Vitousek K, Watson S, Wilson G T
Department of Psychology, University of Hawaii, Honolulu 96822, USA.
Clin Psychol Rev. 1998 Jun;18(4):391-420. doi: 10.1016/s0272-7358(98)00012-9.
Denial and resistance to change are prominent features in most patients with anorexia nervosa. The egosyntonic quality of symptoms can contribute to inaccuracy in self-report, avoidance of treatment, difficulties in establishing a therapeutic relationship, and high rates of attrition and relapse. Individuals with bulimia nervosa are typically more motivated to recover, but often ambivalent about forfeiting the ideal of slenderness and the protective functions of binge-purge behavior. Few attempts have been made to assess denial and resistance in the eating disorders, or to examine alternative strategies for enhancing motivation to change. Review of the clinical literature indicates a striking convergence of recommendations across conceptually distinct treatment approaches. Clinicians are encouraged to acquire a frame of reference that can help them understand the private experience of individuals with eating disorders, empathize with their distress at the prospect of weight gain, and acknowledge the difficulty of change. The Socratic method seems particularly well-suited to work with this population because of its emphasis on collaboration, openness, curiosity, patience, focused and systematic inquiry, and individual discovery. Four themes are crucial in engaging reluctant eating-disordered clients in therapy: the provision of psychoeducational material, an examination of the advantages and disadvantages of symptoms, the explicit use of experimental strategies, and an exploration of personal values.
否认和抗拒改变是大多数神经性厌食症患者的显著特征。症状的自我和谐性质可能导致自我报告不准确、逃避治疗、难以建立治疗关系以及高脱落率和复发率。神经性贪食症患者通常更有恢复的动力，但对于放弃苗条的理想以及暴饮暴食-清除行为的保护功能往往矛盾重重。很少有人尝试评估饮食失调中的否认和抗拒，或研究增强改变动机的替代策略。对临床文献的回顾表明，在概念上不同的治疗方法中，建议惊人地趋同。鼓励临床医生获得一种参考框架，以帮助他们理解饮食失调患者的个人经历，同情他们对体重增加前景的痛苦，并承认改变的困难。苏格拉底方法似乎特别适合与这一人群合作，因为它强调合作、开放、好奇心、耐心、专注和系统的探究以及个人发现。在使不情愿的饮食失调患者参与治疗方面，有四个主题至关重要：提供心理教育材料、审视症状的优缺点、明确使用实验策略以及探索个人价值观。
