Transcript Diapositiva 1 - Association for Contextual Behavioral Science

“Acceptance and Commitment Therapy in eating
disorders.
Clinical practice with complex case.”
Katia Manduchi, Psy D,
Giovambattista Presti MD, Giovanni
Miselli Psy. D & Elisa Rabitti Psy. D
1
Case presentation: G. a woman with disordered eating
problems, depression and chronical illness… can we
make the difference in her life???
G. is 36 years old. Her neurologist suggested her to doing a
psychotherapy with me because, after lots of hospitals, for
Multiple Sclerosis, recurrent nephrotic syndromes, lupus and
their collateral effects, she developed a disordered eating
with food restriction and hyperactivity. Contemporary the
psychiatrist that work in team with the neurologist, suggested
that her diagnosis was complicated from a form of medium
depression. Her BMI at the first session was of 15.
ACT Question
(2) Unacceptance of:
Body weight and
size that started
Acceptance
before the illness
period; unacceptance
of the medical
situation and of the
physical symptoms
Defusion
(3) Fused with
hopelessness and
with the fear of
dying
Contact with the
Present Moment
(6) She hasn’t any
contact with the
present moment but
she’s always
thinking to her food
Values
intake and the
physical activity she
(5)Family and the
“needs” to do
daughter
relationship; thinnes;
having perfect legs.
(4) Food restriction;
Committed
hyperactivity;
Action symptoms
anxiety
(1) Her self definition is: “It
Self as
Context would be better for my daughter
and husband if I’ll died”; “I’m
unworthy”; “I can’t express my
suffering and my worries for my
In the first session I have to choose: can I
believe in “Wilson wager”???
My answer was…..
And then she had to copy with…
Her fear of gain weight
And she felt so little
Assessment
• In self monitoring diaries we noticed that she was
having a food restriction and hyperactivity, daily;
• BIAAQ: 48 (with the score 7 at items 1 e 2)
• VLQ: Intensitivity 88; consistence 70; combined 61,3.
• AAQ2: 41
• BDI 2: 10
BUT: GSI 1,67; WP 1,5; BIC 1,5; A 1,8; CSM 2; D
1,6
PSD 105; PSDI 3,1
EDI 2 PM 8; IN 7; IS 7; SI 10; BU 0; P 2; IC 3; I 2;
IM 13; CE 10; ASC 7
TREATMENT
• During the first 7 months we have had weekly
sessions while she started a nutritional training with
a doctor that works in team with me and was taking
a remedy for the depression under the control of the
team for the medical illness;
The psychotherapeutic work in this
phase
• Defusion on specifical thoughts: for example
we used the “milk milk milk” exercise on the
thougths “I’LL DIE SOONER” and “FORBIDDEN
FOODS MAKE ME BECAME FAT”;
• MINDFULNESS as an exercise for reconnect
her with her body and the physical sensations
from it. After the period of illness G.
developed lots of “thoughts avoided” bacause
was used to feel really bad sensation when
she take an observed position with the body.
• IMAGERY TECNIQUES: for reinforce the vision
of a future, more realistic even if with her
chronical illness. Was really important working
with G. from the beginning on develope a
larger flexibility in her values in this way.
Her Values work
Next phase…till now….
• From January to now we made 6 sessions;
• In this sessions we had work on the reinforce
of the strategies learned during the treatment
and in doing this emerged a thought from her
adolescence on her thights“My thights are a
mess”; this emerged when she arrived to a
BMI of 20, a weight she never had in her life.
So… an exposure with the mirror
• So we both decided in a session to explore the
thoughts that emerged in the moment in
which she was exposing herself to the mirror
for 5 minutes. In doing this….
What are your thoughts about your body while you’re looking
in the mirror?
• She start to recognize thoughts and bodily
sensations: “My thights are disgusting”, “I
hate my legs”, and in the same time she
reported sensations of muscle contraction in
her breast. Than, while she start to defuse her
self….she start to cry…and said “I think
even…that their mine and I need to accept
them as they are” and than embrace me.
Now
• BMI 20
• In this mounth the Sclerosis had an
aggravation but she cope with this asking me
to do a longer period of follow up; asking
more support with the medical teams and
with her family; developing more bodily
awareness as a resource for inform her team.
ACT Question
Contact with the
Present Moment
(2) More acceptance
of shape and weight
and acceptance of
her clinical
situation
Acceptance
Defusion
(3) Strategies
learned during the
therapy and
mindfullnes
Self as
Context
(6) Collaborative
with all the teams
figures she lives a
“normal” life in her
family
Values
(5)Family, being a
mother, being a good
friend, finding some
pleasure activities,
apreciating some
rest, having a
“compassioned”
(4) She is a
relationship
her
“disciplined”with
patient
illness
Committed
and takes
some rest
Actionshe need it;
when
she’e really aware of
the actual medical
situation
(1) She define herself “A
woman that now is taking care
of her, her body and her life”
Re- test
• BDI 13
• VLQ: Intensity 90; consistence 77; combined
62,9.
• AAQ2 52.
• BIAAQ: tot 48 without any high score for
specifical items;
• BUT: GSI 1,2; WP 1,80; BIC 1,22; A 1,33; CSM
1,20; D 0,83; PSD 35; PSDI 0,9
• EDI 2 IM 9; BU 1; IC 8; IN 7; P 3; SI 8; CE 4; PM
5; ASC 6; I 2; IS 2.
60
50
40
BUT (GSI)
BIAAQ
AAQ II
30
20
10
0
May
2009
May
2010
Conclusions
Looking at the scores of the different tests we
can observe:
 Psychological flexibility is increased as we can
see from the results of AAQ II;
 Body uneasiness sadisfaction in decreased as
we can expect;
Body image Acceptance is still at a “border” range:
discussin this with the client she reported that she
have had an harder relationship with her body
expecially in this mounth in which her illness
symptoms started to change and let her suffer more;
the BMI is significantly persistent at 20.
This means that she isn’t avoiding life problems but….
And now she feel like a queen of her dragon
…And I’m simply honored to have the chance to
being a witness of her strenght….
Thanks a lot for your attention!
&
see you in Parma (Italy)
2011 ACBS World Conference
If you want to contact me:
[email protected]
www.act-italia.org
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