Describe Two Approaches to the Treatment of Self-Defeating Behaviour

Word count – 2553 Describe and evaluate two approaches to the treatment of self-defeating behaviour. Module Five Jane Ovington May 2012 Jane Ovington - Chrysalis North2A - Tutor , Steven Lucas, page 1 of 9 Introduction This essay aims to describe and evaluate two approaches to the treatment of self defeating behaviour. To do this I am using the description of Anorexia Nervosa as a self defeating behaviour, one which has far reaching consequences.

I will include possible origins, causes and maintenance of Anorexia and describe two of many ways in which a therapist may help with this condition whilst weighing up the strengths and weaknesses of each. Main essay What is self defeating behaviour? Self defeating behaviour could be described as behaviour that when compared to other possible courses of action, it is never the best possible action for that individual. A self defeating behaviour will at some point have been used successfully as a coping strategy to get through a difficult situation.

This course of action is then stored in the subconscious by that individual as something that ‘worked’ and therefore the behaviour will be re-produced again in times of perceived trouble. The self defeating behaviour will by its very nature actually serve to ensure that the fear or consequence that the person is trying to avoid will in fact come to pass. (Chrysalis Year 2 Module5) What is Anorexia? Anorexia is an eating disorder whose main feature is excessive weight loss and obsessive exercise.

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A very low weight is achieved which is then maintained abnormally low for the patients age and height. The sufferer develops an intense desire to be thinner and an intense fear of becoming fat. Their body image becomes completely distorted and their body weight and shape become the main or even sole measure of self worth as maintaining an extremely low weight becomes equated with beauty, success, self-esteem, and self-control. It is not seen as a problem by the sufferer. Jane Ovington - Chrysalis North2A - Tutor , Steven Lucas, page 2 of 9

Contrary to popular belief this psychological and physical condition is not usually about food. It is a self defeating behaviour used as a way of taking control and trying to make life better and is accompanied by a variety of changes in behaviour, emotions, thinking, perceptions, and social interactions. The name Anorexia nervosa is somewhat misleading as it literally means "nervous loss of appetite. " However, for people with this disorder all waking thoughts are dominated by food, weight, and body image and incredible levels of self control are used to fight feelings of intense hunger. http://ehealthmd. com/content/what-anorexia-nervosa) Approximately 95% of those affected by anorexia are female and most often teenage girls. Higher incidence of anorexia is often seen in environments where thinness is deemed to be especially desirable or a professional requirement, such as athletes, models, dancers, and actors. In order to enter the state of Anorexia Nervosa, a person must lose weight. The majority set out to do so deliberately because rightly or wrongly they feel that they are too fat.

For most people, dieting to lose weight is a struggle. Most dieters 'cheat' or give up before they lose all the weight which they had intended to shed and for those who do reach their intended weight there is a measure of satisfaction and re-education of eating habits which allow them to maintain a healthy weight. In contrast, the soon to be anorexic finds slimming easy, rewarding and something they can be good at from the start, something they can control which brings feelings of success, power and triumph.

The sense of satisfaction gained from the suppression of hunger and the level of self denial required to be successful is frequently reported by anorexic sufferers to be very empowering and so here we see how effective this behaviour may be viewed by the sufferer as a coping strategy. Jane Ovington - Chrysalis North2A - Tutor , Steven Lucas, page 3 of 9 My own experience of this condition was one that arose when my best friend died at the age of 17. I knew for many months prior to her death that death would almost certainly be the outcome of her condition. I felt ‘out of control’ there was nothing I could do to change the course of events.

The one thing I could control however was what went into my mouth. This gave me a comforting sense of taking control of something. Something I turned out to be good at, something I could focus on to make all the other uncontrollable feelings subside. Once these feelings arise, a fear of losing control prevents the sufferer from resuming normal eating habits. Their experience is dominated by these 'feel good feelings' of control and power but it is perceived by the sufferer to be precarious and vulnerable and therefore threatened by any behaviour that may cause unwanted weight gain.

The sufferers preoccupation with maintaining this new postition begins to distort all other interests, concerns and relationships. In some cases the current position is never enough and weight loss progresses until it becomes life threatening. In most cases it seems that the anorexic starts out with similar behaviour and similar intention to the ordinary slimmer but something goes wrong and the slimming behaviour is inappropriately prolonged (My own experience). Ironically, while Anorexia starts out as a feeling of taking control, it rapidly descends into a fear of losing the control the sufferer perceives themselves to have taken.

