PEER RESPONSE:
My client is a 13 year old named Ashley, Ashley suffers from an eating disorder. Ashley tends to binge eat and then makes herself throw up after binge eating a lot of food. In our sessions we discuss possible triggers to what causes Ashley to have this. parents believed Ashley is too hard on herself and compares herself to other girls her way too much, which is what triggered her to develop an eating disorder. Ashley has expressed to me that the real reason this all started was she began to feel overwhelmed when her parents would argue about their own issues and she felt like she was in the middle. The overwhelming anxiety caused her to throw up one day, after she felt that relief from throwing up, she just continued. What I noticed is that Ashley feels negative emotions towards herself so she lets it out on herself, with this it has also become a coping mechanism to any negative emotion in her life. It has become a way for Ashley to view relief and better about herself.
In our sessions we discuss what could possibly trigger and how we can be prepared to deal with it other than throwing up. Ashley has expressed that some internal thoughts she has before fasting include a lot of negative thoughts about herself. Such as ” shes so weak.” if she cannot fight the urges or voices in her head to not binge eat, which then leads her to feeling bad about herself even more. Other thoughts also include No one tends to understand her, when she feels like she wants to binge she feels like she can not speak to others around her about why or they wouldn’t understand why she feels this way and it has more to do than with how she looks or self confidence. She also feels like she is against the world, a feeling of emptiness. This has also caused her to create body dysmorphia that triggers her to throw up because she is seeing something else in the mirror.
The A-B-C contingency in this is
Activating behavior – overwhelming feelings and anxieties, parents arguing, test taking, body dysmorphia
Belief – that she is not good/strong enough to handle what is happening in her life right now
Consequence – she binges eats then throws up to feel a sense of relief, but is also punishing herself as well
Ashley, a 13-year-old struggling with binge eating and subsequent purging, requires a cognitive-behavior modification (CBM) technique to address the root causes of her eating disorder. Understanding the ABC contingency—Activating behavior, Belief, and Consequence—provides a framework to identify triggers and negative thoughts contributing to Ashley’s destructive coping mechanism.
Choosing the Best CBM Technique: The most suitable CBM technique for Ashley’s scenario is Cognitive Restructuring. This technique focuses on identifying and challenging irrational thoughts to promote healthier behaviors. Ashley’s negative beliefs about herself, her inability to cope, and the sense of emptiness suggest cognitive distortions that cognitive restructuring aims to modify.
Justification: Cognitive Restructuring is justified based on Ashley’s distorted thoughts and beliefs contributing to her maladaptive behavior. According to the textbook and related videos, this technique is effective in addressing eating disorders by challenging and altering negative thought patterns (Beck, 2011). It aligns with the cognitive-behavioral therapy (CBT) approach, which has demonstrated efficacy in treating eating disorders (Fairburn et al., 2015).
In sessions, work collaboratively with Ashley to identify specific negative thoughts that precede binge eating episodes. Utilize journaling and reflection exercises to encourage self-awareness.
Once identified, guide Ashley in recognizing cognitive distortions, such as overgeneralization (“I am weak”) and catastrophic thinking (“No one understands me”). Use guided questioning to challenge these distortions, encouraging a more balanced and realistic perspective.
Assist Ashley in developing alternative, positive thoughts that counteract the identified distortions. Encourage affirmations and self-compassion statements to promote a healthier self-perception.
Teach Ashley coping skills to manage overwhelming feelings and anxieties. Introduce relaxation techniques, mindfulness exercises, and assertiveness training to provide alternative ways of dealing with stressors.
Collaborate with Ashley’s parents to create a supportive environment. Educate them on the cognitive restructuring process and involve them in reinforcing positive thought patterns at home.
Address body dysmorphia through cognitive restructuring specific to body image perceptions. Integrate exposure therapy techniques to gradually challenge and modify distorted perceptions.
Monitoring Progress: Regularly assess Ashley’s progress by tracking the frequency of negative thoughts, the use of coping skills, and the occurrence of binge-purge episodes. Adjust the cognitive restructuring plan based on evolving needs and challenges.
Cognitive Restructuring emerges as a comprehensive and evidence-based CBM technique to address Ashley’s eating disorder. By challenging distorted thoughts and fostering healthier beliefs, this approach aims to break the cycle of negative behaviors and contribute to Ashley’s overall well-being. Regular monitoring and collaboration with Ashley and her support system are crucial for sustained progress in her journey toward recovery.
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