Sophie Nesbitt developed a special interest in working with young people with eating disorders while working as a trainee clinical psychologist. Her doctorate research investigated the role of exercise as a risk factor in the development and maintenance of eating disorders. She was also able to work clinically with young people with eating disorders at an inpatient unit. Much of this work involved working and communicating effectively with young people, and she developed a particular interest in the development of psycho-education information for this client group.
Sophie is currently working in a multidisciplinary outpatient team. This provides her with the opportunity to work with other types of disorders, such as developmental disorders and emotional disorders. However, as part of this post she is also involved in training other healthcare professionals in generic mental health issues. By necessity, a large part of this training has focused on raising awareness of eating disorders within primary care settings.
Sophie is also currently involved in a preliminary research study aimed at evaluating the Hunger for Understanding workbook. The main aims of this study are to investigate whether the workbook improves understanding of anorexia nervosa, increases motivation to change and enhances the therapeutic relationship. Findings from this study will be reported in due course.
The Hunger for Understanding workbook was initially developed as a therapeutic tool that could be used by therapists at an inpatient service. Often, the young people who are referred to the service have chronic difficulties with food and weight and have had a diagnosis of anorexia nervosa for some time.
They tend to be difficult to engage in treatment and therefore the aim of the workbook was to provide guidance and structure to therapeutic work. The workbook is based on ideas and techniques that Alison and Sophie have used in therapeutic work, which were influenced by their research and training in this area, and most importantly by talking to patients who have undergone extensive treatment for anorexia nervosa. Their experience of using the workbook to date has been very positive and the feedback received has helped develop and refine the content and structure of the text.

About the authors vii

Foreword ix

Acknowledgements xi

1 The purpose of the workbook 1

Who is Hunger for Understanding for? 2

Who can use Hunger for Understanding? 3

When and how should Hunger for Understanding be used? 3

Accessing the workbook electronically 4

Issues of confidentiality 5

2 Psychological interventions for anorexia nervosa and the role of psycho-education 7

Psychological interventions 8

Motivational-enhancement therapy (MET) 9

Cognitive-behavioural therapy (CBT) 10

Psycho-education in anorexia nervosa 11

The psychological symptoms of starvation 12

The cultural context of eating disorders 12

Set-point theory 12

The physical effects of starvation 13

3 Therapeutic challenges, skills and techniques 15

Challenges of work with people with anorexia nervosa 15

Physical issues 15

Psychological issues 16

Therapeutic skills and techniques 17

Externalisation 17

Instilling hope 17

Empathy 17

Developing emotional awareness 18

Rolling with resistance 18

Dealing with distress 18

Managing relapses 18

4 The contents of the workbook and guidelines for use 21

Section 1 What is anorexia nervosa? 21

Section 2 What causes anorexia? 22

Section 3 How does dieting affect us? 25

Section 4 How does anorexia affect you? 25

Section 5 What keeps anorexia going? 26

Section 6 The tricks anorexia plays 27

Section 7 Thinking about change 27

Section 8 Getting better 29

Section 9 Teamwork 30

Section 10 Becoming assertive 30

Section 11 Myths and questions about anorexia nervosa 31

Some good advice and messages of support 31

Ending the workbook 31

The Workbook 33

Useful contacts 161

References 163

Index 167