正念对饮食行为的影响及作用机理

正念是一种以不批判的态度全然接纳当下体验的觉察力,正念训练对改善不良饮食行为的积极作用正日益受到研究者的广泛关注。本文对正念在改善不良饮食行为中的积极作用与机理,以及基于正念的不良饮食行为矫正方法进行了梳理与归纳。在已有研究的基础上,未来研究需要进一步探索正念对健康饮食行为的作用、从生命周期的视角考察正念对饮食行为的影响、基于思维压抑视角探讨正念的作用机制以及检验正念不良饮食矫正效果的边界。     

An Overview of Trauma-Informed Care and Practice for Eating Disorders

ABSTRACT

This article reviews concepts and principles of trauma-informed care and trauma-informed practice for those with eating disorders (EDs). EDs are not universally recognized to be associated with traumatic events, despite substantial research evidence indicating that individuals with EDs report very high rates of childhood maltreatment, other lifetime traumatic events, as well as adverse consequences from trauma. Using national representative samples, higher prevalence rates of PTSD and other trauma-related comorbidities have been reported in those with EDs, particularly those with bulimic symptoms (binge eating and/or purging). Evidence suggests that those prone to develop EDs appear to be especially sensitive to the effects of stress/adversity and have high rates of premorbid anxiety disorders, personality traits, and neuropsychological features that predispose them to PTSD and its symptoms. This article also reviews some of the important principles for treating individuals with EDs comorbid for PTSD and other trauma-related disorders, including the necessity of moving beyond sequential treatment to the development of integrated treatment protocols. Integration of existing evidence-based treatments, including family therapy, cognitive behavioral therapy, dialectical behavior therapy, cognitive processing therapy, prolonged exposure, and eye movement desensitization reprocessing are recommended. Recent research suggests that ED clinicians view integrated treatment for individuals with ED and PTSD as a top priority, yet they have several concerns about administering such a treatment. As trauma-informed care is embraced by all clinicians and treatment programs that assess and treat eating and related disorders, better outcomes are anticipated.     

PRIVATE THEORIES AND PSYCHOTHERAPEUTIC TECHNIQUE

That if real success is to attend the effort to bring a man to a definite position, one must first of all take pains to find him where he is and begin there. This is the secret of the art of helping others (Kierkegaard [] 1962, p.?27)

The aim of this study is to explore the importance, to the therapeutic process, of the relation between the patient's and the therapist's problem formulations and private theories of pathogenesis and cure. Four cases of young adults in psychoanalytic psychotherapy were compared, two with unequivocally positive and two with more ambiguous outcome at termination. The patients and therapists were interviewed about their private theories initially and at termination of therapy, and a qualitative comparison was made between the cases. In the two more successful cases the therapists had early in therapy perceived obstacles for the therapeutic work in the patients' ways of thinking, feeling, and relating, and made interpretative interventions focusing on these. This was not observed in the less successful cases. In the more successful cases the patient's and the therapist's private theories were more similar at termination than initially, whereas the opposite development was found in the less successful cases. One hypotheses generated is that the therapeutic process can be facilitated by a therapist listening to the patient's private theories, making interpretative interventions focusing on obstacles to the therapeutic work, including contradictions between their private theories, and monitoring the patient's reactions to these interventions.     

The strings on David’s Harp: religious ritual as a container for spirituality

ABSTRACT

Religion and spirituality have often been defined over against each other. The spontaneous, emotional and experiential nature of the spirit has been seen as preferential to the structured, fixed, and predictable nature of religious ritual. Religion education for children has moved away from the performance of ritual behaviour toward creating an environment to nurture the innate spiritual nature of children. This paper questions whether the pendulum has swung too far, neglecting rituals that have sustained religious and communal life for generations, and considers ways of reimagining traditional ritual as a way to encounter the spirit and build community.     

Working with Bangladeshi young women

The author describes once-weekly psychoanalytically informed work in a child mental health setting with young Bangladeshi women making the transition to adulthood. She argues that the prevalent notion of 'culture conflict' used to account for patterns of emotional disturbance and self-harm in these young women is reductionist and represents a denial of severe family dysfunction and individual psychic pain. She shows how, despite cultural differences, psychoanalytically informed thinking can provide a basis for understanding these young women's experience and facilitate their emotional growth. However, faced with complex unconscious processes, the worker has to remain alert to her countertransference in order not to be drawn into an unhelpful collusion or denial of reality. Organizational defences may also operate to protect staff and their institutions from awareness of such high levels of emotional distress, which therefore remain hidden. The author is grateful to the two young women who consented to publication in the hope that it might help others. Details have been changed to protect their anonymity.     

Typical-Atypical Interactions: One Patient’s Experience of Weight Bias in an Inpatient Eating Disorder Treatment Setting

Abstract

This article examines one patient’s experiences with weigh bias in an inpatient eating disorder treatment setting with a focus on interactions between the patient and her primary therapist. These therapeutic interactions had multiple unintended consequences, including bolstering feelings of denial, modeling of disordered behaviors, and disrupting the therapeutic alliance. Additional instances of weight bias with other treatment professionals, including an inpatient nutritionist and psychiatrist, are briefly discussed. The article ends with several brief recommendations for how clinicians can more skillfully approach issues of weight and size in the therapeutic alliance in order to resist size-related oppressions rather than reinforce them.     

A daily diary study of internalised weight bias and its psychological,eating and exercise correlates

Objective: The current investigation extends ecological momentary assessment (EMA) and daily diary weight stigma research in internalised weight bias (IWB). This investigation used daily diaries to examine the relationship between IWB, mood, coping, body appreciation, exercise behaviours and eating behaviours. Design: The study sample consisted of individuals who were overweight or obese (85% female) with M_BMI?=?36.0, SD_BMI?=?6.2. Participants completed a daily diary each evening and wore a Fitbit for 30 days. Main Outcome Measures: Participants reported on IWB, mood, coping, body appreciation, exercise behaviours and eating behaviours.

Results: Both within- and between-subjects IWB were significantly related to positive affect, negative affect, several coping responses, body appreciation, eating behaviours and the urge to avoid exercise. Exploratory analyses indicated that positive and negative affect mediated many of the associations between IWB and coping responses, body appreciation, and eating and exercise behaviours.

Conclusion: This investigation provides evidence that IWB experiences have daily impacts on psychological well-being, body appreciation, coping, eating and exercise behaviours. Also, this study raises awareness about IWB and its potential impact on psychological well-being and health behaviours.