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Characteristics of Anorexia Nervosa

Research proposal includes a literature review on the effectiveness of DBT for Anorexia, as well as a possible research that can be used to address or test this.

Anorexia Nervosa (AN) is an extremely severe psychiatric illness that has been characterized by low body weight and intense fear of being overweight (Kahl, Winter & Schweiger, 2012). With regards to the adult the course of AN is chronic, and is considered difficult with regards to treatment (Kahl, Winter & Schweiger, 2012). The rates of mortality in AN usually are high than any psychological condition, with death that might result from cardiac issues or suicide. Based on study it recommend that less than half of the adults with the AN, develop although many continue on the chronic course or maybe partially improve (Hay, 2013). With regards to adults that have AN, there have been absolutely no particular treatment that has shown to be much superior in place since there us dearth adequately designed and has been powered randomized managed trials (Hay, 2013). There are numerous treatment that have failed to deal with on the core symptoms related to AN. Therefore, there has been new theoretical as well as treatment techniques which are required for this disorder (Kahl, Winter & Schweiger, 2012). There has been numerous psychological treatments which have been tested in outpatient setting, however, based on the reviews as well as meta analyzes there no evidence which has been shown in the superiority of one treatment approach over the other (Baer, Fischer & Huss, 2005). Nonetheless, treatment which has shown some degree of improvement of the condition has been DBT intervention. This  intervention was initially created for the people with borderline personality disorder , but lately it has demonstrated to be effective in two RCTs focusing on binge purge eating disorder especially with the uncontrolled problems for example serious emotion dysregulation (Hay, 2013). The interest in the DBT has grown and experts they have actually begun to use DBT to other clinical populations (Baer, Fischer & Huss, 2005). The adaptation of the DBT to treatment of the patient who experience AN, remains to be modified via the biosocial theory and it continues proposed that people who develop eating disorders they might have certain biological susceptibility to regulate emotions (Kahl, Winter & Schweiger, 2012). In case the biological susceptibility interacts with precise kind of environment, they patient might develop an eating disorder. The invalidating environment could take place across a spectrum from the poor fit between temperament of a person and also their environment.

Treatment Challenges

Currently, DBT is regarded as the frequently looked into psychosocial intervention for the AN treatment. It is an extensive treatment plan that has been targeted at promoting motivation alterations by comprehensive chain evaluates validation techniques and management of reinforcement contingencies in person treatment (Kahl , Winter & Schweiger , 2012). Based on the practice guideline for the therapy of the patient with the eating disorder of United States Psychiatric Association (2006), both males and females with ED for instance AN must evaluated for individuality disorders. Depending on the earlier studies, demonstrate that comorbidity rate for the ED was 3% for the Anorexia nervosa when accessed through diagnostic interviews. When thinking about the feasible confounding impact of malnutrition at intake, personality pathology could possibly be challenging regarding detecting samples with AN (Bankoff, Karpel , Forbes & Pantalone, 2012). However, women who retrieved from anorexia nervosa, restricting type AN-R, they showed significantly low and equivalent rate as those of cluster B issues. DBT concentrates in assisting patients to much more efficiently regulate on their feelings. Given that the patients with ED often display particular degree of difficulties with regards to regulating their emotions so they often display an eating pathology (Navarro-Haro et al 2018). DBT might be deemed as methods to deal with that facet of the emotional susceptibility. The deficits in impacts regulation in the eating disorders patients are wide when it comes to the scope so they differ in AN.

Patients with AN have difficulties in terms of the identification as well as awareness of the emotions, and avoiding of the feelings to some scope. The inherent framework of the DBT is evidently a great model employed to treat ED (Lenz, Taylor, Fleming & Serman, 2014). It provides certain distinct behavioral hierarchy which acts as guides to the therapists especially in focusing on the interventions. Elements for example suicidal and non-suicidal self destructive behaviors components which are not common in AN are sorted out first (Waller, 2016). On the second elements are the habits that could inter with the therapy and then mentioned after which followed by the quality of life interfering behaviors. DBT consists of particular methods with regards to working with the variables commitment to change (Kröger et al 2010). The AN patients normally have some problems with regards to modifying symptoms, so they could be less responsive to the usage of the traditional therapeutic interventions that are thought to be controlling ( Kahl , Winter & Schweiger , 2012 ) . DBT telephone skill coaching might be utilized with ED patients to assist with averting dysregulated eating routine. Moreover, the weekly consultation team meeting could aid clinicians to be motivated and allow helpful input and feedback to the therapy utilized. Regarding AN treatment, there have been deficiency of research outside the subject of FBT (Linehan et al 2015). In the literature it has described psychodynamic treatment and CBT, but there is absolutely no methodical evaluation which has been carried out (Bankoff, Karpel, Forbes & Pantalone, 2012). There is certainly need for the systematic trials which look at the psychotherapy in AN. With regards to DBT continues to be empirical supported treatment there is however no much study done on the clinical trials on AN.

