Samenvattingen Capita Selecta Therapy - CGT bij Eetstoornissen

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Inhoudsopgave
Theorieën over eetstoornissen............................................................................................................................. 3
Fairburn, C. G., Cooper, Z., & Shafran, R. (n.d.). Cognitive behaviour therapy for eating disorders: a
“transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528.
https://doi.org/10.1016/S0005-7967(02)00088-8.....................................................................................................3
Williamson, D. A., White, M. A., York-Crowe, E., & Stewart, T. M. (2004). Cognitive-Behavioral Theories of Eating
Disorders. Behavior Modification, 28(6), 711–738. https://doi.org/10.1177/0145445503259853...........................5

Protocollen / behandeling.................................................................................................................................... 8
Jansen, A., Elgersma, H. J., & Mulkens, S. (2020) Boulimia nervosa en verwante eetstoornissen. In: Braet, C. en
Bögels, S. (red.) Protocollaire behandelingen voor kinderen met psychische klachten. Amsterdam: Uitgeverij
Boom...........................................................................................................................................................................8
Van den Berg, E., Schlochtemeijer, D. (2017). Protocollaire behandeling van patiënten met anorexia nervosa. -
cognitive therapy enhanced. In: Keijsers, G., van Minnen, A., Verbraak, M., Hoogduin, K., Emmelkamp, P. (red)
Protocollaire behandelingen voor volwassenen met psychische klachten. Amsterdam: Uitgeverij Boom. ............12
VGCt podcast over anorexia nervosa, BED, https://kennisnet.vgct.nl/bericht/podcast-anorexia-nervosa/............17
VGCt podcast over ARFID https://kennisnet.vgct.nl/bericht/podcast-arfid/............................................................20
VGCt podcast over eetbuistoornis https://kennisnet.vgct.nl/bericht/podcast-bed/.................................................22
Filmpje over eetbuistoornis: De grootste eetstoornis waar je nog nooit van hebt gehoord – YouTube:
https://www.youtube.com/watch?v=9Zi2AqpKGyo ................................................................................................24

Exposure............................................................................................................................................................ 25
Butler, R. M., & Heimberg, R. G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical
Psychology Review, 78, 101851. https://doi.org/10.1016/j.cpr.2020.101851. ......................................................25

Eten................................................................................................................................................................... 28
Cardi, V., Leppanen, J., Mataix‐Cols, D., Campbell, I. C., & Treasure, J. (2018). A case series to investigate food ‐
related fear learning and extinction using in vivo food exposure in anorexia nervosa: A clinical application of the
inhibitory learning framework. European Eating Disorders Review, 27, 173-181. https://doi.org/10.1002/erv.2639
..................................................................................................................................................................................28
Steinglass, J. E., Albano, A. M., Simpson, H. B., Wang, Y., Zou, J., Attia, E., & Walsh, B. T. (2014). Confronting fear
using exposure and response prevention for anorexia nervosa: A randomized controlled pilot study. International
Journal of Eating Disorders, 47(2), 174-180. https://doi.org/10.1002/eat.22214 ................................................30
Jansen, A., Schyns, G., Bongers, P., & van den Akker, K. (2016). From lab to clinic: Extinction of cued cravings to
reduce overeating. Physiology & behavior, 162, 174–180. https://doi.org/10.1016/j.physbeh.2016.03.018.........31
Protocol cue exposure (from: Jansen, A. (1998). A Learning model of binge eating: cue reactivity and cue
exposure. Behaviour Research and Therapy, 36, 257-272.) https://doi.org/10.1016/S0005-7967(98)00055-2. ...33

Lichaam............................................................................................................................................................. 35
Jansen 2013 Jansen, A.. Voorwinde, V., Hoekbink, Y.Rekkers, M., Martijn, C. & Mulkens, S, (2013) Ontevreden over
uw lichaam? Voor de spiegel! En dan? Exposure aan wat eigenlijk? Gedragstherapie, 46, 57-75.
https://www.tijdschriftgedragstherapie.nl/scripts/shared/artikel_pdf.php?id=TG-2013-2-2 ................................35

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Griffen, T.C., Naumann, E., & Hildebrandt, T. (2018). Mirror exposure therapy for body image disturbances and
eating disorders: A review. Clinical Psychology Review, 65, 163–174. https://doi.org/10.1016/j.cpr.2018.08.006 38

