Psychotherapy and Weight Loss

Weight Loss and Psychotherapy (2)

 

Psychotherapy of Weight Loss

Dr Jonathan Haverkampf, M.D.

 

There are many approaches advertised to reduce weight but I want to focus on one of them, which I also find the most important one, the psychotherapeutic approach. Being overweight or underweight can be due to a medical condition, which needs to be excluded first. Also, there may be a perception of being overweight even when the body weight is normal or even low, such as in the case of anorexia.

 

Body Mass Index

The first question if one’s body weight is too high. A good tool used in many medical settings is the body mass index (BMI). Roughly, a BMI of 18.5 to 25 is seen as ‘normal’, although this always depends on the individual cases, if there are medical or other reasons to divert from it. But the BMI is usually good starting point.

 

‘Intake’

If the BMI is greater than 25 and there is an increased calorie intake (without clear binge eating), the situation appears to be relatively straight forward. One’s ‘intake’ is too high. Reasons for such behaviour, absent any medical condition, can be manifold.

‘Taking in’ food can have a soothing and calming effect because it reconnects one with the world, also in a physical way. But there can also be neurobiological processes, reaching back into the time when a baby sucked at the mother’s breast, which get activated and lead to a secretion of hormones and neurotransmitter substances which have a calming and relaxing effect.

Food intake therefore can be too high because of tensions or stress that increase the urge for relaxation and calming.

 

Stress and Tension

Psychologically, there can be a number of reasons for stress and tension, including a

  • deficient sense of self
  • lack of boundaries
  • strong emotions of loneliness, sadness or even anger that cannot be communicated.

Since there are so many possibilities in terms of psychological dynamics that can trigger and maintain a calorie intake above normal, it is always important to look at the individual case.

 

Life Experiences

There can be several reasons which lead to weight problems. Traumatic life experiences, unstable relationships, low self-esteem, and more are commonly present, but this need not be the case. In a number of instances eating more than one can metabolize may also be a ‘bad habit’ in the sense of a behaviour that has been learned and is difficult to unlearn. Maybe it is out of convenience or a lack of awareness, but change may also be difficult because one does not know how to go about it. Some structure and planning is usually required, at least when it comes to deciding what to order in a restaurant. There are many self-help books and therapists who can help one to deal with this problem. Cognitive Behavioural Therapy (CBT) often provides an effective approach if deeper personality issues and more severe mental health problems are not present.

 

Self-Esteem and Self-Confidence

In another article, I have discussed what to do about low self-esteem and low self-confidence. Psychodynamic therapies are helpful if there are ‘deeper’ issues are present. Insight at least shifts the underlying emotions away from the eating problem towards other strategies. But over the long-term the resolution of conflicts or any other underlying issues that are present and maintain the weight problem usually also make the weight problem go away or improve it considerably. Learning to experience and accept oneself more fully is often helpful in reducing an unwanted behaviour, such as elevated calorie intake.

 

The Sense of Self

The main strategy should be to focus on establishing a sound sense of self that increases happiness and enjoyment in life. This often means identifying one’s values, interests and aspirations. The more the focus can shift to enjoyable ways of constructing one’s life, the less a weight problem will be an issue. The less one actually has to think about the ‘weight problem’ the less it often is a problem, but this requires living more fully. This does not mean drastic changes in one’s life, but a gradual process towards a more fulfilling life in single steps.

 

Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at jonathanhaverkampf@gmail.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.

This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Trademarks belong to their respective owners. No checks have been made.

© 2012-2017 Christian Jonathan Haverkampf. All Rights Reserved.

Critical Decisions

Critical Decisions (2) Ch Jonathan Haverkampf MD

Many areas, such as law and medicine, are largely about making right decisions in the face of incomplete information, but so is making a choice at the local supermarket. With many decisions, we feel we have to get them ‘right’, even if we are not sure what ‘right’ really means. Practically every decision is based on assumptions, but often we also assume basic parameters, such as our basic values and what is important to us, without questioning them, which can lead to decisions that make us worse off. This is why it is important for a good decision to reflect on one’s values and what is truly important to oneself.

