CBT-E 摂食障害の治療（認知行動療法的なアプローチから）解説します　#早稲田メンタルクリニック #精神科医 #益田裕介

04:54 Self-Monitoring 07:01 Treatment Motivations/Goals 07:59 Family and School Issues 10:02 Comorbid Conditions 11:14 Psychoeducation 16:01 Coping Behaviors 16:29 Treatment Process and Predictions 18:18 Agency/Compulsion Today, I'll briefly discuss how to best treat eating disorders, primarily from the perspective of cognitive behavioral therapy. Eating disorders include anorexia (restrictive), in which the patient becomes unable to eat and subsequently loses weight; bulimia, in which the patient repeatedly eats and purges, resulting in a lack of nutrition and weight loss; and in some cases, the patient continues to binge eat and purge, but does not lose enough weight to require hospitalization, maintains a normal body shape, or even gains weight. This disease is extremely difficult. I'm not saying it's incurable, but it's not something that can be easily cured. The reason is that eating disorders are not simply a matter of "eating and vomiting." This may be due to other underlying conditions such as depression, developmental disorders, borderline intelligence, social anxiety disorder, or borderline personality disorder. In addition, there may be practical issues with family, school, or work, as well as cognitive distortions. Being thin can exacerbate cognitive distortions, and a lack of nutrition can lead to increased fixation and an inability to make calm decisions. This makes treatment difficult. There is no correct answer. Hospitalization is sometimes necessary. It is not uncommon for treatment to last for years. Looking at the comments section of this channel, I see many people who also have eating disorders. Many people say that they have been undergoing treatment for years but have not seen much progress, and that even though they are gradually getting better, they just can't seem to break their bad habits. This video is intended for people who have recently been diagnosed with an eating disorder, people who want to learn more about eating disorder treatment, and the families and friends of people with eating disorders. There are many patients who are thinking about starting cognitive behavioral therapy to treat their eating disorder. People often ask me if I provide cognitive behavioral therapy at Dr. Masuda's clinic. Our clinic does not offer cognitive behavioral therapy for patients with eating disorders. This is because it is difficult to follow a program and to design and implement it into management. Not only from a management perspective, but also because it is difficult to determine which topics to address at which timing. It is difficult to schedule 1 to 12 cognitive behavioral therapy sessions, and then say, "Today we'll do this, then next time we'll cover this topic, and then next time we'll do this homework." The priority and urgency of each session change from one session to the next, so it can be difficult to follow a program in a small clinic like ours, and we have to adapt it to each patient. However, we do incorporate the essence of cognitive behavioral therapy. I'll talk about what we cover in our cognitive behavioral therapy program. ■Self-Monitoring The first thing I want you to do is self-monitoring. Please check the amount of food you are eating, the times you eat if possible, and your weight. It's difficult to decide whether to do this or not. Doing it may make you more obsessed with your weight. If it's something you do all the time, it might be a good idea to share it. It's a tough decision. However, doing it will allow you to look at yourself objectively and share the data with your therapist. When self-monitoring, patients and their families often do not have correct self-literacy. For example, if a child of their age should be eating around 2000-2500 kcal a day but is only eating 800 kcal, they will lose weight. They may simply not be able to eat rice, but will eat cabbage instead, saying, "I'd really like to feed them rice, but is it okay since they're eating cabbage?" However, cabbage has no nutritional value, so they will lose weight. In that case, it would be better to eat some potato chips, even if it's just a little bit. Whether potato chips are good or not depends on your physical condition, though. Health literacy is surprisingly important. They may believe incorrect information. Sometimes mothers are surprised, saying, "My child doesn't even understand this?" Self-monitoring is important because it provides an opportunity to learn and communicate proper health literacy. Self-monitoring can also help you become aware of cognitive distortions. The child may not believe they are thin. They may step on the scale and say, "I think I'm really fat," so we explain to them that this is strange. ■Treatment Motivations and Goals Next, we address treatment motivations and goals. Why did your eating disorder start? How much do you want to weigh? What body shape do you want to have? What do you want to achieve in the future? These question...