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Treatment Plans and Interventions for Bulimia and Binge-Eating Disorder

RATIONALE FOR COGNITIVE-BEHAVIORAL TREATMENT LEVEL-OF-CARE DECISION MAKING USING THIS TREATMENT PLANNER Bulimia Nervosa DESCRIPTION Symptoms Prevalence and Life Course Genetic/Biological Factors Coexisting Comorbid Conditions UNDERSTANDING BULIMIA NERVOSA in cognitive-behavioral terms Behavioral Factors Cognitive Factors Interpersonal Factors Emotion Regulation Treatment Outcome Research PSYCHOTROPIC MEDICATIONS FOR EATING DISORDERS Assessment, Diagnosis, and Treatment Planning DIFFERENTIAL DIAGNOSIS TREATMENT PLANNING Case Conceptualization Individualized Treatment Planning Adapting Treatment for Eating Disorder Not Otherwise Specified FORM 3.1. Information for Patients about Bulimia Nervosa FORM 3.2. Case Conceptualization Worksheet Detailed Treatment Plan for Bulimia Nervosa SOCIALIZATION TO TREATMENT MOTiVATION BEHAVIORAL CHANGE Food Records Weekly Weighing Calculating Body Mass Index Discontinuing All Compensatory Behaviors Delaying Purging Regular Eating Functional Analysis of Binge Triggers Stimulus Control Urge Surfing Alternative Activities Problem Solving and Planning Ahead Relaxation Training Reviewing Treatment Progress COGNITIVE RESTRUCTURING The Thought-Behavior Connection A-B-C-D Technique Thoughts about Food, Dieting, and Control Thoughts about Appearance Thoughts about Self in Relation to Others Evaluating Automatic Thoughts and Assumptions Advantages/Disadvantages Selective Attention Automatic Thought Records Rating Belief Using a Different Lens Behavioral Experiments Food Rules Perfectionism Redefining "Healthy"BODY IMAGE INTERVENTIONS The Subjective Nature of Body Image Body-checking and Avoidance Behaviors Cognitive Restructuring of Body Image Unrealistic Standards Broadening Self-Worth Reviewing History Stopping Unfair Comparisons Positive Data Log OPTIONAL SUPPLEMENTARY INTERVENTIONS Interpersonal Interventions Emotion Regulation Interventions RELAPSE PREVENTION INTERVENTIONS Reviewing Treatment Interventions Listing Past Triggers Relapse Roadmap Lapse versus Relapse POSSIBLE "ROADBLOCKS" AND TREATMENT RESISTANCE Reviewing Advantages and Disadvantages Behavioral Experiments Challenging Distorted Cognitions Paradoxical Interventions Adjusting Perfectionistic Expectations SAMPLE 20-SESSi0N TREATMENT PLAN FORM 4.1. Motivation Worksheet FORM 4.2. Food Record FORM 4.3. Information for Patients about Purging FORM 4.4. 10 Steps to Stimulus Control FORM 4.7. Instructions for Diaphragmatic Breathing FORM 4.8. Categories of Distorted Automatic Thoughts: A Guide for Patients FORM 4.9. A-B-C-D Technique FORM 4.11. Automatic Thought Record FORM 4.13. Zero-Point Comparisons: Learn to Stop Your Upward Comparisons FORM 4.14. Costs of the "Perfect" Body FORM 4.15. Self-Image Worksheet FORM 4.16. Coping Cards FORM 4.17. Relapse Roadmap Case Example SESSION 1 Presenting Problem SESSION 2 Set session agenda SESSION 3 Thorough review of daily food records SESSIONS 4-7 SESSIONS 8-10 SESSIONS 10-13 SESSIONS 13-14 SESSIONS 15-16 SESSIONS 17-18 SESSIONS 19-20 Treatment within a Managed Care Context GETTING APPROVAL FOR TREATMENTS Medical Necessity Appropriate Treatment THE INITIAL TREATMENT REPORT Diagnosis Presenting Problem Eating Disorder Symptoms Comorbid Symptoms Strengths Functional Impairment Threat to Self or Others Mental Status Examination Treatment REQUESTS FOR ADDITIONAL SESSIONS

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