Behavioral approaches alone or combined cognitive behavior therapy may be used. Behavioral techniques might include simply not buying trigger foods or avoiding certain shops; that is, building up new habits to replace existing ones. Another example would be modifying eating behavior such as eating in the same place each day, or concentrating solely on eating and not watching television at the same time (Fiona Mantle, 2003)."
It is worth noting here that research has shown that people will change and transform their eating habits, once they learn the advantages and disadvantages of their eating behavioral patterns. However, at the same time, it is also worth noting here that since eating habits can be transformed through learning, they can also be unlearned, however, the process of unlearning may take place through a lengthy passage of time. As Fiona Mantle (2003) writes, "Eating behaviors are learned behaviors therefore they can be unlearned, although this can take some time. Rehearsal, age progression or assertiveness training may be used. Control of binge eating may include eating regular meals, avoiding addictive foods, instigating a controlled binge and delaying tactics (Fiona Mantle, 2003)."
Using hypnosis in treatment
Treatment and therapy results can only be achieved if the patients are willing to acknowledge that they have eating behavioral problems. On numerous occasions, nurses have cited that patients often fail to acknowledge their eating disorders and thus continue to execute problematical behavioral patterns, endangering their renal, cardiovascular, and endocrine systems. However, therapists have come up with some strategies that might open up individuals having problem acknowledging their disturbing behavior patterns. As Fiona Mantle (2003) reveals, "Many eating-disordered patients tend to be resistant to treatment. They deny that they have a problem and it is necessary to devise an eclectic approach to treatment tailored to suit the individual....Given the high hypnotisability of most eating-disordered patients, the adjunctive use of hypnosis is very appropriate. A number of uncovering techniques such as ego state therapy, age regression, age progression and idio motor signaling can be used to identify the origin of the patient's disordered cognitions and emotional conflicts which are precipitating their associated eating disorders (Fiona Mantle, 2003)."
In the past, quite often nurses came to the realization that if the therapy sessions are not organized properly, the patients may loose hope and get discouraged. Therefore, nowadays, utmost care is given to organize competent therapy sessions. Nurses, think, act and speak in ways that relate either directly or indirectly to the patient's growth and development, using various hypnotic techniques. As Fiona Mantle (2003) asserts, "Uncovering distressing material during these sessions may be particularly difficult for depressed patients who will make up a significant portion of this group. Hypnosis may also be used to help patients develop feelings of control and mastery over their thoughts and behaviors. Cognitive and behavioral techniques for weight management have increased efficacy when combined with ego strengthening, imagery, systematic de-sensitisation, and cognitive restructuring because of the need for control within this patient group, the use of indirect and permissive suggestions for trance are more effective since they serve to enhance rather than challenge the patient's need for control (Fiona Mantle, 2003)."
Nurses are extra careful and methodical when they are confronted with patients who possess restrictive eating habits. However, the most valuable assistance hypnosis provides when treating patients with restrictive behavior is it's (the hypnosis program) ability to treat patients with low self-worth and distress routinely. As Fiona Mantle (2003) writes, "Because of their extreme need for control, restrictive eating patients make poor subjects for hypnosis. Patients who binge and then purge are more extrovert and are more highly hypnotizable than restraining anorectics. However, it has been shown that hypnosis can be effective in treating underlying problems of self-confidence, low self-esteem stress and depression. Of particular value is the Calvert-Stein technique for anxiety as well as rehearsal, trader hypnosis, of such techniques as self-talk, safe place imagery and for social phobia (Fiona Mantle, 2003)."
Starvation and under-nutrition can severely hurt cognitive skills of individuals suffering from eating disorders. Therefore, it is essential for nurses to use hypnosis treatment method on patients suffering from under-nutrition after they are on a normal diet. As Fiona Mantle (2003) illustrates, "Severely ill anorectics have cognitive processing problems due to malnutrition but that once re-feeding starts, hypnosis can be used as an adjunct to psychotherapy to facilitate dynamic exploration, conflict resolution, coping strategies and anxiety reduction (Fiona Mantle, 2003)."
