Schema modes in eating disorders: an interpretative phenomenological analysis
- Authors: Bowker, Chantal Ann
- Date: 2021-10-29
- Subjects: Eating disorders , Anorexia nervosa , Bulimia , Compulsive eating , Schema-focused cognitive therapy , Interpretative phenomenological analysis (IPA)
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/196072 , vital:45723 , DOI 10.21504/10962/196072
- Description: The DSM-5 prevalence rate of anorexia nervosa is 0.4%, bulimia nervosa is 1% to 1.5%, and binge eating disorder is 1.6% (American Psychiatric Association, 2013). Although treatment approaches for eating disorders have high drop-out rates and low rates of recovery, treatment modalities that address childhood factors contributing to the eating disorder, as well as the eating disorder behaviours, have better outcomes. Schema therapy is an integrative approach that has been used for the treatment of eating disorders for more than a decade. Central features in schema therapy include the identification of early maladaptive schemas arising from unmet needs and schema modes. Schema modes, composed of schemas and coping mechanisms, are active for an individual at a particular time in response to triggers in the environment (Brown et al., 2016). Identifying an individual’s modes is a crucial aspect that reflects the underlying structure of the individual’s creation of reality. A phenomenological understanding of the modes is essential for developing a case conceptualisation and treatment plan. Differences exist in the naming and description of modes in the current schema therapy literature, which suggests the need for a phenomenological investigation of these structures. This research study used a mostly qualitative approach, in the form of clinical interviews, substantiated by questionnaires, to examine schema modes. Case presentations using the schema therapy model are provided for five women with either anorexia nervosa, bulimia nervosa or binge eating disorder. Then, through a process of interpretative phenomenological analysis, specific modes are examined as to how they are experienced by the participants and influence their behaviour. The features of schema modes in these clinical cases are compared to the existing literature to extend the understanding of schema modes in eating disorders. The participants’ experiences revealed that they had schema modes in common, regardless of the eating disorder presentation, but that the features of the individual modes varied. Modes found in the current literature such as the Detached Self-Soother and Perfectionist Overcontroller coping mode, were found in all the participants. Four of the five participants had an Eating Disordered Overcontroller mode. Features consistent with the existing descriptions of the Perfectionist Overcontroller, Eating Disordered Overcontroller and Detached Self-Soother modes were noted, and new features were identified. The Perfectionist Overcontroller and Eating Disordered Overcontroller have been presented here as complex composite modes with sub-modes that work together in a coherent way in the service of the same project (Edwards, 2020b). Twenty-three features are identified in the parent modes. Blended parent modes, with multiple features active in a situation, were described. The blended parent modes expand on the existing literature on parent modes. The findings in this research support and extend the mode structure identified in the schema therapy theory, and highlight the idiosyncratic nature of the modes. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2021
- Full Text:
- Date Issued: 2021-10-29
- Authors: Bowker, Chantal Ann
- Date: 2021-10-29
- Subjects: Eating disorders , Anorexia nervosa , Bulimia , Compulsive eating , Schema-focused cognitive therapy , Interpretative phenomenological analysis (IPA)
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/196072 , vital:45723 , DOI 10.21504/10962/196072
- Description: The DSM-5 prevalence rate of anorexia nervosa is 0.4%, bulimia nervosa is 1% to 1.5%, and binge eating disorder is 1.6% (American Psychiatric Association, 2013). Although treatment approaches for eating disorders have high drop-out rates and low rates of recovery, treatment modalities that address childhood factors contributing to the eating disorder, as well as the eating disorder behaviours, have better outcomes. Schema therapy is an integrative approach that has been used for the treatment of eating disorders for more than a decade. Central features in schema therapy include the identification of early maladaptive schemas arising from unmet needs and schema modes. Schema modes, composed of schemas and coping mechanisms, are active for an individual at a particular time in response to triggers in the environment (Brown et al., 2016). Identifying an individual’s modes is a crucial aspect that reflects the underlying structure of the individual’s creation of reality. A phenomenological understanding of the modes is essential for developing a case conceptualisation and treatment plan. Differences exist in the naming and description of modes in the