Page 98 nursing.elitecme.com Complete Your CE Test Online - Click Here Psychotherapy Psychotherapy can be conducted in individual and/or group therapy sessions. Therapy may also include family members as indicated. Cognitive behavioral therapy (CBT) is generally recommended as a treatment initiative for persons with eating disorders[12] . Cognitive therapy concentrates on immediate processing of thoughts and feelings. Emotions of sadness, depression, anxiety, and anger are reactions to the environment in which the person lives[12] . Some facets of CBT as they relate to binge-eating disorder and other eating disorders include the following initiatives: ● ● Identification of issues that trigger binge-eating episodes. Examples of such issues are negative feelings about one’s body, work, school, or family-related stressors, or co-existing conditions such as depression[12,20,21,22] . ● ● Learning coping strategies to deal with negative feelings and triggering stressors[1,20,22] . ● ● Learning ways to regain a sense of control over one’s life, including binge-eating behaviors[12,20,21,22] . Interpersonal psychotherapy concentrates on the individual’s current relationships with other people including family, friends, and co- workers. The goal of interpersonal psychotherapy is to improve interpersonal skills, meaning how one relates to others. This type of therapy may help to reduce binging that is triggered by poor communication skills, unhealthy patterns of interaction, and poor interpersonal relationships[22] . Dialectical behavior therapy focuses on techniques to help increase stress tolerance, and is aimed to improve relationships and regulate emotions. This may help to decrease binge-eating episodes, since triggering factors are often negative emotions and unhealthy relationships[22] . Medications Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be prescribed. These kinds of drugs may help to reduce feelings of depression and negative thought patterns. For persons who have a co-existing diagnosis of depressive disorder, antidepressants may be a form of long-term therapy. Children, adolescents, and young adults should be monitored for suicidal ideation, which has been linked to antidepressant therapy in these age groups[7,12,21,22] . The first FDA approved medication for the treatment of moderate to severe binge-eating disorder is lisdexamfetamine (Vyvanse), which acts by curbing the binge-eating episodes. This medication is taken in conjunction with the interventions of a psychologist or psychiatrist[20] . Another medication that has been used with some success for treatment of binge-eating disorder is Topamax. Topamax (topiramate) is an anticonvulsant normally used to control seizures. However, clinical findings indicate that this medicine can also decrease the urge to binge in people who have binge-eating disorder. It may also reduce appetite and assist with weight loss[24] . FDA has issued a warning for Topamax and some other seizure medications about the risk of suicide and suicidal ideation. It is recommended that clients taking these drugs be monitored closely for warning signs of suicidal thoughts and behaviors[24] . Self-help initiatives Self-help initiatives such as self-help books, self-help manuals, DVDs, online programs, and support groups may prove to be helpful for some people. Some of these initiatives can be used independently, while others may need guidance from mental health professionals[20] . Nutritional intake Clients should avoid attempting to change their nutritional intake without help. The assistance of a professional nutritional counselor (in conjunction with medical supervision) can help clients learn how to eat in a healthy manner and to lose excess weight without triggering binge eating[20] . Nursing consideration: Self-help initiatives should not be used in isolation. Professional treatment with psychotherapy and/or medications is usually needed as well[20] . Alternative medicine The following alternative medicine approaches may be helpful to persons with binge-eating disorder[12,20] : ● ● Massage and therapeutic touch: May help to reduce anxiety. ● ● Mind-body therapies: May increase awareness of eating and sensations of fullness and promote a sense of well-being. Examples of mind-body therapies are yoga, hypnosis, and biofeedback. ● ● Acupuncture: May help to reduce anxiety and depression. Client reminders Here are some tips to give persons suffering from binge-eating disorder[12,20,21,22] : ● ● Adhere to treatment regimen. Do not skip therapy sessions. If you have been prescribed a diet or meal plan, follow it carefully. Make sure that you eat foods that give you the proper amount and type of nutrients. Work with the healthcare team to identify an appropriate meal plan. ● ● Avoid dieting. Dieting can trigger an increase in binging episodes. ● ● Avoid having large amounts of food available in your home, which may increase the urge to binge. ● ● Stay in touch with family and friends who want to help you. They can be a significant source of support as you deal with your illness. ● ● Exercise. Talk to your physician about a program of physical activity and exercise. Exercise is good for over-all health, especially if you have health problems that are related to being overweight. ● ● Do not be so hard on yourself. Avoid negative thoughts about yourself. Avoid being over critical of yourself. ● ● Identify situations that trigger binge eating. Work with your psychotherapists to identify and deal with these triggers.