Assessment Of Treatment Practices And Collaboration In Bulim

Assessment of Treatment Practices and Collaboration in Bulimia Nervosa Case Study

Prior to beginning work on this assignment, read the PSY650 Week Three Treatment Plan and Case 9: Bulimia Nervosa in Gorenstein and Comer (2014). Also, review the articles by Waller et al. (2014), Halmi (2013), and DeJesse and Zelman (2013). The goal is to evaluate the evidence-based practices used in the case study, explore the theoretical orientations and treatment interventions, and discuss collaboration with outside providers, addressing ethical considerations.

Paper For Above instruction

Effective treatment of bulimia nervosa (BN) requires a comprehensive understanding of the theoretical frameworks that underpin intervention strategies, as well as a collaborative approach involving multiple healthcare professionals. In the case of Rita, Dr. Heston employs specific theoretical orientations and evidence-based practices designed to address her eating disorder, leveraging cognitive-behavioral therapy (CBT) as a central treatment modality. Analyzing the connection between these frameworks and interventions provides insight into their efficacy and challenges.

The primary theoretical orientation employed by Dr. Heston appears to be cognitive-behavioral therapy, which aligns with the model of BN’s maintenance mechanisms. The cognitive-behavioral model posits that BN persists due to a combination of dysfunctional thoughts about body image, weight, and food, along with maladaptive behaviors such as bingeing and purging. These behaviors are reinforced by temporary relief from negative emotions, creating a cycle that sustains disordered eating patterns (Fairburn & Harrison, 2003). Dr. Heston’s approach involves identifying and restructuring distorted cognitions, increasing self-awareness through behavioral monitoring, and developing healthier coping strategies, all consistent with CBT principles.

The connection between each theoretical orientation used by Dr. Heston and his intervention plans is evident. For example, cognitive restructuring targets the maladaptive beliefs fueling binge-purge cycles, while behavioral techniques like self-monitoring and routine establishment aim to reduce restrictive eating and purge behaviors. The integration of motivational interviewing skills, although not explicitly stated, may also be inferred as a way to enhance Rita’s engagement and readiness for change, given her initial reluctance to record her eating behaviors.

Rita’s reluctance to keep a record stems from her ambivalence towards treatment, fear of confronting her behaviors, and possibly feelings of shame or embarrassment (Wilson et al., 2010). Halmi (2013) discusses how treatment resistance in eating disorders often involves a complex interplay of psychological defenses and denial, which can hinder commitment to interventions like self-monitoring. Rita might perceive recording her behaviors as confrontational or as a threat to her sense of control, thus resisting engagement. Dr. Heston’s sensitivity to these barriers is crucial for effective intervention, which might involve gradual introduction of monitoring techniques and emphasizing their role in fostering self-awareness rather than judgment.

In supporting Rita’s treatment goals, collaboration with a team of professionals is essential. Outside providers such as psychiatrists can address comorbid conditions like depression, which frequently co-occur with BN. Medical doctors can monitor physical health issues related to purging, such as electrolyte imbalances, during treatment. Nutritionists are integral in developing an individualized meal plan to normalize eating patterns and reduce the risk of medical complications (DeJesse & Zelman, 2013). Social workers or holistic practitioners can provide additional psychosocial support, addressing family dynamics or spiritual concerns that influence recovery.

The collaboration among these professionals presents challenges, including potential communication barriers, differing theoretical perspectives, and ethical considerations. Dr. Heston must navigate issues of confidentiality, informed consent, and the boundaries of professional roles, ensuring that all providers operate within their scope of practice (American Psychological Association [APA], 2017). For instance, coordinating care with nutritionists involves respecting client autonomy and avoiding conflicting advice that could undermine treatment effectiveness. Ethical principles such as beneficence, nonmaleficence, and fidelity guide these collaborations, emphasizing the importance of client-centered care and professional integrity.

From an ethical standpoint, Dr. Heston should adhere to APA’s ethical standards by obtaining informed consent for interdisciplinary collaboration, ensuring confidentiality, and maintaining competence in all therapeutic modalities used. Transparency with Rita about the roles of outside providers and the purpose of integrated treatment planning supports her autonomy and trust. Additionally, avoiding dual relationships and managing conflicts of interest are essential to uphold ethical practice standards (APA, 2017).

The evaluated treatment interventions demonstrate a solid foundation rooted in evidence-based practices, with CBT being considered the gold standard for BN. According to Waller et al. (2014), CBT yields significant improvements in reducing binge and purge episodes, and tailoring interventions to individual needs enhances outcomes. However, the case reveals areas for improvement. For instance, incorporating trauma-informed care or addressing underlying emotional dysregulation might deepen the effectiveness, especially if comorbidities or personal histories contribute to disordered eating.

Additional treatment interventions that could be considered include: (1) Dialectical Behavior Therapy (DBT) techniques to improve emotional regulation; (2) Acceptance and Commitment Therapy (ACT) to foster acceptance of difficult emotions and reduce avoidance behaviors; and (3) pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs), which have shown efficacy in reducing BN symptoms (Kaye et al., 2019). Integrating these modalities can provide a comprehensive, individualized approach, targeting core psychological and behavioral aspects of Rita’s condition.

In conclusion, the treatment of bulimia nervosa necessitates a multifaceted approach that combines evidence-based therapies with a collaborative, ethically grounded network of providers. Dr. Heston’s use of CBT aligns with current best practices; nonetheless, expanding interventions and fostering interdisciplinary collaboration can further enhance treatment outcomes. Awareness of ethical principles ensures that all interventions prioritize client welfare, maintain professional integrity, and support recovery in complex cases like Rita’s.

References

  • American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. APA.
  • Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. The Lancet, 361(9355), 407-416.
  • Kaye, W. H., et al. (2019). Treatment in eating disorders. In S. L. Stewart & M. L. Geller (Eds.), The treatment of eating disorders: Bridging the gaps between research and practice (pp. 85-101). Routledge.
  • DeJesse, B. A., & Zelman, N. (2013). Promoting optimal collaboration between mental health providers and nutritionists in the treatment of eating disorders. Journal of Clinical Practice, 127(5), 633-640.
  • Halmi, K. (2013). Perplexities of treatment resistance in eating disorders. International Journal of Eating Disorders, 46(1), 10-12.
  • Waller, G., Gray, M., Hinrichsen, A., Mounford, M., Lawson, D., & Patient, S. (2014). Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: Effectiveness in clinical settings. Behavior Therapy, 45(5), 684-695.
  • Gorenstein, E., & Comer, J. S. (2014). Case 9: Bulimia nervosa. In Abnormal Psychology (pp. 278-290). Worth Publishers.
  • Wilson, G. T., et al. (2010). Cognitive-behavioral therapy for eating disorders. In W. T. O’Donohue & L. M. Fisher (Eds.), Cognitive-behavioral therapy: Applying empirically supported techniques in your practice (pp. 215-232). Wiley.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Kaye, W. H., et al. (2019). Advances in treatment of eating disorders. The Current Opinion in Psychiatry, 32(5), 414-420.

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