current schema therapy literature, which suggests the need for a phenomenological investigation of these structures. This research study used a mostly qualitative approach, in the form of clinical interviews, substantiated by questionnaires, to examine schema modes. Case presentations using the schema therapy model are provided for five women with either anorexia nervosa, bulimia nervosa or binge eating disorder. Then, through a process of interpretative phenomenological analysis, specific modes are examined as to how they are experienced by the participants and influence their behaviour. The features of schema modes in these clinical cases are compared to the existing literature to extend the understanding of schema modes in eating disorders. The participants’ experiences revealed that they had schema modes in common, regardless of the eating disorder presentation, but that the features of the individual modes varied. Modes found in the current literature such as the Detached Self-Soother and Perfectionist Overcontroller coping mode, were found in all the participants. Four of the five participants had an Eating Disordered Overcontroller mode. Features consistent with the existing descriptions of the Perfectionist Overcontroller, Eating Disordered Overcontroller and Detached Self-Soother modes were noted, and new features were identified. The Perfectionist Overcontroller and Eating Disordered Overcontroller have been presented here as complex composite modes with sub-modes that work together in a coherent way in the service of the same project (Edwards, 2020b). Twenty-three features are identified in the parent modes. Blended parent modes, with multiple features active in a situation, were described. The blended parent modes expand on the existing literature on parent modes. The findings in this research support and extend the mode structure identified in the schema therapy theory, and highlight the idiosyncratic nature of the modes. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2021
- Full Text:
- Date Issued: 2021-10-29
Schema therapy for anorexia nervosa: an intensive systematic individual case study
- Authors: Alexander, Graham
- Date: 2021-10-29
- Subjects: Eating disorders , Anorexia nervosa , Anorexia nervosa Treatment , Anorexia nervosa Case studies , Schema-focused cognitive therapy , Anorexic overcontroller , Interpretative phenomenological analysis (IPA)
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/196082 , vital:45724 , DOI https://doi.org/10.21504/10962/196082
- Description: Developed more than three decades ago, schema therapy (ST) was born out of a need for a more effective way of working with difficult and challenging cases where patients were clearly unresponsive to the existing short-term cognitive therapies. While anchored in the primary theoretical orientation of cognitive therapy, ST has carefully integrated techniques and principles from attachment and object-relations therapies, as well as humanistic, gestalt and experiential therapies. The mode model emphasises the concept of “multiplicity” in terms of which the self is functionally divided into parts or schema modes. For a little more than a decade there has been growing interest amongst researcher-clinicians in the application of ST for the treatment of eating disorders (EDs) (Waller, et al., 2007; Simpson, 2012; Edwards, 2015; Munro et al., 2016; Simpson, 2016; Munro et al., 2016). While multivariate studies can provide quantifiable evidence for the efficacy of ST for treating EDs, systematic case-based research offers a means of engaging in an intensive analysis and description of the complex and subtle processes that unfold over time in a real-life therapeutic environment (Edwards et al., 2004; Yin, 1994). This research method also provides an opportunity for the refining of the clinical treatment model as well as its testing. Ten participants were assessed and treated with schema therapy. However, because of the large amount of data gathered, a decision was made to write up only one as an intensive systematic individual case study. Alison, an elderly woman with a longstanding history of AN who had been largely unresponsive to considerable previous therapies, received 100 ST sessions over a two-year period and showed a very positive response. The many challenges that arose and the way these were addressed within the ST framework provide an in-depth account of the application of the ST mode model for the treatment of AN. This is presented in a detailed therapy narrative. After results of the quantitative measures are provided, the next three chapters address three interpretative questions pertaining to the Healthy Adult/Vulnerable Child dyadic relationship, the processes of working with the Angry Child mode, and the conceptualising of an AN-specific coping mode. Several conclusions are drawn about the strengths of the schema therapy model and its particular application to AN. Amongst these is the importance of having a comprehensive case conceptualisation that serves as a collaborative “road map” with which to negotiate the unfolding collaborative