Best talking therapy for Anorexia/Anxiety

[Rollergirl11]

Have posted in Mental Health also…

DD (19) is just about to go in to her second year at uni. She has applied for DSA and has just been told that she is entitled to weekly talking therapy.
She was diagnosed with Anorexia when she was 15 when she was hospitalised. She has been in recovery but with bouts of relapse to varying degrees at times of stress (A levels). She takes fluoxetine for her anxiety and has done for 4 years. She has had private therapy as and when needed and engages well with it. She has raging body dysmorphia and crippling self loathing. She literally thinks she’s absolutely disgusting and thinks she’s a terrible person. There is also a degree of OCD behaviours too.
Despite all the above she has good friends and is enjoying her life at uni. The hatred she has for herself just bubbles away under the surface and DD just seems to accept it as the way things are.
After just coming out of another mini ED relapse (brought on by the prospect of summer holidays and having to be seen in a bikini) she has come to the realisation that she needs to get to the root cause of her issues. She is sick of the constant cycle of being well and then relapsing. She has never got as bad as she was when she was first diagnosed but she is still not free of Anorexia.
What would be the best taking therapy for what I have detailed above? DD needs challenging on her regimented thought processes and to unpick how she feels about herself. I think they will offer CBT but I have heard that it’s not for everyone, A family member is receiving DBT therapy at the moment but don’t know too much about that.
Any thoughts/suggestions appreciated.

I know of trauma therapy, but that's usually obviously if the person has experienced trauma. Though I don't think it's recommended for anorexia as it can trigger relapse.
Is she already with the NHS ED service?

She was with the CAMHS ED team but was discharged from then when she was weight restored the first time 3 years ago. She didn’t get anything positive from them other than her fluoxetine prescription.

Since then she has had private therapy and currently she is under the wellbeing team at her uni. She has had regular calls with a member of the wellbeing team throughout her first year but obviously this has stopped for the summer. It was the lovely wellbeing young woman who gently suggested that DD needs something more and that DSA (Disability Allowance) could cover it.

Has she tried MANTRA therapy? Now she is an adult that may be beneficial to her, especially if she has periods of recovery but then slips back into her anorexia at times of stress.

She hasn’t tried it. Is it limited to dealing specifically with the Anorexia? I think the anorexia is how her feelings of self loathing and perfectionism manifests itself but I think she needs to delve deeper to get to the root of why she feels that she isn’t enough.

DD knows this is the next step for her but admits that part of her doesn’t want to unpick it all as she thinks this is how she stays in control of everything. If she “gets better” then she’ll still hate herself but also be “fat” to boot.

@Rollergirl11 I’m so sorry to hear about what you and your DD are going through. I have no idea about therapy as DD won’t talk about it with anyone but she was offered Ketamine infusions to help with the rigid thoughts.
Your DD sounds so like mine in the fact she hates herself, all she wants to do is lose weight and it’s a constant battle to keep her from going back to inpatient care.
She also says she never wants to recover or be well as she would hate to be weight restored.
I hope you can find something to help, I’ve asked her Drs before about micro dosing mushrooms when she reaches 18 I’m that desperate x

Here is a link explaing MANTRA

https://www.thelondoncentre.co.uk/mantra-therapy

It’s much more tailored to individuals and their struggles than CBT or DBT which tend to follow a more structured approach

Thanks for the link @alwayshungryhippo. It does look quite promising. I am not sure what therapy is on offer through her DSA but she can certainly ask about it.

Sorry to hear your DD struggles too @CoriolanusSnow. It’s heartbreaking how much they despise themselves isn’t it? 💔

NICE recommend MANTRA or CBTe for anorexia.
best for OCD will be CBT from someone with OCD experience/training
Anxiety and OCD might well lessen with improvements in anorexia
I would choose a different therapy to what dd has had previously,

Hi rollergirl. My DD has also completed first year of uni. Although much better than she was a few years ago still has issues.
She completed at the time cbt-e, which helped. However I don't think it really got to the root problem but helped her manage things.