Aandachtspunten / technieken........................................................................................................................... 41
Waller, G., Pugh, M., Mulkens, S., Moore, E., Mountford, V. A., Carter, J., Wicksteed, A., Maharaj, A., Wade, T. D.,
Wisniewski, L., Farrell, N. R., Raykos, B., Jorgensen, S., Evans, J., Thomas, J. J., Osenk, I., Paddock, C., Bohrer, B.,
Anderson, K., Turner, H., … Smit, V. (2020). Cognitive-behavioral therapy in the time of coronavirus: Clinician tips
for working with eating disorders via telehealth when face-to-face meetings are not possible. International
Journal of Eating Disorders, 53(7), 1132–1141. https://doi.org/10.1002/eat.23289..............................................41
Fairburn, C. G., & Wilson, G. T. (2013). The dissemination and implementation of psychological treatments:
problems and solutions. International Journal of Eating Disorders, 46(5), 516–521.
https://doi.org/10.1002/eat.22110..........................................................................................................................42
Waller, G., & Mountford, V. A. (2015). Weighing patients within cognitive- behavioural therapy for eating
disorders: How, when and why. Behaviour research and therapy, 70, 1–10.
https://doi.org/10.1016/j.brat.2015.04.004............................................................................................................44
Mulkens, S., de Vos, C., de Graaff, A. & Waller, G. (2018). To deliver or not to deliver cognitive behavioral therapy
for eating disorders: Replication and extension of our understanding of why therapists fail to do what they should
do. Behaviour Research and Therapy, 106, 57-63. https://doi.org/10.1016/j.brat.2018.05.004............................46
Handout over starvation (uit; Dalle Grave & Calugi, 2020): The effects of caloric restriction and weight loss - The
Minnesota Starvation Experiment............................................................................................................................47

Nieuwe (onderzoeks)ontwikkelingen.................................................................................................................. 49
Mulkens, S., & Waller, G. (2021). New developments in cognitive-behavioural therapy for eating disorders (CBT-
ED). Current opinion in psychiatry, 34(6), 576– 583. https://doi.org/10.1097/YCO.0000000000000745...............49
Roefs, A., Lemmens, L., & Jansen, A. (2019). Eetstoornissen als een netwerk van symptomen. Gedragstherapie..50
Jansen, A. (2016). Eating disorders need more experimental psychopathology. Behaviour Research and Therapy,
86, 2-10. https://doi.org/10.1016/j.brat.2016.08.004 ............................................................................................52

Walging.............................................................................................................................................................. 54
Glashouwer, K. A., & de Jong, P. J. (2020). Walging als de motor achter voedselrestrictie in anorexia nervosa.
Tijdschrift voor Gedragstherapie, 3, 174- 186.
https://pure.rug.nl/ws/portalfiles/portal/135294093/TG_2020_3_4.pdf ..............................................................54
Porras-Garcia, B., Ferrer-Garcia, M., Serrano-Troncoso, E., Carulla-Roig, M., Soto-Usera, P., Miquel-Nabau, H., …
Gutiérrez-Maldonado, J. (2021). AN-VR-BE. A randomized controlled trial for reducing fear of gaining weight and
other eating disorder symptoms in anorexia nervosa through virtual reality-based body exposure. Journal of
Clinical Medicine, 10(4), 682. https://doi.org/10.3390/jcm10040682 .................................................................56

ARFID................................................................................................................................................................. 57
Howard, M., Hembry, P., Rhind, C., Siddall, A., Uddin, M. F., & Bryant-Waugh, R. (n.d.). Cognitive behaviour
therapy (CBT) as a psychological intervention in the treatment of ARFID for children and young people. The
Cognitive Behaviour Therapist, 16. https://doi.org/10.1017/S1754470X22000629................................................57
Zimmerman, J., & Fisher, M. (2017). Avoidant/Restrictive Food Intake Disorder (ARFID). Current Problems in
Pediatric and Adolescent Health Care, 47(4), 95–103. https://doi.org/10.1016/j.cppeds.2017.02.005.................60
Thomas, J. J., & Eddy, K. T. (2018). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder:
children, adolescents, and adults. Cambridge University Press. Hoofdstuk 1, 4 en 5. . https://doi-
org.proxyub.rug.nl/10.1017/9781108233170 ........................................................................................................62

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Theorieën over eetstoornissen
Fairburn, C. G., Cooper, Z., & Shafran, R. (n.d.). Cognitive behaviour therapy for eating disorders: a
“transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528.
https://doi.org/10.1016/S0005-7967(02)00088-8
 This article is about the psychological processes that contribute to the persistence of severe eating disorders,
and its cognitive behavioural theory and treatment.
 The Cognitive Behavioral Theory underlying CBT-BN emphasises dysfunctional self-evaluation related to
eating habits, shape, and weight, leading individuals to judge themselves primarily based on these factors →
This is a core psychopathology.
 This core psychopathology drives behaviours such as dietary restriction, binge eating, purging, and extreme
self-criticism. Binge eating is seen as a response to rigid dietary rules and negative emotions, maintaining
the cycle of disordered eating. Compensatory behaviours like purging reinforce binge eating by providing
perceived control over weight gain.
 Additionally, individuals with BN tend to be highly self-critical, setting unattainable standards and blaming
themselves for perceived failures, which further perpetuates the disorder by intensifying efforts to control
eating and weight.




