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aliwali1701

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Reply with quote  #1 
I know that the first battle with anorexia is weight restoration. When a child works with a therapist to overcome problems with anorexia and anxiety, how is it done and what is the focus of therapy? What are the steps of therapy which will lead to recovery?
melstevUK

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Reply with quote  #2 
Hi aliwali1701,


I have no idea how therapists relate to younger patients but parents themselves can help a lot with anxiety in their children.  I can recommend 'Parenting your anxious child with mindfulness and acceptance', which you can buy on Amazon.

Assuming the anxiety is about things other than eating, helping your child break scary things down into tiny steps can also help.  I spent a lot of time with my child when she was young, discussing difficult situations at school and helping her deal with them - when other children were horrible to her, for example (as children often are).  I ensured she did not have just one best friend but had lots of friends who she could play with, so that if there was a fall out she always had others to turn to.  

If there is still anxiety about eating, then Eva Musby's 'bungee jumping' video is hugely helpful.

It is probably true to say that most eating disorder patients are 'wired' to be more sensitive and have a parasympathetic nervous system which is much more easily aroused than with other people - and for that medication can help.  There can be a lot of reluctance to put young children on medication, however, depending on which country you are in.  However, if suffering is severe and interfering with normal functioning - in my view not using medication is a no-brainer.  Why allow such extreme suffering to persist?

Others may be able to answer your question more specifically but I hope that helps.

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mjkz

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Reply with quote  #3 
My daughter's therapist works with her on coping skills, life skills, very practical things.  She helps her identify faulty thinking and replace the thinking with more realistic thoughts (or at least helps her identify the thoughts as faulty so she doesn't react to them).  She role plays situations that are problematic for my daughter and sometimes just listens to her vent about all the things that are going on in her life.  I have a tendency to want to fix things rather than just listen so her therapist can the person to listen and then ask her if she wants to do anything about it.  I know her therapist has worked very hard with her on how to not sabotage herself and relationships that she is in.  Those are just a few of the things her therapist helps her with.
pjdj

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Reply with quote  #4 
My D ‘s therapist is suggesting eye movement Desensitization reprocessing. Has anyone’s D been recommended that? Or tried it? Please let me know.
Kali

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Reply with quote  #5 
Hi pjdj,

My understanding is that EMDR is often used to treat trauma or PTSD.
I haven't heard of any studies or randomized trials that have shown that it is an effective treatment for an eating disorder though.

I did try it once a number of years ago, and I did think it was calming. 

I remember that I had headphones on with rhythmic sounds in each ear and was told to think about the events that were difficult for me and then be aware of the thoughts that came after. The therapist then may have asked me to say some of those thoughts out loud. She may also have asked me to move my eyes following something. It was a long time ago.

Kali

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OneToughMomma

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Reply with quote  #6 
Dear aliwali,

You ask, 'When a child works with a therapist to overcome problems with anorexia and anxiety, how is it done and what is the focus of therapy? What are the steps of therapy which will lead to recovery?'

I think your questions will have many different answers, depending on who responds.

I will tell you my experiences of therapy for my d's anxiety and anorexia.  When her ED became acute anorexia, standard treatments were no longer effective.  What worked for her was manualized FBT.  The focus is completely on full nutrition and weight gain.  It offers very little else, especially from the patient's point of view.  As my d gained weight, she had better tolerance to the extreme anxiety that came with eating, food, and gaining weight. Her relationships with me and her dad naturally improved. Everything just slowly got better with time and weight gain.

The three stages of FBT are pretty well documented and are weight restoration, handing over control of food to the adolescent, and restoring a healthy identity.  The suggested/proposed time lines are a complete load of stuff, imo. It took a solid 18 months to get my d from hospital discharge to FBT discharge.  (she had been ill on and off for almost a decade)  And even after FBT, she still has challenges with anxiety.

FBT is not the only option, but it does offer evidence-based treatment with the best chance of recovery.  It's also not the only solution, as in our experience, there's lots of mopping up to do even after phase 3. 

