Introduction
Brief Overview of Eating Disorders and Their Prevalence
Eating disorders, sometimes fatal ones, are severe mental disorders that affect a person’s eating routine and to a degree that might be life threatening. Food, weights, and bodies, being so essential, also may signify an eating disorder [1]. Frequently perpetrated nutrition problems are bulimia nervosa, binge eating and anorexia nervosa [1]. It has been suggested that based on the diagnosis interviews of the National Comorbidity Survey Replication (NCS-R), the rate of binge eating disorder was on average at 1%. 2% [1].
Introduction to Interpersonal Psychotherapy (IPT) as a Treatment Modality
IPT is a focal, time bound and present oriented psychotherapy or a treatment that promotes the patient to recover from mood and functional disruption [4]. IPT participates in educating patients how their emotions signalize and how this knowledge is used to improve situations with interpersonal relationships, and it helps patients to find social support [2].
Understanding Eating Disorders
Definition and Classification of Eating Disorders
The eating disorders which are behavioral conditions of abnormal and continuing disturbance in appetite and connected emotional and intellectual dynamics are the eating disorders [3]. They may be sometimes vicious and responsible for affecting the health of patients in psychological, physical as well as social aspects [3]. Eating disorders covered anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, other specified feeding and eating disorder, pica and rumination disorder [3].
Factors Contributing to the Development of Eating Disorders (Biological, Psychological, Social)
Eating disorders could be genetically predetermined or they might be the consequence of a mixture of a number of factors such as one’s character, strengths, and environmental issues. Some of the origins of having eating disorders can be found in genetics, such as family history of eating disorders, and chemical imbalances that may cause the need to eat, loss of appetite, and satisfaction. There are also other personality traits that have an influence on your employment opportunities [4]. Social factors such as fitting in the right societal pressure to achieve a specific bodily type and societal beauty standards are also important [4]. Psychological causes such as low self-esteem, or possibly a sense of inadequacy or lack of control over their life events that lead to stress, depression, or it could be some form of anger and anxiety could also contribute [5].
Impact of Eating Disorders on Individuals’ Lives
Eating disorders could be one of the most challenging parts of life because of their serious consequences. They can result in physical illnesses, a negative self-perception and low self-esteem, a very distorted body image, living life by food timetables, doing not want any socializing, and no aspirations for the future [6]. Another health consequence linked to junk food is that it can lead to cardiovascular and gastrointestinal problems which in extreme cases may reach headings like heart attack and stroke [7].
Overview of Interpersonal Psychotherapy (IPT)
History and Development of IPT
The interpersonal psychology therapy named interpersonal psychotherapy (IPT), was developed by Gerald Klerman and Myrna Weissman in the 70s [8]. This model concerned Harry Stack Sullivan, Adolf Meyer and John Bowlby treatises [8]. The roots of IPT is at Yale University in year 1970 , when Dr. Gerald Klerman was allied by Dr. Eugene Paykel from London , to conduct a study which targeted at testing the particular effectiveness of using a tricyclic antidepressant alone or in combination of psychotherapy, against recurring non bipolar depression as maintenance treatment [9].
Core Principles and Techniques of IPT
The basic principles of IPT include:
The most obvious influence your current mood has on interpersonal relationships is the wrong ones [10].
Enhancing the bonds between people is one of the most effective method of treating your mental illness problems [10].
Makeover of mood and symptom lead to the betterment of being and social liaison [10].
IPT methods include asking, clarifying, and analyzing communication as well as helping in decision making, expression of emotion, and role playing [11]. The therapeutic dynamic and the role of therapist’s in IPT those aspects are being talked about [11].
How IPT Differs from Other Therapeutic Approaches for Eating Disorders
IPT deviates from other types of psychotherapy by concentrating on an individual’s current social interactions and his/her relationships [12]. It is associationally focused, which means that the IPT is concerned with the current connections, not the grave situations in the past [12]. It is activity-type, meaning your psychologist and you will find a restricted amount of activities that will be therapeutic to you [12].
