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Unread November 8th, 2010, 05:16 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
Posts: 283
Default Re: Dichotomous thinking in Anorexia Nervosa

If you look back at jenmichelle's post, I don't think she's dichotomizing between "good" thoughts that clients are allowed to have and "bad" thoughts that they aren't allowed to have. She's noticed that certain thoughts turn out to be dysfunctional for her client and that these dysfunctional thoughts are characterized by dichotomus thinking regarding weight gain. This type of thinking is quite common among individuals with anorexia and bulemia and a number of CBT approaches to eating disorders use interventions that target such thoughts.

In terms of how one might target these thoughts, one option is to start by pointing the thoughts out to the client and checking to see if she believes that they are literally true (e.g. "You mentioned thinking 'If I begin to gain weight, I will be fat. Everyone will see me as being humongous.' and those thoughts seem to have a big impact on you. What do you think, is it true that if you gain any weight, you'll be fat and everyone will think you're humongous?"). If the client is convinced that these thoughts are literally true, I'd want to find out what convinces her that these thoughts are true ("What convinces you that you'll be fat if you gain any weight at all?", "What convinces you that everyone will see you as humongous if you gain any weight at all?, etc.) and to see if she is able to recognize and consider evidence that conflicts with the thoughts ("Have there been any times when you gained a pound or two despite your efforts not to gain weight? What happened then? Did you immediately become fat? Did people think you were humongous then?). In doing this, it is important to be trying to help her think it through step by step and draw realistic conclusions. If you're trying to prove a particular point, that will generate extra resistance and be less effective.

With eating disorders, it often turns out that the client knows it isn't literally true that he or she will immediately become "fat" if he or she gains any weight but they persistently tell themselves this anyway. Why? In trying to find out, I might ask something like "So, if gaining a pound or two doesn't immediately make a person fat or humongous, what's the point to telling yourself that it does? What's it supposed to accomplish? What would happen if you didn't tell yourself that it did?" It usually turns out that they are afraid that they will become fat if they do not take extreme steps to control their weight and that these self-statements are an attempt to motivate themselves to restrict eating and/or engage in compensatory exercise/purging/etc. Often they are afraid that a more moderate view will result in their not trying as hard and that they would then gradually gain more and more weight until they eventually become "humongous."

What other dialog/questions would others suggest? Can you think of more promising intervention approaches?
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