Original theory vs New ‘extended’ theory above:
Patients often abandon general healthy-eating guidelines in favor of multiple extreme and highly specific dietary
rules. When they inevitably break these strict rules, even in minor ways, they tend to interpret it as a failure of self-
control. This reaction frequently leads them to temporarily give up their restraint, resulting in episodes of binge
eating. Over time, this creates a cycle in which periods of rigid dietary restriction are repeatedly disrupted by binges.
These binges then reinforce their concerns about losing control over their eating, shape, and weight, which in turn
drives them to adopt even stricter dietary rules, further increasing the risk of additional binge episodes.

The cognitive-behavioural theory of bulimia nervosa indicates that treatment should not focus only on reducing
binge eating. For lasting improvement, it must also target patients’ dietary restraint, their reactions to negative mood
states, and their over-evaluation of eating, shape, weight, and control.

When it comes to treatment, CBT-BN highlights the importance of addressing not only binge eating but also dietary
restraint, mood responses, and distorted self-evaluation. The outpatient-based treatment typically spans 15-20
sessions over about five months and employs various cognitive behavioural techniques within a personalised
framework of the maintenance theory. Research on the efficacy of CBT for BN has been extensive. Key findings
include significant reductions in binge eating and purging frequencies, with approximately 40-50% of treatment
completers achieving remission of these behaviours. CBT-BN has shown superiority over pharmacotherapy and has
been compared favourably to various psychological treatments, including supportive psychotherapy and exposure
with response prevention. While consistent predictors of treatment response are challenging to identify, early
reduction in binge eating and purging behaviours is a promising indicator of long-term success, a pattern observed
across other disorders as well.

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Two main findings emerge from this research on CBT-BN: (1) it is effective, (2) but not effective enough, with only
about half of patients achieving lasting improvement. Therefore, CBT-BN was optimised to focus on maintenance
mechanisms. And why aren’t more people getting better? Reasons are:
1. The theory upon which CBT-BN is based is incorrect, and therefore the targeted maintaining mechanisms
are the wrong ones
2. CBT-BN has not been implemented optimally in the research trials
3. While the theory underpinning CBT-BN is valid and the focus of treatment is therefore appropriate, the
existing treatment procedures are not sufficiently potent
4. The theory is valid but it needs to be extended to embrace additional maintaining mechanisms

The new CBT-BN maintenance expands on the original theory by introducing four additional maintenance
processes:These processes interact with the core mechanisms of the disorder and hinder change when present.
1. Clinical perfectionism: Patients with bulimia nervosa often exhibit perfectionism in striving for demanding
standards, even when it leads to adverse consequences. Correcting clinical perfectionism may remove
barriers to change.
2. Core low self-esteem: Some patients have a pervasive negative view of themselves, independent of their
ability to control eating. This core low self-esteem prevents change by fostering hopelessness and
reinforcing determined pursuit of goals.
3. Mood intolerance: Certain patients have difficulty coping with intense emotional states, leading to
dysfunctional mood-modulating behaviours such as binge eating or self-injury. These behaviours become
habitual means of mood regulation and hinder change.
4. Interpersonal difficulties: Interpersonal processes contribute to maintaining eating disorders in various
ways, such as family tensions intensifying resistance to eating and adverse social environments magnifying
concerns about weight control. Resolving interpersonal difficulties can facilitate change in patients.

Transdiagnostic Perspective
The transdiagnostic perspective on eating disorders suggests that common maintaining mechanisms underlie various
eating disorders, including anorexia nervosa, bulimia nervosa, and atypical eating disorders (EDNOS). While these
disorders may present differently, they share similar psychopathological features and patients may transition between
diagnostic categories over time. For example, clinical perfectionism, core low self-esteem, mood intolerance, and
interpersonal difficulties may contribute to the persistence of symptoms across different disorders. These maintaining
mechanisms are not disorder-specific but are relevant across diagnostic categories.

Transdiagnostic Treatment
The transdiagnostic treatment has several characteristics:
 Suitability for all forms of clinical eating disorders.
 Focus on psychopathological features:
o The patient's specific diagnosis is not relevant to the treatment because the treatment targets
specific psychopathological features and maintaining mechanisms.
 Practicability under outpatient conditions
 Two versions of treatment:
o The treatment is provided in two versions - a 20-session treatment for the majority of patients and a
40-session treatment for significantly underweight patients.
o The longer treatment includes procedures to help patients regain weight.
 One-to-one delivery: The treatment is delivered on a one-to-one basis to address individualised needs
effectively.
 Four stages of treatment:
1. Stage One: Focuses on engaging and educating the patient, creating a personalised formulation,
and initiating behaviour change.
2. Stage Two: Identifies barriers to change and formally assesses the contribution of maintaining
mechanisms. A revised formulation is created based on this assessment.
3. Stage Three: Addresses the revised formulation including modules targeting clinical
perfectionism, core low self-esteem, mood intolerance, and interpersonal difficulties
4. Stage Four: A maintenance stage focusing on ensuring that progress is maintained after treatment
ends, with sessions held every 2 weeks.