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Porto, Portugal | September 20-22, 2012
59
technology assisted guided self-help is equally effective for
adolescent females with BN as it is for adults and can be
recommended as a first step within a stepped care approach
also for adolescent patients with BN.
F73
SYMPTOM CHANGE AND THE THERAPEUTIC ALLIANCE
IN CBT FOR THE EATING DISORDERS
Glenn Waller
1, 2
, Amy Brown
3
, Victoria Mountford
1,4
1
King’s College London, London, United Kingdom,
2
Central
and North West London NHS Foundation Trust, London, Unit-
ed Kingdom,
3
Royal Holloway University of London, London,
United Kingdom,
4
South London and Maudsley NHS Founda-
tion Trust, London, United Kingdom
Introduction It is commonly assumed that a positive ther-
apeutic relationship is a key factor in positive outcomes of
treatment for the eating disorders. However, that relationship
is more complicated in cognitive behaviour therapy (CBT) for
other disorders, with a positive working alliance being a result
of symptom reduction, rather than a cause of such changes.
This study explored whether the therapeutic relationship
precedes or follows behavioural change in CBT for anorexia
nervosa. Methods Sixty seven women with anorexia ner-
vosa undertook a course of outpatient CBT for their eating
disorder, with symptoms measured throughout. They also
completed a standardised measure of the working alliance
at the sixth session. Results Levels of therapeutic alliance
were satisfactory overall. Early weight gain led to a more
positive overall alliance by session 6 of treatment, and weight
gain in the later part of CBT (session 6 to end of treatment)
was associated with therapeutic alliance at the endpoint of
treatment (over and above the association of early and late
therapeutic alliance). Conclusions The therapeutic alliance
does not appear to be a driving factor behind weight gain in
CBT for anorexia nervosa. Instead, as with other disorders,
changes in the key symptom appear to drive a better working
alliance. This finding has implications for the structure of CBT,
and needs to be tested out in other therapies for the eating
disorders.
F74
The pros and cons of changing eating as a core element
of cognitive behavioural therapy for the eating disorders
Glenn Waller
1,2
, Jane Evans
2
1
King’s College London, London, United Kingdom,
2
CNWL
NHS Foundation Trust, London, United Kingdom
Introduction Dietary change is a core element of evi-
dence-based cognitive-behavioural therapy (CBT) for the
eating disorders. However, many CBT clinicians do not
encourage patients to change their eating pattern or content,
preferring to focus on cognitive challenges. This study ad-
dressed what patients experience as the pros and cons of di-
etary change over the course of CBT for their eating disorder.
Methods A cohort of patients in the latter part of CBT for their
eating disorder were asked to identify the short- and long-
term pros and cons of changing the structure and content of
their dietary intake over the course of that treatment. Themes
were extracted by the researchers. Results These patients
described their short-term reactions to the change in their eat-
ing as mixed, with high levels of anxiety, but improvements in
their social and physical functioning. Long-term, they reported
consistently positive reactions to their change in diet, feeling
happier and less anxious, with improved cognitive and social
functioning. Conclusions Patients find the focus on dietary
change in CBT to be initially anxiety-inducing. However, if
patients and clinicians alike stick to the target of improving
the structure and content of food intake, there are benefits
that are sustained in the form of better cognitive, emotional
and social functioning. This information can be shared with
patients to reassure them that there are good reasons to stick
with dietary change.
F75
Response to Day Hospital Treatment in Males
D Blake Woodside, Marion P Olmsted, Wendi Rockert
Toronto General Hospital, Toronto, ON, Canada
This paper reports on immediate response to Day Hospital
treatment for a sample of 12 males with bulimia nervosa(BN).
Before treatment these men had a mean of 40 binge and 58
vomit episodes per month and had profiles similar to those of
our female BN patients. 16.7% of the men left treatment early
(less than 4 weeks). Of the remaining 10 patients, 60% were
abstinent from bingeing and vomiting at the end of treatment
and an additional 30% had subthreshold symptom frequen-
cies. This response to treatment compares very favourably to
the 50% abstinence rate observed at the end of DH in female
BN patients. There were similar improvements in psychologi-
cal test scores. These results suggest that men respond well
to DH treatment for their ED. Our clinical experience is that
the male patients fit in well with the female patients and share
similar issues and concerns in intensive group therapy.
F76
The link between the level of stress and disordered
eating pathology among high school dance students:
controlled study
Eynat Zubery
1,2
, Latzer Yael
2,3
, Ruth Katz
2
, Evelyne Steiner
1
1
Eating Disorders Treatment and Research Center, Hano-
trim Clinic, Raanana Shalvata Mental Health Center, Israel,
2
University of Haifa, Haifa, Israel,
3
Rambam Medical Center,
Haifa, Israel
Background
: Dancers are at high risk for Disordered Eating
Pathology.
Goal:
to examine the relation between the stress
and disordered eating among dance program students in art
schools and in regular schools.
Method:
1031 school girls
divided into four groups: 115 dance students from art schools,
312 non dance students from art schools, 263 dance stu-
dents from regular schools and 341 non dance students from
regular schools. Disordered eating and psychopathology was
measured by the EDI-2, BDI, and the MPS.
Results:
Beyond
research groups, greater amounts of remarks and greater lev-
els of parental criticism were found to be correlated with high-
er levels of depression and perfectionism that in turn created
an environment conducive to higher levels of ED pathology.
Furthermore, the dance programs in art schools, significantly
higher exposure to the stressors shown above and according-
ly higher levels of depression and perfectionism contributed
to higher levels of ED. In contrast, the dance programs in
regular schools demonstrated the lowest scores in drive for
thinness, body dissatisfaction and depression.
Conclusions
:
the research findings sharpen the necessity of implementa-
tion of prevention programs which emphasize the correlation
between remarks and the level of disordered eating patholo-
gy and screening for levels of Ed pathology, depression and
perfectionism when entering art schools to accurately gauge
if the adolescent can cope with the demands of competitive
programs.
F77
THE EVALUATION OF OBESITY AND NIGHT EATING
SYNDROME WITH RORSCHACH TEST
ASLIHAN TOPYAY ÖZFİDAN
Ersoy Hospital, İstanbul, Turkey
There aren’t enough studies made on usage of projective test
in obesity and night eating syndrome.In regard to this fact,
Rorschach Test is applied to four obese adult women and
four obese adult women with night eating syndrome to define
and understand psychic functioning of obesity and night
eating syndrome with a psychoanalytic perspective. In terms
of this perspective mentalization processess, maternal and
paternal identification, early object relations, affective world,
defense mechanisms which support the idea that obese
person uses overeating and nighteating to handle the prob-
lems and anxiety are evaluated in this study. Findings show
that the characteristics of obese and night eating syndrome
patients are using self-soothing skills to reach calmness and
it becomes repetetive as psychosomatic patients. Acoording
to evaluation,obese individuals have signs of borderline and
night eating syndrome patients have signs of narcissisitic
personality development. Both groups have different respons-
es to the cards which are about early motherhood period.
Obese patients have extensive problematic of symbiosis
and individuation. Patients with night eating syndrome gives
narcissistically identical responses which doesn’t contain
impulsive symbols of femaleness, have more difficulties with
sembolization, give food responses and poor fantasmatic
world according to obese patient
POSTER SESSION 2 ABSTRACTS