Nurses treating patients suffering from Bulimia nervosa reveal that these patients have the utmost tendency to be hypnotized, when compared with other patients suffering from eating disorder. Their treatment too comprises cognitive and behavioral therapy sessions for a long period of time. As Fiona Mantle (2003) writes, "Patients with Bulimia nervosa have been noted to score higher hypnotisability levels than anorexic patients or controls. Extreme weight control behaviors may be similar to hypnotic-like states such as dissociation, which is a reported characteristic of bulimics during binge eating. This dissociation might be related to cognitive and perceptual distortions reported by many eating-disordered patients. Treatment of bulimics with hypnosis.... may involve supportive intervention during cognitive and behavioral change, dealing with underlying triggers to the condition and as long-term maintenance therapy (Fiona Mantle, 2003)."
Nurses recognize that hypnosis can greatly assist people who are in a weight loosing program. Furthermore, it is considered as a very good therapy program for those who are keen to loose their weight and their unhealthy eating behaviors. As Fiona Mantle (2003) asserts, "Hypnosis is particularly valuable for clients who need to lose weight in that it can address a number of underlying psychological barriers to successful weight loss. Specifically, it can address faulty cognition around food, identify antecedents to eating, and help with stimulus control difficulties and other lifestyle issues on an individual basis (Fiona Mantle, 2003)."
Underlying problems with Hypnosis Treatment Method
Eating disorders can be triggered from various social, economic and psychological factors. It is well-known that environment has had a strong influence on those suffering from eating disorders, either directly or indirectly. Amongst various internal factors that contribute towards eating disorders, depression and anxiety are listed on the top by nurses all over the country. However, hypnosis seems to be a good intervention strategy as it has been identified by many practicing professional nurses. Fiona Mantle (2003) writes, "Depression and anxiety, particularly social phobia, were both noted precursors to anorexia and a concomitant problem within all eating disorders. Although the use of hypnosis in depression has been treated with caution, cognitive and behavioral procedures, both of which can be augmented by the use of hypnosis, have been identified as being of value. Techniques include rehearsal with cognitive restructuring, ego strengthening, age progression and post-hypnotic suggestions, as well as assertiveness training. Depressed patients, however, may respond less well to the traditional hypnotic inductions emphasizing as they do, a relaxed, more passive effect which may be counter-productive in patients who are already passive. Therefore the use of the active alert method may be more appropriate (Fiona Mantle, 2003)."
Disorder Treatment being offered at Children's Medical Center of Dallas (CMCD)
As mentioned above, highest percentage of people suffering from eating disorders are children. For many years, children have been suffering from eating disorders and have therefore been under the lime light of the health department, which had been occupied in crafting an effective treatment strategy for children. Several treatment plans have been crafted and implemented, however, this study will focus on the treatment strategy being employed in the Children's Medical Center of Dallas (CMCD).
The program had been designed with the sole intention to help children suffering from eating disorders in a cost-effective manner. Cathie E. Guzzetta (2001) illustrates various stages of treatment that are being offered to children suffering from eating disorder: "The continuum of care was developed by adapting the Association of Ambulatory Behavioral Health Services: three levels of intensive outpatient care and adding two additional levels: inpatient at one end of the continuum and traditional outpatient at the other end. Thus, the five levels of continuum of care would offer: Level 1: Inpatient hospitalization, Level 2: Partial hospitalization, Level 3: Day treatment, Level 4: Intensive outpatient, Level 5: Outpatient (Cathie E. Guzzetta, 2001)."
Various principals had been established so that the process of admission into each level of treatment can be clarified and implemented without exception by all nurses. The thinking behind the process of admission had been very logical and critical as they (nurses) had been asked to assess various physical and psychological symptoms of the child in question. Cathie E. Guzzetta (2001) writes about the process of admission and release that are being offered to children in the Children's Medical Center of Dallas (CMCD): "Criteria for admission to each of the five levels were developed based on the severity of the patient's physical instability as evidenced by weight, vital signs, electrolytes, electrocardiogram (ECG), suicidal ideation, and failure of symptom relief in a less…