Unlike other ad therapeutic techniques such As cognitive behavioral Thing (CBT) and Dialectical Behavioral Therapy (DBT) which focus on modifying one’s thought and behavioral patterns, IPT concentrates on the one’s relationship system. Versus cognitive and behavioral therapies, the discipline is unique as it focuses on working on the maladaptive thoughts and behaviors only in reference to the people you connect with, while the other techniques deal with behavioral and cognitive issues in other areas of life [14].
Application of IPT for Eating Disorders
Assessment and Formulation in IPT for Eating Disorders
During consultations, Interpersonal Psychotherapy for cases of eating disorder focuses on a patient’s interpersonal factor whereby a client’s eating disorder has arisen and is often sustained. The therapist works to assist the patient in recognizing the origin of social support available, the type of confiding relationships, romantic attachments, the style of communication, or if difficulties have arisen from the eating disorder by providing information about different types of such [15].
Target Areas of Focus in IPT Sessions
Interpersonal Disputes
The types of interpersonal conflicts lie between the patients and one of their key relations who do not have similar expectation levels in the relationship. Some of the conflicts happen openly, while others are more tacit (passive). This part is aimed at helping the patient in passing their expectations and needs on to the administration more effectively, so that the disagreement can be resolved [16].
Role Transitions
This type of transition applies when one is struggling with the shift from one living context to another due to certain circumstances [17]. It may happen a lot in many spheres that are related to work, relationship status, health, habitat, socioeconomic status, etc [18]. This area’s goal is to have the patient accept the new role and in how they can manage the stress caused by the change [17].
Grief and Loss
As suggested by the IPT manual, grief is the topic of choice when a patient shows signs of distressing psychological problems after the loss of a close person to them or the loss of other critical components in their life [19]. The object of bereavement as the topic is to assist the patient in covering the phases of loss and eventually coming to a closure of grief [19].
Interpersonal Deficits
Among interpersonal deficits is the selection of problem domain when an individual lacks a clear acute interpersonal event of onset or maintenance of depressive episode and he/she describes a long history of of impoverished or contentious interpersonal relations [6]. That is the area where the main aim is to work with the patient to create such relationships that would contribute to the improvement of their social skills [20].
Case Studies or Examples Illustrating IPT Interventions for Eating Disorders
IPT has been applied successfully in the management of different eating issues. In this context, cognitive behavioral therapy has been utilized to treat bulimia nervosa and binge eating disorder, and research shows that it can lead to crucial drops in purging and binge eating behaviors [21]. At these times, therapists often choose a process aimed at uncovering and resolving interpersonal issues that might be causing the eating disorder, for example, conflicts in relationships or difficulties with role transition or life changes. The therapist helps the patient to devise alternative, more healthy ways to deal with these issues and by doing so they can lead to the diminishing of the symptoms of the eating disorder [21].
Effectiveness and Research Findings
Review of Empirical Studies Supporting the Efficacy of IPT for Eating Disorders
Interpersonal Psychotherapy (IPT) was shown to be efficient in several clinical trials [22,23]. A systematic review of studies on IPT for eating disorders revealed six main findings [22]:A systematic review of studies on IPT for eating disorders revealed six main findings [22]:
Head-to-head comparison of Interpersonal Psychotherapy (IPT) and Cognitive-Behavioral Therapy (CBT) was performed in the case of anorexia nervosa with no significant differences in the use of the singular approach in patients.
When and promoting as standalone therapy for BN remain the case indicating lower IPT treatment than CBT and its enhanced version.
The people diagnosed with BN who remit after IPT treatment show a longer-lasting clinical remission period, which was documented in the long-term follow up.
IPT and CBT, but each approved for different time-periods, had success in long-term periods in binge-eating patients.
CB and its derived version was observed to provide the fastest chances of recovery during the initial stage of the treatment. IPT was calculated to be more indirect and tardy as the change mechanism is based on improvements occurring at a later stage with difficulty in maintaining long-term sustainability.
