accommodation and enabling: being bullied by the eating disorder into disregarding or ignoring maladaptive behaviours in an effort to keep the peace
affirmations/praise: affirmation and praise for all efforts towards changing maladaptive behaviour (for carer and sufferer). Praise the process, not the outcome
animal analogies: a light-hearted approach to considering individual responses to the illness. This may require reflecting upon one’s own personality characteristics or traits
assessment: (any past attempts at change) examination of past and current attempts to make changes to eating disordered behaviour
autonomy/choice: emphasizing the importance that the individual chooses to get well for themselves – recognizing that we only have control over our own behaviour
bigger picture thinking: discrepancy between future goals, dreams, aspirations and current maladaptive detailed/rigid behavioural approaches
boundary setting: setting of consistent boundaries accompanied by an expectation for these boundaries to be adhered to
“C” words: use of coaching skills in a compassionate, calm and consistent manner when communicating with the sufferer
CASIS: ”Carer Assessment, Skills and Information Training” – full multi-centre randomized controlled trial with 15 inpatient units to test effectiveness of skills training for families of inpatients.
central coherence: a term used to describe the ability to look at the bigger picture as opposed to being stuck with the detail. People with eating disorders tend to have an eye for detail at the expense of being able to consider the bigger picture.
choice/autonomy: emphasizing the importance that the individual chooses to get well for themselves – recognizing that we only have control over our own behaviour
collaborative caring: developing a collaborative approach in the fight against the illness (sufferer/carers/professionals. Eating disorders flourish on conflict. Use emotional intelligence and problem solving strategies to address any challenges in utilizing different responses to the illness
commitment talk: encourage and look out for signs of ‘commitment to behaviour change’ talk. Use of motivational interviewing to elicit concerns about eating behaviours and to elicit change talk
Develop discrepancy: develop discrepancy between values, change talk, hopes for the future and current maladaptive behaviour
Elicit views (other perspective/change talk): elicit the views and opinion of the individual, their views on the eating disorder and on change
Empathy: skillful reflective listening that clarifies and amplifies the person’s own experience and meaning
Environmental restructuring: discuss the environment in which one can promote behaviour change and recovery engaging sufferer in shaping their environment to one that supports change without carers accommodating to the illness
Externalizing illness: visualize illness as a separate entity from suffer, e.g. anorexic minx, bulimic boa constrictor
Family-based treatment (FBT): family therapy for the treatment of anorexia nervosa devised by Christopher Dare and colleagues at the Maudsley Hospital in London in 1985.
Flexibility: role model and encourage flexibility not only in food and meal planning but in other areas of life
Functional analysis: examine and reflect on unhelpful routines and interactions. Use functional analysis (ABC) model with sufferer to discuss unhelpful routines, explore change and consequences. Help patient identify triggers for problematic behaviours and make strategies to cope with those triggers in advance
Goal setting facilitation: facilitate the setting of specific and achievable goals – help the individual develop their own appropriate goals for behaviour change towards recovery. Once goals have been set help sufferer review those goals. Remember importance of setting SMART goals.
Information sharing: (biological) share biological information of EDs and implication for brain functioning; (ED support and sharing) Encourage self efficacy in accessing support; facilitate use of local services and information on recovery; (patient needs in regards to support required) Encourage open discussion with patient on experiences in therapy as well as perspective on the support the carer gives.
meal planning: ensure consistent support and guidance over meal-planning using communication techniques such as OARS with sufferer
medical monitoring: ensure medical monitoring of patient, facilitate where necessary. Encourage measurement of improvements in health e.g. weight, blood tests. See medical risk.
motivational encouragement: use of motivational interviewing to nurture self-confidence and self-efficacy; facilitate hope towards change and recovery
motivational interviewing: an evidence-based approach to overcoming the ambivalence that keeps many people from making desired changes in their lives
non-eating disorder identity:reinforce and engage in non-ED aspects of personality, conversation and actions/activities
non-eating disorder talk: engaging in and encouraging non eating disorder talk; encouraging participation of shared activities that occurred before the eating disorder
non-negotiable: eating is non-negotiable. We all have to eat to live – ultimately the State will take responsibility if individual cannot do this for him/herself.