All the while the condition is actually controlling the sufferer. While the media definitely plays a role in how we view ourselves, anorexia is a way of coping with what’s going on in a teen’s life. Stress, pain, anger, acceptance, confusion and fear can all become triggers for this debilitating eating disorder. The goal is one of trying to make their whole life better. Families can play a huge role. Some families are over protective and smothering which can create a need or rather a demand for independence. Jane Ovington - Chrysalis North2A - Tutor , Steven Lucas, page 4 of 9

Some families are critical of weight gain, academic or sporting accomplishments or are rigid and even abusive. Some younger people do not feel safe in their own homes, they don’t know where to turn or what to do and the need to find a way to deal with what’s going on in their lives. Life transitions such as a break up, a divorce, death of a loved one, failure at school or at work are all stressful incidents that need to be dealt with. Genetic factors can also play its part in contributing - anorexia in teenage girls occurs eight times more often in people who have relatives with the disorder. Anorexia – a guide to sufferers and their families R. L Palmer 1980). My own Mother was grossly overweight at the time of my condition and I viewed her as someone who was completely out of control with no respect for herself. This was a very negative view, one which I could not see in myself at the other end of the spectrum! Effects on families and friends For parents and others who are close to a person who is trapped inside the condition of anorexia, there can seem like there is no escape. It is difficult for them to understand and empathise with self destructive behaviours.

It becomes extrememly distressing to see a loved one wasting away whilst refusing offers of food which seem such a tantalisingly simple solution to the problem. Feelings of helplesness and guilt set in, along with frustration, anger and despair. (Quote from my Mum from 1991). My Mother set about criticising my ‘ridiculous behaviour’ in a bid to scare me into eating this only served to make me more determined to empower myself with what had turned from self defeating behaviour into self destructive behaviour and ultimately formed a self defeating behaviour in my Mother. Jane Ovington - Chrysalis North2A - Tutor , Steven Lucas, page 5 of 9

Treatment The idea of being ‘cured’ of Anorexia by the sufferer is usually completely undesirable because what that ‘cure’ implies is that they will eat more food, put on more weight and become fat, the very thing they are trying to avoid! Therefore, Anorexia has to be acknowledged as a problem by the sufferer before effective treatment can take place. Traditionaly the disorder is treated with a combination of individual psychotherapy and family therapy to look beyond the basic issue of food intake and address the emotional issues that underpin the disorder using a psychodynamic approach. Important ethical considerations

It is important for therapists to consider that Anorexia Nervosa, although starts out as a self defeating behaviour, it’s consequences lead to many serious medical conditions which can range from malnutrition, loss of concentration and loss of periods to total organ failure and death. Therefore a therapist should never aim to treat the condition alone, but any psychological intervention to treat the underlying causes should take place alongside appropriate medical care. Any therapists working with an anorexic client would always need written medical consent and specialist supervision and should be experienced in this field of work.

However, members of the sufferers family and close friends may also benefit from therapy to address any stress, anxiety and guilt surrounding the issue and in the absence of any other contraindications, medical consent for this group would not be necessary. The psychodynamic approach The psychodynamic approach will view the clients behaviour as being derived from some internal conflict, motive or unconscious force. Once it is discovered where this conflict began the therapist can set about working through those issues to a resolution. Jane Ovington - Chrysalis North2A - Tutor , Steven Lucas, page 6 of 9

Generally, it is believed that if behaviours are discontinued without addressing the underlying motives that are driving them, then a relapse will occur. During my battle with Anorexia, I was hospitalised and fed to increase my body weight. I ate willingly and was quickly considered cured and discharged from the hospital. However, I had deliberately manipulated the situation with the view that the sooner I could ‘escape’ the quicker I could get back on with the job. Taking control, to bring back the feel good feelings and the sense of empowerment that meant even more to me after having been ‘overpowered’ in the hospital.

