Last lesson….

1. Last lesson…. • Describe two examples of the application of cross-cultural studies in Psychology and discuss the potential effect of cultural bias in their interpretation (12 marks)

2. Anorexia Nervosa

3. Eating Disorders • The main two types of eating disorders are Anorexia Nervosa and Bulimia. • Do you know what the differences are? • You only need to know anorexia nervosa.

4. Symptoms of Anorexia Nervosa • Refusal to eat and maintain a minimum average expected body weight. • Fear of gaining weight • Distorted body image • Amenorrhea (absence of at least three consecutive menstrual cycles) • Weight less than 85% of expected

5. Cut and Stick Explanations worksheet

6. How does Holmes and Rahe’s diathesis Stress Model relate to Eating Disorders?

7. Learning Approach-Social Learning Theory • SLT suggests anorexia nervosa may be due to role models in the media. • Young people may feel they have to get to around the same weight as thin celebrities in order to be accepted

8. Social Learning Theory • Teenagers pay attention to the fact that many celebrity role models are extremely thin. • They retain this information. • They have the ability to reproduce being thin if they diet excessively and will do it if they are motivated to do so. • They can see that their role models are famous and rich and this may motivate them to be thin too. Teenagers may think that being thin is what is needed to be rich and famous or even just accepted.

9. + Lai (2000) found that the rate of anorexia increased for chinese residents in Hong Kong as the culture slowly became more westernised. +Crisp et al. (1976) found that dancers and fashion models were more likely to develop anorexia nervosa. +Mumford et al. (1991) found that Arab and Asian women were more likely to develop eating disorders if they moved to the West. - Doesn’t explain why the disorder usually develops in adolescence. - Everyone sees the pictures of slim people, so why is it only some of the population develop an eating disorder? There are psychodynamic explanations for anorexia nervosa such as fear of growing up and family issues. Evaluation of the Learning Approach

10. Hospitalization Hospitalization of anybody for a mental disorder can often be a confusing and emotion-wrought decision. Family members or significant others may need to intervene in the patient's life to ensure they do not starve themselves to death. In these cases, hospitalization is not only necessary, but a prudent treatment intervention. Family members should be aware that individuals who suffer from anorexia nervosa will often resist treatment of any sort, especially hospitalization. It is important, therefore, to come to an agreement about the need for such a step and not be swayed by the patient's pleas for seeking alternative treatment options. Often these have already been tried to no success.

11. Treatment-Token Economy • Uses operant conditioning to get sufferers of anorexia nervosa to eat. • Eating food is reinforced by the use of tokens. • Tokens can be exchanged for privileges such as make-up, outings and watching favourite TV programmes.

12. Living as an in-patient • A behaviourally-oriented token economy often exists in psychiatric inpatient units specializing in eating disorders. • This program rewards patients for eating regular meals and ensuring they do not purge afterwards. • As the patient gains weight, additional hospital privileges may be granted. • A specific target weight should be set as the treatment goal, upon which time the patient (ideally), should graduate from the hospital into an outpatient program consisting of individual therapy, group therapy, or simply a support group. Often this is not possible because of financial limitations. • Treatment will usually then continue in an outpatient modality. • If such a behavioural program is not implemented in the inpatient treatment facility the individual is in, treatment progress will likely be much slower and less steady.

13. How does it work? • Daily fluid intake and weight should be tracked. • If the person vomits after meals, they should be watched for a few hours after each meal to ensure no vomiting occurs. • The individual's diet should begin between 1,500 and 2,000 calories per day. This calorie intake can increase gradually as the patient makes treatment gains. • The patient should have six equal feedings throughout the day, although this may not always be possible. • Severely anorexic patients can be started on a liquid food supplement (e.g., Sustagen) or an IV, if necessary. • Inpatient programs (especially) should be careful not to overemphasize the importance of a person's weight, however. Weight is only the symptom in this disorder of poor body image and self-esteem problems. These primary difficulties should be the focus of any treatment approach for an eating disorder. • Weight gain can be used as an objective measure as to treatment progress.

14. How to search for research…….A useful undergraduate tool! • www.google.co.uk • http://www.ncbi.nlm.nih.gov/pubmed/ • www.isiknowledge.com

15. Research – have a go at APRC A case of anorexia nervosa successfully treated by behavior therapy in an outpatient clinic. Sonoda, Junichi;Hirayama, Kiyotake;Nozoe, Shinichi;Takayama, Iwao [Journal Article]Japanese Journal of Child Psychiatry, Vol 15(3), May-Jun 1974, 115-123. Reports the case of a 10-yr-old girl treated for anorexia nervosa on an outpatient basis with behavioral therapy (operant conditioning). The patient was one of monozygotic twins who started to lose weight after an appendectomy operation. Her replacement as the baby of the family by a younger brother born when she was 6 and the special care and attention, especially in regard to food, she received from her mother during her hospitalization for the operation were important factors in triggering the symptomatic response. At the time of treatment she weighed 20.4 kg, about 30% below normal. She was treated for 2 mo with appetite stimulants without result. The successful behavioral therapy included the following techniques: (a) praise and encouragement for eating but no attention for refusal, and no comments about the girl's emaciated condition; (b) more frequent feedings, with reduced amounts; (c) covert reinforcement with hypnotherapy; and (d) a token economy system. After acquiring 4 tokens she would be rewarded with a coveted bicycle. A token was rewarded for each kilo gained. At first her weight increase was very slow. Only after the introduction of the token system did she begin to gain weight at the approximate rate of 1 kg/mo. She reached her target of 25 kg in 9 mo. A follow-up study 10 mo after treatment shows good home and school adjustment and continued normal weight gain. (English summary) (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)

16. Token Economy Evaluation +It is good at getting sufferers to a reasonable weight after which the issues can be addressed. + It can be used in conjunction with other treatments. • Token economy does not deal with the underlying issues. • May only work short-term whilst the person is being treated in an institution. • Considered to violate human rights. (Key issue / debate of Social Control).

17. Write a conclusion for a 12 mark essay on behavioural Treatments of Anorexia.