nutritional risk ruler: assess nutritional risk on a score of 1-10. Psycho-educational information can be used to assess the nutritional risk in comparing current BMI with a BMI in the healthy range
OARS: communication techniques used in motivational interviewing, (OARS) Open questions, reflective listening, affirmations and summarizing
Perfectionism: elevated perfectionism or high self expectations are common in people with eating disorders; this trait is also often found in other family members
Praise/affirmations: affirmation and praise for all efforts towards changing maladaptive behaviour (for carer and sufferer); praise the process, not the outcome
Problem solving facilitation: help the individual to identify barriers to recovery and develop problem solving strategies for any future challenges
Problematic behaviour: behaviours associated with eating disorders include restricting foods, bingeing, purging, over-exercise, obsessive compulsive behaviours, drug or alcohol abuse, self-harming
Pros & Cons of change: explore with patient the negative side effects of change as well as positives, e.g. what are the pros and cons that the sufferer perceives of any change behaviour, provide empathetic support – discuss reasons for and against change, especially working towards recovery (e.g. bigger picture)
Randomized controlled trial: (RCT) is a specific type of scientific experiment, and the preferred design for a clinical trial. RCT are often used to test the efficacy of various types of intervention within a patient population. The key distinguishing feature of the usual RCT is that study subjects, after assessment of eligibility and recruitment, but before the intervention to be studied begins, are randomly allocated to receive one or other of the alternative treatments under study.
readiness ruler: assess current readiness and ability to make change with regards to ability and confidence to change on a score of 1-10: the readiness ruler can be used with both carer and sufferer
reassurance trap: occurs when the sufferer frequently asks for reassurance around food, weight and shape. Useful to remember the analogy with medication in that reassurance may initially have a short-term positive effect. However, in the longer term, it will have a reduced effect and the sufferer may need more and more reassurance.
reflective listening: use reflective listening to model and encourage more adaptive communication techniques
relapse prevention: recognize possibility of reverting to old behavioural patterns. Explore triggers of relapse, encourage transparency and help seeking behaviour: 1) review what has been learned 2) encourage and maintain new perspectives 3) maintain positive attitude and 4) regard relapse as part of the learning process.
role modeling: importance of positive and supportive role modeling, e.g. lower high expectations of oneself, nurture flexibility in various areas of life, take care of one’s own physical and psychological needs
rolling with resistance: avoid getting caught up in arguments and criticism – when emotions run high, take a break
Self-care (carer): importance of: remember the adage “a distressed carer is an ineffective carer”. As in airline regulations, it is important for carers to remember to put on their own oxygen masks first. Role-model self compassion. Take time out to look after one’s own physical and psychological needs.
Self-help: encourage and increase motivation, confidence and self-efficacy. (Carers) access and use of self-help resources, e.g. written resources, support groups, Beat etc. (Sufferers) access support; facilitate use of local services and information on recovery. Self-monitoring: helping the individual to record for themselves their own progress, consequences and future problem solving strategies
Set shifting: a term used to describe the ease in which one can alternate between tasks. People with eating disorders tend to show a certain degree of inflexibility or difficulty in adapting to change, i.e. they demonstrate considerable rigidity in various areas of their life.
S.M.A.R.T. goals: set appropriate goals, according to individual needs and abilities. Set graded tasks to alter unhelpful patterns of behaviour. Goals should be specific, measurable, achievable, realistic and timely.
Sidestep ED talk: keep food, weight and shape talk to a minimum. Use this skill in conjunction with the avoiding the reassurance trap.
Social support (carer): seek out support, whether this is partner, family, extended family, friends, support groups. Don’t allow the family to be bullied by the eating disorder. See self-care and accommodation and enabling.
Social support (sufferer): facilitate patient’s constructive use of current social networks to help the recovery process.
Summarizing: use summaries to clarify information shared by reflecting on any plans for change – repeat and confirm decisions to make any plans or commitment to make positive changes
trans-theoretical model of change: assesses an individual’s readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance
Visualization: visualize what life would be like in a year, 2 or 5 year’s time without an eating disorder….then with an eating disorder. What is the individual doing, thinking, feeling? What’s going on around them. A comparison can also be made between now and before the eating disorder took a hold.
Weight and medical monitoring: discuss with sufferer the importance of continued medical monitoring and facilitate motivation to engage in monitoring