She has dsa support, but my understanding was that it doesn't provide for MH treatment? Her weekly support , although helpful, is not really "medical".
She tried through her GP to get ED related help but when she went for an assessment they said she was "too good".
Myrtlewilson on another thread recommended some charities through Redcan. I think they charge some, although if you can't pay they will try and sort something out.
DD is due an assessment with them later this month.

Depending on where your DD is, there may be an NHS Adult Eating Disorder Integrated Mental Health Service (AEDIMHS). Where I am, your doctor can make a referral to them. They do have BMI criteria, but it’s primary care so they’re treating mild-moderate eating disorders and the criteria are nothing like as stringent as they would be in e.g. CAMHS. Our local service is very good, and they’ll do a really in-depth assessment with specialists, and make recommendations for next steps depending on what the patient wants to achieve. Could be worth investigating.

What about Compassion Focussed Therapy (CFT)? It’s a trans diagnostic approach- so not anorexia specific. But would definitely address how/why the self-loathing and perfectionism developed and how your DD copes and protects herself from these fears about herself (i.e. using the eating disorder presumably as a way of coping with the self loathing). It’s a lot less rigid than CBT. But do ensure you/your DD do your research re properly accredited therapists etc.

I second a Compassion Focused Therapy approach may be helpful, and potentially EMDR (both can be integrated well if being provided by appropriately trained professional such as a Clinical or Counselling Psychologist).

CBT deals with behaviours/ habits and faulty thinking patterns but won't be any good for getting to the root of her issues.
If she wants to work out why she feels like she does, she is better off with a person centred counsellor or psychologist (who tend to be better trained than counsellors) or a psychodynamic psychologist.
It's very hit and miss finding one who is good because it's a lot about the relationship and the therapist's skills rather than their training and it can take a while to find out.
Many do a free 20 minute or so meeting so you can see if you like them.

Hello Rollergirl 11.
I'm sorry to hear about the D's condition. This illness is very much an 'uninvited guest' that refuses to leave. However, it's essential to take an aggressive, combative stance against it.
As a psychotherapist with twenty years of experience, I believe there is no single "best" therapy. In fact, there are many effective models. The key is to find the therapeutic approach with which the individual feels comfortable.
Yet, more important than the specific therapy is the therapist themselves. A strong, trusting alliance is half the battle won.
Third, regardless of the therapy or therapist you choose, I believe they should possess the following features:

1. Competency in Developmental History: Are they skilled at analyzing the patient's early developmental years?
2. Emotional Intuition: Are they adept at reading emotions? Are they intuitive?
3. Therapeutic Flexibility: They may begin with an analytic stance, but can they shift their emphasis as the patient's needs change? Can they adapt and integrate techniques from other models like CBT or systemic therapy?
4. Externalization of the Illness: Can they sufficiently separate the illness from the patient's identity?
5. Humility and Humor: Can the therapist be self-effacing, avoiding the role of the all-knowing expert? Can they appropriately use humor in their therapeutic approach?

Ultimately, what is needed is to take the time to choose the right therapist. Have conversations with several to find one who provides reassurance that the process will be money well spent.

Buffon, I don't disagree, but I myself would struggle with (the practicalities of) find someone like this despite me being a HCP.
How would a 18/19 year old find this, who refuses too much of parental help.

She has already asked help from GP and been referred to ED unit, who, despite her purging refused to take her on as she was '"too good"

I know she can pay privately but without help she won't able to navigate this. I know Orri in London has good reviews but DD not keen on online sessions.

Yes I agree, I have much esteem for Orri having spoken to Ms Jones the Founder. Orri does day hospital and once a week face to face- i believe. ??
That said, The girl needs the help of a competent adult.
That would usually ( though not exclusively ) be a Uni trained Psychotherapist. (Being a psychotherapist myself, i have a bias.) I would look on the UKCP website for a psychotherapist ( Uni trained) who has experince in ED and who has a sound understanding of Child development.