Healthy occupation in the management of eating disorders : a program development plan

In recent years, there has been a growing trend away from a dogmatic adherence to any one approach in the treatment of eating disorders. This paper adds the new element of practice in relation to cognitive change. The activity-oriented approach outlined here stresses that patients with anorexia nervosa or bulimia must maintain responsibility for their own food intake throughout treatment. The key role of the occupational therapist in the treatment team is outlined, and suggestions for assessment and management of this type of patient are given. This paper outlines a practical approach that enables occupational therapists to use a wide range of activities to treat the patient with anorexia nervosa or bulimia. Summary and Significance: In the article, Giles (1985) briefly describes the history of the use of purposeful activity in the treatment of psychiatric conditions and other approaches toward treatment that were based on medical, behavioral, or psychoanalytic models, none of which have proven completely fail-proof. Then, Giles justifies the use of a client-centered approach with varying interventions to treat the population since there are typically multiple causative factors underlying an eating disorder. He specifically outlines different modes of intervention including the medical, family therapy, psychoanalytic, behavioral, and cognitive behavioral approaches utilized to treat eating disorders. Additionally, the article highlights the specific role of Healthy Occupation 177 occupational therapy in the treatment of eating disorders and provides a detailed description of selected relevant occupations for this population which will be helpful in the development of the occupation-based program development plan at the River Centre Clinic. 3. Henderson, S. (1998). Frames of reference utilized in the rehabilitation of individuals with eating disorders. Canadian Journal of Occupational Therapy, 66, 43-51. Abstract: An occupational therapists role with clients diagnosed with eating disorders, both anorexia nervosa and bulimia nervosa, has been described throughout the literature. However, the frames of reference and treatment approaches that occupational therapists implement have not been clearly established or validated. This paper outlines the symptomatology of anorexia nervosa and bulimia nervosa, and critically reviews the current literature concerning the frames of reference and treatment approaches used by occupational therapists when intervening with this population. The literature reviewed indicates that therapists are using a variety of frames of reference and treatment approaches. There appears to be an emphasis on the psychoanalytical and cognitive behavioral frames of reference, although there is a lack of empirical evidence in regards to all frames of reference and treatment approaches. Reasons for the lack of current An occupational therapists role with clients diagnosed with eating disorders, both anorexia nervosa and bulimia nervosa, has been described throughout the literature. However, the frames of reference and treatment approaches that occupational therapists implement have not been clearly established or validated. This paper outlines the symptomatology of anorexia nervosa and bulimia nervosa, and critically reviews the current literature concerning the frames of reference and treatment approaches used by occupational therapists when intervening with this population. The literature reviewed indicates that therapists are using a variety of frames of reference and treatment approaches. There appears to be an emphasis on the psychoanalytical and cognitive behavioral frames of reference, although there is a lack of empirical evidence in regards to all frames of reference and treatment approaches. Reasons for the lack of current research with this population, and possible future areas of research are suggested. Summary and Significance: This article takes a unique look at the training and potential contributions that occupational therapists can provide for the treatment of individuals with eating disorders. Henderson (1998) states that the goal of occupational therapy intervention with these clients is to maximize function in social, psychological, and physical domains and assist them in engaging in meaningful occupations. Henderson introduces the most frequently used frames of reference including the psychoanalytical, cognitive, familial, developmental, medical, and Healthy Occupation 178 behavioral approaches and describes specific occupation-based interventions. This article will be useful to provide theoretic models and types of intervention to guide the development of the Capstone Experience. 4. Robinson, A. , Kane, M. , & Leicht, S. (2005). Psychologists' perceptions of occupational therapy in the treatment of eating disorders. Occupational Therapy in Mental Health, 21(2), 39-53. Abstract: From a review of the literature it appears that occupational therapists (OTs) have been less actively involved in the treatment of clients with eating disorders in the last 10 years. With the job markets changing for OT, it is important to understand the factors influencing therapists’ involvement in this area. One factor that may limit the number of therapists working with clients with eating disorders may be the limited understanding of and lack of referrals to OT by psychologists. This study investigates whether psychologists perceive that OTs provide From a review of the literature it appears that occupational therapists (OTs) have been less actively involved in the treatment of clients with eating disorders in the last 10 years. With the job markets changing for OT, it is important to understand the factors influencing therapists’ involvement in this area. One factor that may limit the number of therapists working with clients with eating disorders may be the limited understanding of and lack of referrals to OT by psychologists. This study investigates whether psychologists perceive that OTs provide beneficial treatments for clients with eating disorders and if they would refer eating disorder clients to OTs. This study also aims to identify if there are similar treatment models and techniques used by both OTs and psychologists in treating this population. Summary and Significance: Surveys were sent to 75 members of the New York State Psychological Association who had self-identified as treating eating disorders. An effective return rate of 44% was achieved. The results of this study show that psychologists currently use many of the same treatment modalities that OTs use with people with eating disorders and view those techniques as beneficial for this population. They would refer to OT for all modalities Healthy Occupation 179 except assertiveness training. The results also show that psychologists are not aware of OT’s role with this population, and, thus, education about OT is needed. 5. Kloczko E. & Ukiugu M.N. (2006). The role of occupational therapy in the treatment of adolescents with eating disorders as perceived by mental health therapists. Occupational Therapy in Mental Health, 22(1), 63-83. Abstract: The purpose of this study was to explore occupational therapists’ perceptions of how they contribute or may contribute to the treatment of adolescents with eating disorders. A naturalistic type inquiry with a phenomenological design was used to complete the study. Three occupational therapists (OTs) participated in the study. The findings of the study indicated that OTs saw their role in the treatment of adolescents with eating disorders as consisting of functioning in a multidisciplinary team setting, addressing co-morbid problems associated The purpose of this study was to explore occupational therapists’ perceptions of how they contribute or may contribute to the treatment of adolescents with eating disorders. A naturalistic type inquiry with a phenomenological design was used to complete the study. Three occupational therapists (OTs) participated in the study. The findings of the study indicated that OTs saw their role in the treatment of adolescents with eating disorders as consisting of functioning in a multidisciplinary team setting, addressing co-morbid problems associated with eating disorders, using occupational therapy (OT) interventions to enable clients to cope with and manage symptoms, and using therapeutic relationships in their interventions. Summary and Significance: The findings of this study indicated that individuals with eating disorders benefit from the holistic, client-centered, and theory-based interventions provided by occupational therapists. Occupational therapists were described to utilize their knowledge and competence to address limitations in occupational performance in the lives of these clients. The study supports a role for occupational therapists in the treatment of patients with eating disorders and illustrates a need for research investigating the outcomes of OT for people with eating disorders. The study also has implications for OT education since participants indicated no prior education regarding the disorder. OT curricula therefore need to explore the need to include more content specific to interventions for people with eating disorders Healthy Occupation 180 6. Lim, P.Y. & Agnew, P. (1994). Occupational therapy with eating disorders: A study of treatment approaches. British Journal of Occupational Therapy, 57, 309-314. Abstract: The incidence of two complex and serious eating disorders, anorexia nervosa and bulimia nervosa, has increased markedly during the last decade. Despite much research, there is still no consensus on the etiology or treatment of eating disorders. It has been recognized that multiple factors of causation are involved and a multidisciplinary team of various health workers, including occupational therapists, is needed for optimal treatment. The aim of this pilot study was to determine treatment approaches currently used by occupatio