Depression and Psychotherapy

Depression and Psychotherapy (2)

Depression usually means feeling low and lacking motivation and energy to do anything enjoyable, but sometimes it may predominantly show in disturbed sleep, a lack of appetite and other diffuse bodily symptoms. The latter condition we call an atypical depression. Often individuals remain undiagnosed or misdiagnosed for a long time before someone correctly identifies the underlying problem as a depression. Frequently, depression is associated with anxiety, and in many cases also with OCD, because they involve some of the same neurobiological pathways, and the same medication can have an effect on all three.

Building Self-Confidence

Self-Confidence (2)

Self-Confidence is quite simply when you have confidence in yourself. It is often seen as the holy grail of psychotherapy in the belief that the right amount of confidence in oneself will solve problems from anxiety to depression. And while it is true that higher confidence in one’s ability to get somewhere increases the sense of control and self-directedness, knowing where one is going is important as well. If where you are going is an extension of your values, you will also have more self-esteem, because you feel that you are adding to your own value.

Schizophrenia and Medication

Schizophrenia in virtually all cases requires lifelong treatment, even when symptoms have subsided. Treatment includes better coping skills in everyday life, strategies to reduce stress and become aware of early warning signs of a psychotic episode, psychotherapy to better manage life, and medication. Medication may be life-long, but does not have to be.

Medication for an independent, autonomous life

Treatment with medication (antipsychotics) and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed. However, medication has drastically reduced the need for hospitalization. Many patients who had to be hospitalized for most of their lives in earlier times can now care for their families or work as highly paid managers in large corporations.

Medication allows people with schizophrenia to lead normal lives. Especially the newer generation of antipsychotics has increased the quality of life significantly, while reducing some of the side-effects of the earlier generation of antipsychotic medication. Still, antipsychotic medication has overall still not reached the low side-effect profiles of newer antidepressants. While tardive dyskinesia has become rarer with the second-generation antipsychotics (SGAs) and is virtually absent in clozapine especially and the potentially lethal malignant neuroleptic syndrome is a very rare phenomenon, they are often associated with side-effects from weight gain (especially olanzapine) to drowsiness (quetiapine). It seems that we are only willing to accept the greater potential side-effects of modern antipsychotics because of the enormous improvement they can bring in a patient’s quality of life.

Schizophrenia and Medication (2)

Schools of Psychotherapy

CBT and Psychodynamic Psychotherapy – A Comparison Ch Jonathan Haverkampf

Cognitive Behavioural Therapy (CBT) and psychodynamic psychotherapy, the less intensive form of psychoanalysis, are arguably the most prominent and well-researched schools of psychotherapy (see Lambert and Bergin, 1994), apart from interpersonal therapy (IPT) models.

Essentially all psychotherapies go back to the revolutionary concept of the ‘talking cure’[1] in the late nineteenth century, the use of communication as an instrument of healing. CBT and psychodynamic psychotherapy as descendants from the same concept should be viewed as complimentary rather than as substitutes. Technical approaches from both can be helpful in individual situations.

The aim of psychotherapy is not merely to eliminate suffering (WHO, 1946), but to help patients develop as humans. The primary tool is communication, in CBT to provide information that generates change and in psychodynamic psychotherapy to reveal the information that brings about change.  There are synergistic effects from using both. Zipfel et al (2014) showed in a large sample of anorexic patients, that CBT was associated with weight gain, while psychodynamic psychotherapy with lower relapse rates at the 12-month follow-up. McFall and Wollersheim (1979) in an early study successfully used a combination of CBT and psychodynamic psychotherapy in anxiety[1]. Given the widely-perceived need for multimodal approaches[2], it is difficult to comprehend that this should not apply to the most important therapeutic models we have. In ancient Greece, knowing oneself (γνῶθι σεαυτόν, “know thyself”) and the process of the Socratic dialogue were inextricably linked. Psychodynamic psychotherapy and CBT should be viewed as complementary rather than substitutes.

[1] The objective was to “modify their unrealistic cognitive appraisals of threat” (cognitive), “test the validity of their fears” (behavioural), and “realize resources … for coping with uncertainty and anxiety” (psychodynamic).

[2] A multimodal approach with intensive psychotherapy, medication, and psychosocial rehabilitation has repeatedly been shown to yield superior outcomes (see, for example, Saxena et al, 2002, Greist et al, 2003).

[1] Breuer et al, 2000