Clearly this treatment was very ineffective. Later I sought help through a therapist who, using a psychodynamic approach, was able to take me back through the death of my friend and deal with the grief in an appropriate way. This eventually helped me to let go of controlling my food intake as a way of dealing with these suppressed emotions. Behavioural symptoms in the psychodynamic approach are viewed as expressions of the patient's underlying needs. Often issues can disappear or lie dormant with the completion of working through these issues.

However, a psychodynamic approach to anorexia is not all encompassing. During the recovery process, anorexics will frequently suffer from feelings of panic as they learn to lessen their control. As weight is gained, they will feel anxious much of the time and suffer from low self esteem or perhaps even feel that they are a 'bad' person and have to become a 'people pleaser' to make up for it. Anorexics are very often perfectionists and can be very harsh on themselves. All these things combined can make the process of recovery a very stressful, anxious and self deprecating experience (My own experience).

A cognitive behavioural therapy approach may best meet the needs of a client feeling this way. Anorexics are often not fully aware of the initial cause of the condition and therapy may be a way to Jane Ovington - Chrysalis North2A - Tutor , Steven Lucas, page 7 of 9 lift the lid off of buried emotions to enable sufferers to deal with their underlying emotions. During the grip of the disorder the over-riding emotion felt is fear and this fear over rides the body's natural wisdom around food and eating, the sufferer distrusts themselves and fears that their 'secret greedy self' may emerge and they will lose control completely.

The sufferer will hate their 'secret greedy self' and cognitive behavioural therapy would be a valuable tool in rebuilding self trust, improving self esteem, and overcoming fear and anxiety that arises through the process of recovery. Cognitive behavioural therapy (CBT) is a time-limited and focused approach that helps a person understand how their thinking and negative self-talk and self-image can directly impact their eating and negative behaviours. CBT usually focuses on identifying and altering dysfunctional thought patterns, attitudes and beliefs that may perpetuate the sufferers restrictive eating.

A researcher in the early 1980’s by the name of Chris Fairburn developed a specific model of CBT to help in the treatment of Anorexia, using the traditional foundations of CBT therapy – helping a person understand, identify and change their irrational thoughts (the ‘cognitive’ part) and helping a person make the changes real through specific behavioural interventions such as promoting healthy eating behaviours through rewards. (http://psychcentral. com/lib/2006/treatment-for-anorexia/all/1/) Strengths and weaknesses

It is clear to see that both approaches are somewhat lacking and a multi-model approach should be taken to ensure success. The psychodynamic model will uncover the initial cause of the behaviour and addressing these issues will go a long way toward a successful outcome. However, it does not address the subsequent negative thought processes that keep the sufferer a prisoner within the condition. This is something that a CBT approach can successfully address but a CBT approach could fail to prevent a relapse if the underlying reasons for the negative self talk are not uncovered.

Both treatments together will hold more strength in long term success, but neither seeks to address nutritional issues, food related symptoms or deep seated behavioural rituals of the eating disorder. Jane Ovington - Chrysalis North2A - Tutor , Steven Lucas, page 8 of 9 Summary Anorexia although initially can be viewed as a self defeating behaviour, is a complicated and mulit-faceted field and I would expect a consistent and long course of therapy that may focus on a psychodynamic approach alongside person centred counselling, alongside cognitive behavioural therapy, alongside appropriate medical intervention.

Hypnotherapy may also be used to improve self esteem, reduce stress and anxiety, coping with panic and confidence building to help the sufferer relax levels of control and resume a more healthy relationship with themselves. As the anorexic begins to regain trust in themselves and their body, they can begin to feel back in control of their emotions and thoughts, thus lessening their levels of anxiety and helping toward a successful recovery. Ultimately, the pace of therapy has to be set by the client and the client has to admit to the problem in the first place before any type of therapy can begin.

References: I personally suffered from this disorder from the ages of 17-21 and some of the information used has been based on my own experiences and that of my Parents. (Chrysalis Year 2 Module 5) R. L Palmer – Anorexia Nervosa. A guide for sufferers and their families. Penguin Books 1980 (http://ehealthmd. com/content/what-anorexia-nervosa http://psychcentral. com/lib/2006/treatment-for-anorexia/all/1/) Jane Ovington - Chrysalis North2A - Tutor , Steven Lucas, page 9 of 9 any type of therapy can begin. has to be set by the client and the client has to admit to the problem in the first place before

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