OTM

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D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
EC_Mom

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Reply with quote  #7 
Our FBT did mind-gym-like exercises with our daughter at first while we were refeeding. Nothing to do with eating--just trying to break the rigid thinking patterns. Just puzzles and problems that required her to "set shift", i.e. try to solve problems with a different perspective.

FBT was terribly frustrating, it was about helping parents cope with the distress and feeding. Much much later the therapist worked with d on coping with anxiety.
tina72

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Reply with quote  #8 
Hi,
in our case therapists in IP tried a lot. They talked to her, she had music and paint therapy and they offered her a complete program what insurance would pay. Some do even horse therapy and there are a lot of possibilities to get money out of the patients.
Do you know what has worked? None of it.
Eating is the therapy. Food, food, distraction, food. To get into a normal life again. See friends and do normal things. And did I mention food?
Today I am the "therapist". I dry the tears, hug, serve dinner. Talk and give hope.
Unfortunately I do not get 100 Dollars/Euros/British pounds for every hour I have set with her. But I do it for a smile of her. And a hug. That is priceless...
So if that was your question, what therapy will get ED out of your house: food.
Tina72
EDAction

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Reply with quote  #9 
Hi aliwali1701,

During refeeding at home, the therapist was more a support to us.  T spoke with our D too during this time.  We had one weekly session, but divided it between us and D.  T supported us and answered our questions re: refeeding.  And we felt better knowing that an ED professional was laying eyes on, and talking with, our D once a week.

As time moved on T spent more of the weekly session with D and less with us and eventually all of the session with D.  T helped explain to my D what was happening to her and eventually gave D a place to be honest about how ED was affecting her with someone who understood it.  Eventually T worked on DBT skills with D too.  D didn't talk about it with me much either, but we have gotten better at talking about it together as time has gone on. 
Torie

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Reply with quote  #10 
Hi pjdj - I don't know anything about your journey so far, but as tina said, the only thing that matters when they are in the throes of AN is getting the weight on.  Okay, maybe that's a slight exaggeration for some, but it's amazing how much truth there is in that.

Please feel free to ask all the questions you like.  xx

-Torie

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"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
pettelly

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Reply with quote  #11 
Our therapist supports us in strategies to get our D to eat more and challenge anorexic behaviours. Once she is WR, the plan is to move on to something like CRT to try to change some of the behaviours associated with anorexia like perfectionism, rigid thinking and low self esteem to build up her resilience in the future. We will probably have to chagne therapists. Ours is lovely but D hates her with a passion (due to being forced to gain weight and transferring a lot of her anger from us to her) and we all agree better we start afresh with a new therapist once she is WR so she will be more compliant. 
Foodsupport_AUS

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Reply with quote  #12 
The therapy my D has done is mostly CBT type work, teaching her coping strategies for management of anxiety and depression. There has also been a lot of work on cognitive rigidity. Early on part of it was just helping her cope with the distress caused by weight gain. He has helped her remarkably and I have seen an improvement in self confidence for her as well. Food is essential but there is definitely a role for therapy for some. 

Pettelly I wonder if you will need to change therapists, or even if that is a good idea? You are obviously getting great support for weight gain. Once that is done, often the anger and resentment from your D settles down, and the therapy will be able to be directed towards helping her deal with this better. CRT can even be done prior to weight gain, it is one of the few treatments that has shown benefit at any weight. A new therapist will need to support any continuing gain required and good therapists can be hard to find. 

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D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
tina72

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Reply with quote  #13 
Pettely,
I think it is totally normal that they hate the therapist during refeeding but a lot of us (me included) experienced that change in behaviour after WR includes change in behaviour with the therapist. In the early days my d just sat there very withdrawn and said nothing or was angry with her and on the last session she was sitting relaxed and talked to her like to a normal friend of the family. So if you like the therapist wait and see what is happening. Good therapists are really rare.
Tina72
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