therapeutic process. Another is the identifying of the “Anorexic Overcontroller” as a stand-alone coping mode that clarifies the functions of AN to hinder schema-based emotional injury, but paradoxically, still denies the individual’s basic core needs being met. Such a conceptualisation significantly assisted in the suspension of anorexic behaviour. A further significant observation is how emotion-focused work (especially within the context of chair work and imagery) brought therapy to life and was particularly effective in mobilising the conflict between internal voices. Another outstanding feature is how the building of a strong Healthy Adult mode proved vital in the healing process and the development of patient autonomy. Finally, therapy revealed how central the establishment of a sturdy, warm and loving therapeutic relationship is, and how influential the resonance between the therapist and patient is in the outcome of treatment. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2021
- Full Text:
- Date Issued: 2021-10-29
- Authors: Alexander, Graham
- Date: 2021-10-29
- Subjects: Eating disorders , Anorexia nervosa , Anorexia nervosa Treatment , Anorexia nervosa Case studies , Schema-focused cognitive therapy , Anorexic overcontroller , Interpretative phenomenological analysis (IPA)
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/196082 , vital:45724 , DOI https://doi.org/10.21504/10962/196082
- Description: Developed more than three decades ago, schema therapy (ST) was born out of a need for a more effective way of working with difficult and challenging cases where patients were clearly unresponsive to the existing short-term cognitive therapies. While anchored in the primary theoretical orientation of cognitive therapy, ST has carefully integrated techniques and principles from attachment and object-relations therapies, as well as humanistic, gestalt and experiential therapies. The mode model emphasises the concept of “multiplicity” in terms of which the self is functionally divided into parts or schema modes. For a little more than a decade there has been growing interest amongst researcher-clinicians in the application of ST for the treatment of eating disorders (EDs) (Waller, et al., 2007; Simpson, 2012; Edwards, 2015; Munro et al., 2016; Simpson, 2016; Munro et al., 2016). While multivariate studies can provide quantifiable evidence for the efficacy of ST for treating EDs, systematic case-based research offers a means of engaging in an intensive analysis and description of the complex and subtle processes that unfold over time in a real-life therapeutic environment (Edwards et al., 2004; Yin, 1994). This research method also provides an opportunity for the refining of the clinical treatment model as well as its testing. Ten participants were assessed and treated with schema therapy. However, because of the large amount of data gathered, a decision was made to write up only one as an intensive systematic individual case study. Alison, an elderly woman with a longstanding history of AN who had been largely unresponsive to considerable previous therapies, received 100 ST sessions over a two-year period and showed a very positive response. The many challenges that arose and the way these were addressed within the ST framework provide an in-depth account of the application of the ST mode model for the treatment of AN. This is presented in a detailed therapy narrative. After results of the quantitative measures are provided, the next three chapters address three interpretative questions pertaining to the Healthy Adult/Vulnerable Child dyadic relationship, the processes of working with the Angry Child mode, and the conceptualising of an AN-specific coping mode. Several conclusions are drawn about the strengths of the schema therapy model and its particular application to AN. Amongst these is the importance of having a comprehensive case conceptualisation that serves as a collaborative “road map” with which to negotiate the unfolding collaborative therapeutic process. Another is the identifying of the “Anorexic Overcontroller” as a stand-alone coping mode that clarifies the functions of AN to hinder schema-based emotional injury, but paradoxically, still denies the individual’s basic core needs being met. Such a conceptualisation significantly assisted in the suspension of anorexic behaviour. A further significant observation is how emotion-focused work (especially within the context of chair work and imagery) brought therapy to life and was particularly effective in mobilising the conflict between internal voices. Another outstanding feature is how the building of a strong Healthy Adult mode proved vital in the healing process and the development of patient autonomy. Finally, therapy revealed how central the establishment of a sturdy, warm and loving therapeutic relationship is, and how influential the resonance between the therapist and patient is in the outcome of treatment. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2021
- Full Text:
- Date Issued: 2021-10-29
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