervosa was conducted by Mitchell J E, Hoberman H N, Peterson C B, Mussell M and Pyle R L and published in ‘international journal of eating disorders’. In the result of their study they speak that “the existing research data speak convincingly to the efficacy of cognitive behavioral treatment (CBT).” (Mitchell, Hoberman, Peterson, Mussell, & Pyle, 1996, Results, para.1).
Group therapy is one of the effective methods in treating binge eating disorder and there are various types of therapeutic techniques in group therapy. Therapists made a study to assess the effectiveness of the therapeutic techniques.
There were three groups, first group following the psycho therapy where the psycho therapist has a pertinent role; second group was assisted by a psycho therapist but his role was nominal; and the third group was self-help group.
The first group that was led by psycho therapist was given psycho education in the first part of each session and the second part was allowed for discussion.
In the self-help group, the participants were the facilitators and they watched video clips for psycho education. The researchers divided the adults into three groups and assigned to a control group. The researchers tested the adults of each group before starting the therapy in order to assess the decrease of the severity of the problem.
The objective of the researchers was to evaluate the effectiveness of the treatment methods. “At end of treatment, the therapist-led (51.7%) and the therapist-assisted (33.3%) conditions had higher binge eating abstinence rates than the self-help (17.9%) and waiting list (10.1%) conditions.” (Grohol, 2009, para.7).
So, the researchers found that the first group showed more improvement and the clients who belong to first group were assisted by professionals. More than fifty percent of the clients showed significant change. The second group, where the professional assistance was nominal, showed 33.3% improvement.
The third group which was self-help group demonstrated 17.9% of efficacy of the method and the control group also had 10.1% of change. “Therapist-led group cognitive-behavioral treatment for binge eating disorder led to higher binge eating abstinence rates, greater reductions in binge eating frequency, and lower attrition compared to group self-help treatment.” (Grohol, 2009, para.10).
A retrospective case study was conducted to assess the effectiveness of group therapy in eating disorder. This study reveals that “An increasing amount of research supports group therapy as an effective treatment option for eating disorders.” (Janine, Kelly, & Hannah, 2005, Abstract, para.1).
There is a relationship between the quality of life and the prevalence of eating disorders. “A sample of 4400 randomly selected adult households shows a significant association between poor quality of life and eating disorder behaviors.” (Philipia, 2003, Article abstract, para.1).
The objectives of proposals
- To formulate and develop a group therapy to deal with the eating disorders among adult population.
- To provide a supportive atmosphere for the clients in the group.
- To facilitate the interaction between the clients in the group and thereby developing interrelationships.
- To identify the efficacy of the various therapies like cognitive behavioral therapy, psychotherapy, interpersonal therapy etc.
Composition of the group
This group will include around seven to eight members who are affected by eating disorders like anorexia nervosa, bulimia nervosa, binge eating disorder etc. Both genders who are adolescents can be included in this group and they should be identified as having the problem of eating disorders.
This group will be led and facilitated by male and female therapists. The focus of this group is adults who are suffering form eating disorders. The therapists will be professionals who are specialized in group therapy, psychotherapy, cognitive therapy, behavioral therapy and interpersonal therapy.
The group therapy will be conducted in group therapy centre in the evening so that everyone can come and attend the therapy even after their study and other works. The program will be designed and structured before the session. All clients should attend each session.
They would not be allowed to avoid any session for unreasonable cause. There will be different stages of activities in each session, such as warming-up session, lecturing stage, sharing stage, practical stage and evaluation stage. The various therapeutic techniques, like cognitive behavioral therapy, interpersonal therapy and behavioral therapy will be used in this group therapy to maximize the results in the clients.
Logistics
Recruitment: The information on group therapy for adults who suffer from eating disorder will be announced through newspapers, internet and other types of ads. A discussion between the participants and therapists will be conducted and it will be more informative session. After screening, interested persons will be selected for the group therapy and they will be informed through written communication.
Screening and selection process
There will be a screening process to select the clients for the group therapy. There will be 30 minutes duration to identify and screen the client whether he/she is really having the problem of eating disorder. At the time of screening, the client will be given an occasion to share his/her expectations on the group therapy and if the client has some doubts and questions, the therapist will clarify them.
Screening process is very significant for the therapist and the client, because it allows the client to decide whether he has to join or not according to the informed consent.
