Instructions Playmobil Castle

Psychological Treatment of Insomnia Psychological Treatment of Anorexia Nervosa

ASSESSMENT PSYCHOLOGICAL

behavioral determinants

Anorexia nervosa is characterized by a common set of observable behaviors aimed also observable, is the loss of weight. Both the process of acquisition and consolidation are the result of an interaction between factors that contribute to high vulnerability, operant mechanisms, and different cognitions.

Development disorder
Explanatory Hypothesis acquisition of behaviors aimed at weight loss. It starts with 3 possible areas of vulnerability:

• A permanent general area of \u200b\u200bvulnerability, which can be factors such as membership in an overprotective and rigid family environment in which the patient has only its own initiative, the coexistence of a high level aspiration in life, lack of coping skills to handle stressful situations.
• A temporary general area of \u200b\u200bvulnerability, which can be located factors such as interpersonal conflicts, intense experiences of failure; presence of menarche or first menstruation, or the presence of other stress to the patient.
• Finally, an area of \u200b\u200bparticular vulnerability to attempt to lose weight, which can be factors as a mother, sister or other significant person who is obese and also the existence of a mother or sister with anorexia to act as models.

From these three main areas of vulnerability, there are two pathways that can contribute to the problem:

• On the one hand, the interaction of vulnerability usually permanent and temporary general vulnerability may lead to the development of perception "loss of control", the fear of "losing control" and an exacerbation of low self-esteem.
• On the other hand, the specific vulnerability to attempt to lose weight, especially when they coincide with periods of high vulnerability to temporary general, favors the person begins to carry out some behavior to lose weight. When the result is the expected weight loss takes place a reinforcement of behavior. The action of the reinforcement can lead to a double learning: the weight loss behaviors are rewarding and gratifying to be thin.

The second lesson (being thin is gratifying) seems to favor the emergence of fear to gain weight and consequently increase the likelihood of a repetition of the behaviors to lose weight. The first (weight loss behaviors are rewarding) leads to repetition future of rewarding behavior, especially if it coincides with the presence of general characteristics such as perceived loss of control, fear of losing or low self-esteem. The result of this convergence, consolidation may be the weight loss behavior as the only stable source for obtaining gratification, I can help to increase the probability of occurrence of these behaviors.

Consolidation and maintenance Once acquired
behaviors to lose weight, consolidation and maintenance may be due to certain mechanisms.
Among the most frequent habitual behaviors to lose weight are: restricting food intake, controlling calories consumed, take amphetamines to suppress appetite, excessive physical exercise, laxative and diuretic and vomiting voluntarily.
The intrinsic reinforcement, through the perception of personal and environmental control (including control over the family), the achievement of goals set in advance (lose weight), increasing self-esteem as a result of the perception domain self-efficacy, the avoidance of being overweight and / or the satisfaction of being thin, the absence of menstruation and the appearance of a problem (anorexia) that allows "explain" the failure to achieve personal aspirations beyond high weight.
The extrinsic reinforcement through constant care and attention the patient receives from family members and relevant environment.
gratification that the patient receives as a result of weight loss through the intrinsic and extrinsic variables, reinforcing the likelihood of behaviors that lead to this loss, consolidated, in this way, the mechanism of maintenance of the problem.
Weight loss is not the only consequence. Others may be considerable state of starvation, the serious deterioration of their lifestyle and, in general, significant restrictions in their normal operation and the consolidation of inappropriate eating patterns. These consequences, clearly negative for the patient, can lead to frequent adverse emotional responses seen in these people and that can strengthen the perception that weight loss is the only stable way to obtain gratification. Ie also the negative consequences of weight loss behaviors, through the mechanism explained, may increase the likelihood occurrence of such conduct in the future, thereby contributing to the consolidation and maintenance of the disorder.