Dialectical Behavioural Therapy (DBT) as a treatment for AN

There has been little research outside the field of FBT. Thus, the researchers in other field need to do more research in relation to the DBT treatment of AN (Ozier & Henry, 2011).  Additionally, DBT was initially developed for the treatment of the female multi-problem outpatients who were diagnosed with the borderline personality disorder. There should more interest in the DBT and research done in order to apply to the other clinical populations with and without the Axis (Ozier & Henry, 2011). Presently, there is certainly just one research which exists on the effectiveness for the adolescent patients who are afflicted with AN. Within this pilot research it only evaluated the effectiveness of the DBT which seems to be promising treatment especially to the inpatients adolescents with ED (Ozier & Henry, 2011). There have been absolutely no research yet which examined whether the outpatient DBT interventions has been feasible and effective to reduce symptoms of AN (Palmer et al 2003). This is a research gap and further research could be done on this research area.

The research question for this proposal is as follows;

To find out the effectiveness of Dialectical Behavioural Therapy (DBT) as treatment for the eating disorder Anorexia Nervosa?

In this research study the principle variables which are being examined were on the demographic variables and the Body mass index. At the therapy admission, the participants filled demographic form that composed information on their gender, age, ethnicity and the admissions to date (Safer, Couturier & Lock, 2007).

In this proposed study is feasible and carried out to answer on the research question the follows are the sections which describe on this hypothetical study.

In this proposed study it would utilize quasi-experimental design methodology. Within this research all the subjects in this research have the same chance of being assigned to the intervention group or perhaps the comparison group (Navarro-Haro et al 2018). The use of this methodology is ideal for this research given that the researcher is enthusiastic about the independent variables which could not be randomly assigned (Hayes et al 2004). It has something which is an innate characteristic of the participants who are involved since it focuses on the emotions of the participants (Salbach-Andrae et al 2008). The method which would be used to collect would be interviews. There would be use of the structured clinical interview. The interviewers would be trained in the administering ads well as scoring of the instruments by clinician who had been trained (Hay, 2013).

Research Gap

In this research it will use twenty four individuals (12 young and 12 adolescent) of who would be selected from the child and adolescent outpatient psychiatric division of the major university hospital in Australia. All would certainly be required to meet the criteria outlined in diagnostic as well as statistical manual of the mental disorder.  The participants who are included in this research are between the age of 12 and 18 years of age. To undertake on the research permission would need to be granted by the Institutional Review Board (Kristeller, Baerm & Quillian-Wolever, 2006). All themes will require a written notification form which indicates the project and inclusion as well as exclusion requirements to the study. Participants that are under age of 18 can simply be a part of the study in case the parent provides them written informed consent.

The organized inventory for the Anorectic syndrome could be utilized to evaluate the prevalence and severity to particular eating relevant pathology for over three months based on the DSM-IV diagnostic criteria to individual who were between 12 to 18 years. The semi-structured interview might supply general probes to each item to evaluate if the item for the investigation is true for the individuals who would be questioned (Lock, 2015). There would be measurement of the demographic variable along with the BMI on the patients.

Due to the small sample size which would be used for this research as well as the requirements of the statistical procedures, the proposed research would use distribution free methods. There is comparisons of categorical data at the pre treatment that will be analysed employing exact tests bases on Fisher-Yates (Hay, 2013). There would be two tailed permutation tests especially for the unpaired samples based on the Fisher-Pitman that will be conducted to be able to compare frequencies of disorders at the pre-treatment. For the proposed study to look at on the indices of eating disorder which are relevant complaints through use of the two- tailed permutation test for the purpose of the group comparison (Peterson et al 2016).

There are various ethical issues which would be encountered in this research study they are as follows;

Respect to confidentiality and the anonymity. It is crucial for the researchers to protect data which is shared by the respondent it should always protect the subject identity.

References

Baer, R. A., Fischer, S., & Huss, D. B. (2005). Mindfulness and acceptance in the treatment of     disordered eating. Journal of rational-emotive and cognitive-behavior therapy, 23(4),   281-300. Accessed At:             https://www.researchgate.net/profile/Sarah_Fischer/publication/225413776_Mindfulness            _and_Acceptance_in_the_Treatment_of_Disordered_Eating/links/09e41509174f600e940            00000/Mindfulness-and-Acceptance-in-the-Treatment-of-Disordered-Eating.pdf

Research Question and Methodology

Bankoff, S. M., Karpel, M. G., Forbes, H. E., & Pantalone, D. W. (2012). A systematic review of            dialectical behavior therapy for the treatment of eating disorders. Eating disorders, 20(3),       196-215.