As far as screening process is concerned for the therapist, he can assess the clients’ motivation, attitudes, disposition and nature. If the client is introvert, the therapist has to take some other ways to treat the client. Therefore, the screening process has got an immense importance for both the client and the therapist.
Frequency and duration of group session: The group will assemble on every Sunday and Wednesday in the evening in the group therapy centre. The group that includes maximum 8 members will get sufficient time for interaction between the clients and they can develop self-esteem and positive thoughts.
It will be two hour session in which everyone will be assessed – the current situation and the variation also will be counted. Each session includes lecture session, sharing session and practical session. The clients will be given opportunities to ask and get clarification for their doubts. The therapists will be vigilant to assess and identify the various disturbances shown by the client.
Group process and content
The therapist will consider whether there is cohesiveness between group process and content in order to assess that this process will bring the desired change for the client. Before beginning group therapy, a pre-group preparation meeting will be conducted in which the clients will share their expectations and knowledge on group therapy.
The therapist will explain the importance of punctuality, correctness, confidentiality, need of respecting each other, necessity of sharing, building self esteem, not becoming too much involved in the matters of others, importance of being sympathetic etc. The client will be allowed to develop the group norms that are supposed to be performed by everyone in the group.
At the last part of the pre-group preparation meeting, the therapist will present an evaluation report on the attitudes and interaction of the clients. Following the pre-group preparation meeting, group sessions will start and firstly, they emphasize the establishment of group cohesion among the clients.
Each session will start with energizing session including singing songs or other warm activities. The next phase will be action phase in which the client takes responsibility to address the issues of eating disorders. There will be time allotted for group discussion in the practical session. There will be a small evaluation session at the end of each session so that the improvement could be assessed very soon.
Research questions
- Does the group therapy meet the needs of the client who are in this group?
- Do the clients of this group feel very comfortable with the interpersonal relationships and strategies of the group?
- Does this group develop the self-esteem of the clients?
- What factor will improve the quality of group therapy?
Significance of the group therapy
Group therapy has a pivotal role in the treatment of eating disorders among adults. Researches found that group therapy is effective for the treatment of eating disorders. In group therapy, the client feels more comfortable in the group and in the interpersonal relationships.
He gets self-esteem, consideration, information on the disorder and the exercise to come out of his problem. He gets strength to address the issues. Therefore, group therapy has got a vital place in the treatment of eating disorder.
Conclusion
This paper presents a group proposal for group therapy which would be conducted for the treatment of eating disorders among adults. Group therapy is one of the good treatments for eating disorders and different researchers opined that group therapy is very effective in dealing with eating disorder. This paper discusses various topics in a detailed way starting from application of group therapy in eating disorders, literature review and group proposal.
Reference List
Anorexia nervosa. (2009). About.com: Teens.
Anorexia nervosa in young female adolescents. (2009). McGill: Centre for Research on Children and Family.
Bulimia nervosa: Research findings. (2009). About.com: Teens.
Busko, M. (2007). “DSM- IV diagnostic criteria for eating disorders may be too stringent: Presence of unspecified eating disorders investigated”. Medscape Today.
Eating disorder medical glossary: Binge eating disorder. (2006). Second Opinion.
Engel, B., Reiss, N S., & Dombeck, M. (2007). Eating disorders: Characteristics of Binge eating disorder. Mental Help.net.
Felicia, R. (1994). “Article: adolescent boys and anorexia nervosa”. Adolescents Magazine. High Beam Research.
Grohol, J M. (2009). World of psychology: Group therapy for binge eating. Psych Central. Web.
Janine, W., Kelly, M J., & Hannah, M T. (2005). “Group therapy of eating disorders: a retrospective case study: Abstract”. Journal of Specialists in Group Work, 30(1), 47-66. Philadelphia: Customer Service for Taylor and Francis Group Journals: ERIC: Education Resources Information Center.
Kienlen, P L. (2008). DSM- IV psychological disorder: a list & definition of 16 categories of mental illness: Eating disorder. Suite 101.
Mitchell, J E., Hoberman, H N., Peterson, C B., Mussell, M., & Pyle, R L. (1996). “Research on the psychotherapy of bulimia nervosa: half empty or half full: Results”. The International Journal of Eating Disorders, 20(3), 219-29. Biomed Experts.
Philipia, H. (2003). “Quality of life and bulimic eating disorder behaviors: findings from a community based sample: Article abstract”. The International Journal of Eating Disorder. John Wiley and Sons.