Bulimia Symptoms
In cases of anorexia nervosa in which it operates compulsive food intake and vomiting caused, can operate a mechanism responsible for the consolidation and maintenance of these manifestations. Vomiting
results on the one hand, weight loss and other consequences outlined above. These consequences contribute to the strengthening of this behavior.
On the other hand, induced vomiting lead to learning that it is possible the desired control weight without the need to restrict food intake, enabling, while exercising this control, appetite and calm the anxiety that usually occurs when there is conflict between the desire to eat but do not want to do, strengthened, also in this Thus, the behavior of voluntary vomiting.
This process consists of the compulsive ingestion of food first and then by induced vomiting may increase the perception of control over the regulation of the body, strengthening, directly, the process itself, while contributing to the consolidation and maintenance of the entire mechanism and the problem of anorexia in general through behavior-specific reinforcement of voluntary vomiting.

Procedure and instruments

The goal of behavioral assessment must be multifaceted and numerous contributing variables, whose successful treatment may depend on accurate knowledge of many of them.
Evaluation can focus, initially, in the functional analysis of the problem, to understand the behaviors that the patient usually used for weight control, its frequency, its antecedents and its consequences, including in this last section, your current weight and the progression that has taken it, the presence or not menses, the patient's daily routine operation, eating habits, etc.
It is also important to know the patient's vulnerability to explore areas of potential vulnerability general and specific vulnerability to attempt to lose weight. Similarly, try to detect the existence of any patient support or resources that can be used during the therapeutic process (social relationships, family support or other sources of gratification). It should also hear the views, motivation and expectations for therapy, as is common in anorexics see a negative initial bias.
Obtaining information designated, may serve for an initial knowledge, or at least as a hypothesis about thoughts, beliefs and emotional responses that may contribute to the maintenance of the problem. As in most behavioral interventions, the interplay between assessment and treatment should be continued, considering and reconsidering the assessment in terms of present and future needs of the patient.
information to carry out the assessment, may be obtained through various sources, as patients themselves, their families, professionals who care nursing and therapist's observations.
some instruments have been developed: The Behavior Scale Anorexic Attitudes Questionnaire relating to Anorexia, etc. .. however, these instruments seem to be more useful in the field of research in clinical practice.
also for the purpose of obtaining information, can be made in each case and according to existing needs, tools for self-registration book or the registration thereof by any observer. Each clinician should decide, depending on the circumstances of each case and every moment of it, the procedure that aims to gather the information necessary to conduct a comprehensive and, above all, useful behavioral assessment of the problem. TREATMENT

PSYCHOLOGICAL

General Considerations

Treatment of anorexia is a complex intervention for two main reasons: the difficulty of the problem and the usual lack of cooperation from patients.
The proper relationship between therapist and patient in this context is crucial and should be avoided confrontations that would threaten the continuity of the intervention. In general, it is not right to want to go too fast, especially as regards the modification of dysfunctional cognitions, require that the therapist prepares the patient before tackling the finer points.
psychological intervention can be distributed essentially in two phases. In the first, most often in inpatient, apply strategies to regulate the patient's weight and prepare for the second phase, in this, the objectives are to maintain proper weight and reduce the vulnerability of the patient.

behavioral strategies to increase the weight and eliminate harmful behaviors

One of the goals of behavioral intervention programs is to increase weight, used in the hospital environment, procedures based on operant conditioning (from a situation of deprivation, the patient gets that from what has been deprived of a quota to weight gain or food intake). You can also use a mixed schedule of reinforcement. In these cases, it seems appropriate that the main source of reinforcement is to increase (or maintain) weight, and in parallel, establishing a complementary way, and not alternative, reinforcement contingent on appropriate food intake
addition operant strategies, these treatment programs often include other components:

• Provide the patient with an extensive dietary information that will enable little by little, control your own healthy diet.
• Give periodic feedback on progress.
• The technique of response prevention, with the specific intent to prevent vomiting caused. The patient underwent continuous monitoring during all meals and for an hour afterwards.

