Because anorexia is fed by distressing and inaccurate thinking, therapies such as REBT, which teach patients how to think, may be useful to people with this condition. Read More
While I agree with much about RET (It was culled from
Buddism) I would not want to be an adherent of Albert
Elias. He was not only a supreme egotist, but also a
sexual weirdo. But when it comes to getting "help" we
should develop an eclectic attitude, I suppose.
Thanks for your comment and willingness to develop an eclectic attitude. It is unfortunate that you may have had a bad experience with Dr. Ellis or an impression of him that would lead you to label him in his totality.
I can only share my own experience as a student. I had the honor of completing training under various experts, including Dr. Ellis. I know that Dr. Ellis, in his own admission, was a controversial figure who was willing to speak out against traditional viewpoints, and he probably did not appeal to everyone due to his stances.
I think he might say that it is important to distinguish between the message and the messenger, in the event that the messenger might be delivering a great message in a fashion that you didn't particular care for. He shared many valuable points and his theories and methods have helped many people.
Personally, I found him to be quite brilliant, articulate, and compassionate, and I would hope that you would re-consider his work, which could really help you & others in your world.
Thank you again for your comment and read.
Dr. Pam Garcy
Dear Ms Garcy,
Is there any evidence that your approach (REBT) actually is effective in treating anorexia nervosa? For example, have there been any randomized controlled clinical trials testing REBT against placebo or other standard treatments? If so, could you please provide us with the data developed in those clinical trials? Thanks
Great question. In answering this question, I just did a search on the psychological/psychiatric databases called EBSCO, which I have access to through the university & didn't see a randomized clinical trial testing REBT against placebo for anorexia.
I found a study that uses an approach that is extremely similar to REBT that the authors call Enhanced Cognitive Behavior Therapy. The specifics they put in their article have some things that mirror what I'm suggesting & has found good efficacy rates, given the complexity of anorexia. Here is the reference: Fursland, A., Byrne, S., Watson, H., La Puma, M., Allen, K., & Byrne, S. (2012). Enhanced Cognitive Behavior Therapy: A Single Treatment for All Eating Disorders. Journal Of Counseling & Development, 90(3), 319-329. doi:10.1002/j.1556-6676.2012.00040.x
I can only comment that in my own experience as a clinician that adding this into a comprehensive approach may be worth considering. I'm not a researcher myself or I would certainly consider conducting the very trials you suggest.
Thanks for your question.
I am aware of all the published studies of treatment for anorexia nervosa. I agree with you that there is no reliable evidence REBT is effective. At this point, using REBT to treat anorexia nervosa would be entirely speculative and might be dangerous or risky.
You mention CBT-E as a possible treatment for anorexia. However, the world's leading proponents for CBT-E acknowledge that for adolescents with anorexia nervosa, the leading treatment at this time is not CBT-E but rather FBT. See Dalle Grave et al, Enhanced Cognitive Behaviour Therapy for Adolescents with Anorexia Nervosa, http://www.ncbi.nlm.nih.gov/pubmed/23123081
In my opinion, I think that the rift between clinician and researcher is widened by a lack of appreciation for the role of individual differences.
This BLOG isn't saying to exclude methods that work! It is saying that REBT has some useful elements to consider adding in as appropriate, given the areas of direct overlap.
Done in this manner, within the realm of listening to the individual and within a comprehensive treatment in a multidisciplinary setting, it is quite improbable that it would be dangerous.
There are actually elements of REBT that are directly contrary to elements in evidence-based treatment for anorexia nervosa. Therefore, it is entirely possible that REBT would be harmful, because it would counteract effectiveness. Also, REBT involves financial expense. If the treatment is ineffective and costs money, then harm is done. Furthermore, if a sufferer is told that REBT may be effective, and it is not, then the sufferer and her family tend to become demoralized and tend to give up trying to recover. This is a real danger when unproven methods are used.
If it is felt by proponents that REBT has value in the treatment of anorexia nervosa, why have they not conducted any clinical trials to test their hypothesis in practice?
Thank you very much for taking so much time to share your opinions on this topic over the past few days.
I agree that it would certainly be of benefit if those who are in the position to research this, such as those at the Institute, would do so. Perhaps someone like yourself (if you work there or in an academic setting) would consider taking it on as a research project, given your passion for the current conversation and apparent expertise on research in this area.
I suppose we can agree to disagree on some of your views--not saying you're wrong or I'm right, just that we see it differently.
Presently I accept that I operate with the level of certainty that is available from (1) CBT research which is available to date (2) direct experiences of successful outcomes with clients and (3) active feedback obtained by clients during their treatment. I think it is fair to offer additional approaches that may work in an informed consent format, so clients can make the decision to add something or not. I've seen treatment in action by other therapists & in a variety of settings, and I will tell you that much of what is being done is far from research based & far from useful, whereas people have told me that this is useful. That's a bit real-world and maybe we don't like to hear that or talk about it, but it is the reality. Ask people in treatment.
So, for reasons I described earlier, for me personally & not saying it is something you have to agree with, the advantages of incorporating this on the occasions when it is a match for someone can far outweigh the potential disadvantages.
Just to clarify (and maybe I wasn't clear enough), I'm not advocating that a single-minded approach be taken with anyone; just the opposite--I'm advocating a healthy respect for individual differences in treatment response in light of the information we now have. I'm also advocating multi-disciplinary treatment so that there can be a check & balance going on.
Certainly, this is best weighed out and considered carefully for each person, since every patient and every therapist is an individual & all treatment (even researched ones) involve a degree of risk and the potential for waste/failure.
Thanks again for the conversation & let us know if you decide to do some more research for us. I'd be happy to consider posting a blog about your findings if you do.
Very helpful and informative blog. Thank you for posting this.
Thanks for the feedback. I appreciate it. I hope that something in here helps you or someone you know with this condition.
Hello, I really am glad that I read your blog concerning anorexia. It will be a year next month sense the first day I started treatment and in January it will be a year sense discharge. I have been fighting a battle with disease sense I was seventeen years old. I have had issues with food restricting, purging, and laxative abuse.
In your blog there were a lot of great points. The topic that stuck out for me was the Low Tolerance/High Tolerance. It is very true for myself who battles when things get tough and I can't handle things I tale it out on my body. The eating disorder has become my coping skill. Thank you for sharing this approach, I plan on researching it more and maybe even applying it to myself.
Thanks for the feedback and kind words. Keep up the good work--this blog is just the beginning of the journey & I hope you learn lots to help yourself! Dr. Pam
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Pamela D. Garcy, Ph.D., serves on the faculty of the Texas School of Professional Psychology at AU-Dallas.
It can take a radical reboot to get past old hurts and injustices.