Introduction
First of all, it is worth noting that Heston uses only one theoretical model such as Dorothy Orem’s version. The essence of the approach is to combat the lack of self-care of the patient, where the responsibility for progress lies with Rita (Agras, 2019). This is noticeable primarily in the types of medical interventions that Hudson uses when interacting with Rita. It is assumed that as a result of these processes, Rita should come to realize the wrongness and perniciousness of her own behavior and lifestyle. In addition, the most striking example is keeping a food diary (Waller et al., 2014). The patient should self-record episodes of food and calorie intake, as well as her subsequent behavior. The nurse here performs rather an auxiliary function, sets the vector for Rita’s reflection and development.
Cognitive Behavioral Model of Bulimia Nervosa (NB)
Cognitive behavioral therapy (CBT) for bulimia nervosa is highly effective. The technique is based on the classic Beck approach, which has been successfully used to treat depression, as well as anxiety and personality disorders (Waller et al., 2014). The three main goals of the psychotherapy of eating disorders are the restructuring of nutrition, the change of attitudes regarding body schema and negative feelings associated with one’s figure (Waller et al., 2014). With the help of CPT, Rita’s case is solved as follows:
- Power restructuring. Patients with BED (binge eating disorder) are characterized by a chaotic eating style and a tendency to be overweight. The phobia of certain products, which in itself can be a risk factor, is removed (Waller et al., 2014). The APA recommends that nutritional rehabilitation for NB should focus on helping the patient develop a structured eating plan.
- Therapy of stress reactions. Cognitive behavioral therapy uses problem solving training and stress coping training (Waller et al., 2014). In the first, the emphasis is on identifying what is a problem for the patient, and then looking for alternative ways to solve it until a positive sustainable result is obtained (Waller et al., 2014). In the second training, the patient, under the guidance of a therapist, analyzes the occurrence of his stress reactions and their consequences, and then, based on the analysis, an effective strategy for coping with stress, both short-term and long-term, is developed.
Reasons for Rita’s Unwillingness to Participate
Rita’s treatment is significantly complicated by her unwillingness to participate in some of the behavior change processes. There are reasons for this, which the specialist needs to take into account and eliminate as much as possible (Halmi, 2013). Bulimia is often caused by sharply negative emotions towards food consumption. At the same time, a person is irritated or repelled not by the products themselves, but by the consequences of their consumption, in particular, by their body (Halmi, 2013). In this way, it can be established that the reasons for the unwillingness to be patient are psychological difficulties and disorders. In order to overcome them, it is necessary to understand the prerequisites for the occurrence of such consequences (Halmi, 2013). The most useful here is the interaction with the patient and the recognition of his character, past and the necessary aspects of socialization. For example, bullying by peers or family, low self-esteem, hysteria or depression can be the root causes of the disease (Halmi, 2013). Without the elimination of triggers and psychological barriers, it is impossible to position the patient to begin effective treatment, in particular, food intake.
The Need for Third-Party Specialists
After establishing the main psychological prerequisites for both the onset of the disease and the inhibition of treatment, it makes sense to recommend additional specialists. Integration into the treatment process of a psychologist is the most effective way out of this situation (Dejesse & Zelman, 2013). In addition to professional medical care, Rita needs to work through and destroy the disorder that aggravates her well-being and pain (Dejesse & Zelman, 2013). It was noted that Rita mostly feels a sense of shame, which means that the presence of complexes is potentially likely. It is this that needs to be worked out by a psychologist who will introduce additional therapy and exercises for the patient (Dejesse & Zelman, 2013). A professional will be able to analyze the reasons for failures, unwillingness or impossibility of any step for Rita more efficiently than a nurse.
Potential Pitfalls and Ethical Issues in Collaboration
However, when two specialists collaborate, difficulties may arise in their interaction. First of all, Heston’s activities are aimed at regularity and achieving a positive effect on Rita’s health. At the same time, the psychologist may determine that it is too early to implement any of the interventions due to the patient’s condition, which means that it should be postponed (Agras, 2019). There is a potential conflict of interest because the nurse will come to modernize her approach. In addition, from the point of view of a psychologist, some of Heston’s actions may exert unnecessary and negative pressure on Rita, which will also complicate and slow down the healing process (Agras, 2019). Finally, it makes sense to highlight ethical principle regarding the fact that everything Rita said to the psychologist is confidential information (Agras, 2019). This means that the specialist cannot divulge information and also share it with the nurse (Agras, 2019). Another ethical principle here is respect for the problems and slowness of the patient, caused by serious complexes (Agras, 2019). These difficulties can be avoided if Heston chooses more flexible treatment methods that do not suffer from the integration of psychological therapy.
Effectiveness of Treatment Interventions
When analyzing Heston’s treatment interventions, it was found that not all of her solutions are effective enough. For example, the first two stages, the essence of which is to familiarize Rita with useful information, are useless in the context of bulimia. This is explained by the fact that in the presence of serious complexes and psychological disorders, the patient is not able to fully realize the danger or unfavorability of his situation. Accordingly, Rita perceives information detachedly, without comprehending it fully. However, it should be noted that the method of keeping a food diary is a useful and effective method. The idea of interaction with Rita is useful in that the patient does not feel like a burden or an extra element of the whole treatment, but is aware of her own participation and responsibility.
Conclusion
Thus, two of Heston’s trait interventions were found to be ineffective. It is necessary to develop three additional methods that could simplify the work of the nurse and at the same time take into account the integration of the psychologist into the treatment process. The first intervention has already revealed the study of disorders and psychological complexes that serve as the root causes of the appearance of bulimia and negative emotions in relation to oneself and one’s body (Lutter, 2017). The second method is to offer exposure therapy, the essence of which is the modeling of various situations (Agras, 2019). In the context of Rita, it would be appropriate to experience the state prior to the binge episode – without the ability to carry it out. Finally, the most striking method of achieving recovery is to recommend group psychotherapy (Hay, 2020). For Rita, the actual feeling of shame, and the peculiarity of the strategy in overcoming this emotion and providing interpersonal feedback and group support.
References
Agras, W. S. (2019). Cognitive behavior therapy for the eating disorders.The Psychiatric clinics of North America, 42(2), 169–179. Web.
Dejesse, L. D., & Zelman, D. C. (2013). Promoting optimal collaboration between mental health providers and nutritionists in the treatment of eating disorders. Eating disorders, 21(3), 185–205. Web.
Halmi, K. A. (2013). Perplexities of treatment resistance in eating disorders.BMC psychiatry, 13, 292. Web.
Hay, P. (2020). Current approach to eating disorders: A clinical update.Internal medicine journal, 50(1), 24–29. Web.
Lutter, M. (2017). Emerging treatments in eating disorders.Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics, 14(3), 614–622. Web.
Waller, G., Gray, E., Hinrichsen, H., Mountford, V., Lawson, E., & Patient, E. (2014). Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: Effectiveness in clinical settings.International journal of eating Disorders 47(1), 13-17. Web.