Strategy for anxiety and fear

A technique used in some programs of systematic desensitization intervention is directed specifically to treat anxiety-related with food intake, fear of weight gain, fear of changes in physical appearance and other fears.
Such fears, along with others also characteristic of the disorder, such as fear of losing control over weight gain, have been addressed by behavioral and cognitive strategies, often used in conjunction, are:

• Informing the patient about his problem, the mechanisms that maintain and possible alternative treatments.
• Provide regular feedback regarding the weight off. Narrow
• minimum weight to be achieved, and a maximum weight that should be spent.
• detect the patient's dysfunctional thoughts that generate anxiety and analyze them from different perspectives.
• Situate in the worst consequences. Check
• evidence of dysfunctional thoughts with behavioral exercises. Discuss
• dysfunctional thoughts that generate anxiety from the patient's weight gain.
• Modify the overall objective of control of its own weight, self image and, in general, the patient's own body, replacing the goal of control through weight reduction, alternative target for control by the increase and subsequent weight maintenance.

Strategies for weight maintenance and reduce vulnerability

Most experts agree that the first goal of intervention should be to increase the weight to allow the resumption of menses. During the treatment period, and strategies to increase weight, and others to control anxiety and fear associated with the problem, you should use strategies to prepare the patient and family to later stages of treatment in which the main objectives should be to maintain the weight gain and reducing the patient's vulnerability to relapse.
Thus, they can be regular sessions, usually weekly, family-level intervention, which are addressed:

• Identify and modify family patterns of eating behavior inappropriate.
• identify and modify factors that may have contributed to the general or specific vulnerability of the patient.
• prepare the family for the patient to return home once the period of hospitalization.

This therapeutic approach may also provide for the family level, in the absence of patient-specific work with parents, including training in appropriate skills for continued intervention program in the post-hospital and interpersonal skills improve communication within the family. Has also been addressed
patient preparation for their future outside the hospital, trying to reduce their vulnerability to new relapses. This attempt to reduce the vulnerability can be accomplished in two ways: first, through modification of dysfunctional cognitions regarding weight, physical appearance self-contained, self-efficacy, self-esteem, sexual development and body in general, family and other issues that may relate to the problem and, secondly, through patient training in skills such as:

• Select and even make the appropriate menu.
Healthy eating
• . Check
• exercise.
• Plan activities such as social contact and others that are rewarding.
• social skills if he had not.
• identify and cope with stressful situations at high risk, as the episodes of bulimia, dysfunctional cognitions or behaviors to lose weight.
• coping skills such as relaxation or self-application procedures that include self-instruction and self-statements.

Despite these therapeutic efforts aimed at reducing the vulnerability of the patient once he leaves the hospital, there was, in many cases, when discharge, the patient is not yet sufficiently prepared to face successfully the new goal of weight maintenance in conditions of little or no environmental control, as some scholars suggest that this phase of treatment should be started even in inpatient, so that they can build better weight maintenance achieved, while eliminating the environmental control gradually rather than abruptly. In this vein, the patient may spend short periods of time at home, being able to take these as useful experiences in the process of therapy.
In any case, with or without hospitalization, intervention programs at this stage may include the following strategies: Strengthening

• quota to the maintenance of weight between the agreed limits. Self
• progressive patient's diet.
• therapy sessions at the family level, with the intent to detect and modify family interactions in relation to food.
• also at the family level, the intervention may be addressed to achieve the necessary independence of the patient's daily life and other family changes that may contribute to increased vulnerability. For example, improve dysfunctional patterns of interpersonal communication within the family.
• Intervention fears in relation to the weight, the figure itself or body image and loss of control.
• cognitive-behavioral intervention for the modification of variables that may facilitate the patient's vulnerability as a low perceived self-efficacy, self esteem, etc. Continued
• patient training, usually begun in the previous period, in various skills that enable healthy to prevent and address high-risk situations.

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