Hay, P. (2013). A systematic review of evidence for psychological treatments in eating disorders:             2005–2012. International Journal of Eating Disorders, 46(5), 462-469. Accessed At: https://s3.amazonaws.com/academia.edu.documents/37203697/Hay-2013-International_Journal_of_Eating_Disorders.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1532690235&Signature=P6%2BFyY9ntSBCmboDZH0KxJ%2B327E%3D&response-content-disposition=inline%3B%20filename%3DA_Systematic_Review_of_Evidence_for_Psyc.pdf

Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP, and ACT:            How empirically oriented are the new behavior therapy technologies?. Behavior Therapy,           35(1), 35-54. Accessed At: scholarworks.gsu.edu/cgi/viewcontent.cgi?article=1082&context=psych_facpub

Kahl, K. G., Winter, L., & Schweiger, U. (2012). The third wave of cognitive behavioural             therapies: what is new and what is effective?. Current opinion in psychiatry, 25(6), 522-        528.

Kristeller, J. L., Baer, R. A., & Quillian-Wolever, R. (2006). Mindfulness-based approaches to      eating disorders. Mindfulness-based treatment approaches: Clinician's guide to evidence        base and applications, 75. Accessed At:             https://www.researchgate.net/profile/Ruth_Wolever/publication/259297093_Mindfulness              -            Based_Approaches_to_Eating_Disorders/links/0c9605293ebb40514b000000/Mindfulnes s-Based-Approaches-to-Eating-Disorders.pdf

Kröger, C., Schweiger, U., Sipos, V., Kliem, S., Arnold, R., Schunert, T., & Reinecker, H.            (2010). Dialectical behaviour therapy and an added cognitive behavioural treatment     module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial        with a 15-month follow-up. Journal of behavior therapy and experimental psychiatry,             41(4), 381-388. Accessed At:             https://www.researchgate.net/profile/Soeren_Kliem/publication/44575049_Dialectical_be            haviour_therapy_and_an_added_cognitive_behavioural_treatment_module_for_eating_di            sorders_in_women_with_borderline_personality_disorder_and_anorexia_nervosa_or_bul            imia_nervosa_who_failed_/links/5677e3ae08aebcdda0eb9a41.pdf

Lenz, A. S., Taylor, R., Fleming, M., & Serman, N. (2014). Effectiveness of dialectical behavior   therapy for treating eating disorders. Journal of Counseling & Development, 92(1), 26-  35.

Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., ... &    Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in    individuals with borderline personality disorder: a randomized clinical trial and            component analysis. JAMA psychiatry, 72(5), 475-482. Accessed At:             https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2205835

Lock, J. (2015). An update on evidence-based psychosocial treatments for eating disorders in       children and adolescents. Journal of Clinical Child & Adolescent Psychology, 44(5), 707-           721. Accessed At: https://www.tandfonline.com/doi/full/10.1080/15374416.2014.971458

Navarro-Haro, M. V., Botella, C., Guillen, V., Moliner, R., Marco, H., Jorquera, M., ... & Garcia-Palacios, A. (2018). Dialectical Behavior Therapy in the Treatment of Borderline           Personality Disorder and Eating Disorders Comorbidity: A Pilot Study in a Naturalistic         Setting. Cognitive Therapy and Research, 1-14.

Ozier, A. D., & Henry, B. W. (2011). Position of the American Dietetic Association: nutrition      intervention in the treatment of eating disorders. Journal of the American Dietetic        Association, 111(8), 1236-1241. Accessed At: https://jandonline.org/article/S0002-   8223%2811%2900712-7/pdf

Palmer, R. L., Birchall, H., Damani, S., Gatward, N., McGrain, L., & Parker, L. (2003). A            dialectical behavior therapy program for people with an eating disorder and borderline personality disorder—description and outcome. International Journal of Eating           Disorders, 33(3), 281-286.

Peterson, C. B., Becker, C. B., Treasure, J., Shafran, R., & Bryant-Waugh, R. (2016). The three-   legged stool of evidence-based practice in eating disorder treatment: research, clinical,       and patient perspectives. BMC medicine, 14(1), 69.Accessed At:           https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0615-5

Safer, D. L., Couturier, J. L., & Lock, J. (2007). Dialectical behavior therapy modified for            adolescent binge eating disorder: A case report. Cognitive and behavioral practice, 14(2),     157-167

Salbach-Andrae, H., Bohnekamp, I., Pfeiffer, E., Lehmkuhl, U., & Miller, A. L. (2008).    Dialectical behavior therapy of anorexia and bulimia nervosa among adolescents: A case            series. Cognitive and behavioral practice, 15(4), 415.Accessed At:         https://elsevierscitech.com/pdfs/CBPRA-DialectalBehaviorTherapy.pdf

Waller, G. (2016). Treatment protocols for eating disorders: Clinicians’ attitudes, concerns,           adherence and difficulties delivering evidence-based psychological interventions. Current             psychiatry reports, 18(4), 36. Accessed At:   https://link.springer.com/article/10.1007/s11920-016-0679-

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