The cognitive behavior therapy (CBT) for eating disorders has become prevalent in Japan as well as in western countries in recent years. The aim of this presentation was the demonstration and discussion of both advantages and shortcomings of CBT for eating disorders. The following are presumed advantages: 1) Behavioral techniques can be used whose effects were experimentally substantiated. 2) Cognitive techniques are expected to be effective at least for bulimia nervosa. 3) Treatment can be performed in a supportive atmosphere. These points were discussed further presenting a case of anorexia and bulimia nervosa who was treated by CBT and recovered from illness in about 1 year. The operant conditioning technique and the assertiveness training whose effects had been sufficiently validated were primarily effective for this case. However, the assertiveness training did not work well before Katzman et al's psychoeducational approach was introduced, and thus psychoeducation, self monitoring, and cognitive restructuring method may have played a certain role in the whole treatment. Furthermore, the multifaceted treatment itself as mentioned above could be fairly supportive for the patient. On the other hand, the following are presumed shortcomings: 1) Standard strategies of CBT should be modified especially for anorexia nervosa patients because of lack of motivation and complex interactions between mind and body. 2) The grounds for effectiveness of cognitive techniques are insufficient especially for anorexia nervosa. 3) The validated concrete guideline for making a therapeutic relationship is not presented. While the second point means that the precondition for the use of CBT with eating disorders has not been established yet, as a matter of fact, how various cognitive variables lead to the onset and exacerbation of the disease has hardly been clarified yet. We presented one of our research findings in which 'beliefs on self appraisal' played a critical role in the causal chain of various cognitive and behavioral variables. That is, if we can change 'beliefs on self appraisal', other variables including symptoms of eating disorders such as excessive dieting behavior can also be changed sequentially, and we can assume that the effectiveness of cognitive intervention with eating disorders was supported by this result. It was then suggested that more relevant researches should be performed before the scientific grounds of CBT for eating disorders were sufficiently established.
|ジャーナル||Japanese Journal of Psychosomatic Medicine|
|出版ステータス||Published - 1997|
ASJC Scopus subject areas
- Psychiatry and Mental health