Persistent abstinence of binge eating and IPT for binge eating disorder that was recorded as stable and improves as the treatment proceeds (22).
Comparison of IPT with Other Treatments for Eating Disorders
IPT and CBT have been shown to be effective in treating eating disorders, but to determine which treatment is better, more research is necessary. Said comparisons have produced quiet up to noisy waters [22,24,25]. For example, a study found that anorexia nervosa patients who received IPT also responded to CBT when given as single therapies [22]. But the result of administering IPT without other interventions to patients with bulimia nervosa was noticed to be worse than all the therapies which were based on cognitive-behavioral therapy (CBT) and its enhanced versions [22]. However, IPT and CBT, were both evidenced as a useful strategy, although these two methods for short and long terms of the patient with bulimia nervosa.
Limitations and Challenges of Implementing IPT for Eating Disorders
Although instrumental psychotherapy comes out as a very effective way for eating disorders prevention and treatment [26,27,28], it has its limitations and challenges, when implementing it. Among many other problems, the main challenge is that the patients with eating disorders don’t show as much improvement for a period of time [28]. In conjunction with the lower frequency of treatment sessions once a week, this may turn out to be an unsuitable option for those with pronounced eating problems, who need a more continuous provision of assistance instead. Better research on IPT outcomes in anorexia nervosa are needed for its better development [29].
Practical Considerations and Implementation
Training Requirements for Therapists Delivering IPT
Through the International Society of Interpersonal Psychotherapy (ISIPT), the certification is given to the therapists, trainers and supervisors in IPT [30]. The certification procedure consists of an online application and a fee for certification [30]. The therapists have to submit the documentation of the 40 hours of IPT training which they have taken in the past five years and which are the reasons for their IPT skills, knowledge and experience to be maintained since certification [31]. To acquire the trainer certification, one has to provide proof of attending at least eight two-day IPT training workshops or one has to study for at least 100 hours of academic IPT teaching [32].
Integration of IPT with Other Treatment Modalities
The IPT can be combined with other treatment methods like pharmacotherapy and cognitive-behavioral therapy [33]. This combination can boost the quality of the treatment by considering the different aspects of the patient’s health. To illustrate, the biological aspects of the disorder can be dealt with through pharmacotherapy, while the interpersonal issues can be tackled by IPT [33].
Considerations for Adapting IPT for Diverse Populations and Cultural Contexts
Changing the IPT for the diverse populations and cultural contexts is a matter of taking into account the cultural and social factors that might affect the growth and the treatment of eating disorders [34,35]. To name one, the research in Nepal adapted the IPT for adolescents with depression by making the therapy a part of secondary schools, using the locally acceptable terms for mental disorder and framing the intervention as a training program to de-stigmatize the treatment [34].
Conclusion
Summary of Key Points Regarding the Use of IPT for Eating Disorders
IPT is a short term focused therapy that concentrates on interpersonal problems that are related to the beginning and/or the maintenance of eating disorders [36,37]. It has been proven to be helpful in the treatment of eating disorders in several researches [36,37]. IPT emphasizes social functioning in order to lessen the symptoms [38].
Future Directions for Research and Practice in the Field
The research can be done in the future to improve the delivery of IPT for eating disorders, sharing the IPT in routine clinical care settings through dissemination and implementation efforts, IT adolescent and parent-child adaptations in diverse and high-risk groups, and the further exploring of IPT for the prevention of eating and weight-related problems that may promote full-syndrome eating disorders or obesity [39].
Final Thoughts on the Potential Impact of IPT on the Treatment Landscape for Eating Disorders
IPT is capable of changing the treatment scenario of eating disorders in a big way. Its concentration on the interpersonal problems is what makes it a different kind of treatment that goes together with other types of treatments. Besides, its being able to adjust to every situation makes it an attractive choice for the different people and places [40].
References
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