بررسی اثرات حرکت، آرام سازی و آموزش در سطح استرس زنان با سطوح تحت بالینی پرخوری

The purpose of this study was to assess the impact of a multidisciplinary intervention program on the attitudes and symptoms associated with bulimia nervosa (BN). The Bulimia Test (BULIT) and subscales from the Eating Disorder Inventory-2 (EDI-2) associated with BN were administered to 373 females to determine eligibility for participation in the study. In order to qualify for the study, participants had to be female, not be anorexic, and meet one of four criteria indicating that they had some of the symptoms of BN. Following the screening, 12 females were randomly assigned to a control group (C, n=6) or an intervention group (I, n=6). The I group then participated in an 8-week multidisciplinary intervention program consisting of small group discussions, movement improvisation, and relaxation techniques. Dependent variables consisted of scores from standardized instruments for anxiety, self-esteem, and BN. A multivariate analysis of variance (MANOVA) on the difference score from post- to pretest was calculated for state and trait anxiety. That analysis indicated that compared to the C group, which showed no reduction in anxiety, the I group had a significant reduction in anxiety following the intervention program. No significant differences were found between groups for self-esteem or symptoms of BN. Conclusions were that anxiety levels were lowered in the I group; however, attitudes or behaviors associated with BN were not affected by the intervention.

Research has shown that women with bulimia nervosa (BN) report higher levels of distress than a nondisordered-eating group (Soukup, Beiler, & Terrell, 1990). According to the interpersonal stress theory, a stressful antecedent triggers binge eating, and this overeating becomes a learned response to external and internal stress stimuli (Laessle et al., 1991). Hetherington, Altemus, Nelson, Bernat, and Gold (1994) found that anxiety levels were higher before eating a meal intended for purging relative to a nonpurged meal, both before and after the binge. However, one hour after the meal, anxiety increased in those who binged and did not purge. Furthermore, increased guilt, shame, and anger have been found after binge eating and purging (Kaye et al., 1992). A vicious cycle ensues—distress, binge, purge, guilt, and increased distress. The relationship between the distress caused by stressful life events and eating disorder symptoms is bidirectional and complex (Shatford & Evans, 1986). Distress predicts eating disorder symptoms, and eating disorder symptoms predict increased distress (Rosen, Compas, & Tacy, 1993). Researchers have found that women with increased stress-induced cortisol reactivity consumed more calories than women who had low stress-induced cortisol reactivity when exposed to a laboratory stressor (Epel, Lapidus, McEwen, & Brownell, 2001). Even preference for food intake was affected by stress reactivity, as high cortisol reactors also ate significantly more sweet food. However, other studies have demonstrated that eating disorders in and of themselves create substantial stress in patients' lives Hetherington et al., 1994 and Rosen et al., 1993. For example, one study found that adolescents with eating disorders reported a greater number of stressful life events than non-eating-disordered adolescents only when eating disorder-related events were included in the analysis (Sharpe, Ryst, Hinshaw, & Steiner, 1997). According to Fryer, Waller, and Kroese (1997) stress should be considered both as a risk factor for eating disorders and a target for intervention. Many researchers have advocated the use of stress management strategies in preventative interventions for populations at high risk for developing eating disorders Epel et al., 2001, Hetherington et al., 1994, Laessle et al., 1991 and Soukup et al., 1990. Group interventions targeting eating disorders have typically provided psychoeducational information about the symptoms of ED, the consequences of these behaviors, and healthy weight control techniques. While some of these psychoeducational group interventions have met with success (Jones & Stone, 1992), many of these interventions resulted in no positive changes Carter et al., 1997 and Mann et al., 1997. Stice, Mazotti, Weibel, and Argras (2000) experimented with a covert prevention program that did not explicitly present information on eating disorder symptoms but used cognitive dissonance theory, and preliminary results were positive. Based on comparative studies, cognitive–behavioral therapy used alone or in combination with other techniques has resulted in the most significant reductions of binge eating and/or purging (McGillery & Pryor, 1998). While cognitive–behavioral interventions have met with partial success for some (Smolak, Levine, & Schermer, 1998), a small number of individuals with BN may not benefit at all (Wilson, 1996). Researchers have cited the need for creative and innovative intervention approaches for individuals with BN who may not respond to the more traditional approaches Carter et al., 1997 and Mann et al., 1997. Carl Jung thought that creative play was a healing factor that operated in adults and children (DuBose, 2001). Body image is such an important concept in ED, it is surprising that so few empirical research studies have attempted to engage participants through the use of their physical bodies in an attempt to decrease distress and change behavior through play or movement. It is commonly acknowledged that a primary symptom associated with most eating disorders is body image disturbance (Cash & Pruzinsky, 1990). The formation of body image is based on reception of sensations coming from skin, viscera, and muscles and on the awareness of position and posture (Totenbier, 1995). There are some pioneers in the field of creative movement, play, and the healing of eating disorders, however. Body image therapy was developed by Totenbier (1995) in the early 1980s in response to a request from a multidisciplinary eating disorders team working in a psychiatric hospital. The basic premise of Totenbier's body image therapy is that looking at, examining, and experiencing the body through movement enhances an individual's perception of her body image, hence making it less frightening and more acceptable. Totenbier (p. 200) also states, “Most patients with eating disorders have trouble relaxing. They have lost touch with their internal sensations, in order to control their eating habits, and consequently have lost sensitivity to their musculature.” She uses movement to help clients redevelop body awareness and relearn hunger sensations. Totenbier presents a case study using her therapy in the treatment of eating disorders. Krantz (1999) presented a model for treating women with eating disorders through dance/movement therapy. According to Krantz, reconnecting the body with feelings through the use of dance, movement, and verbalization allows the client to experience affect and express her inner world, to recognize meaning in her behavior and relationships, and to develop healthy psychological unity. She discusses the potential of this approach for promoting therapeutic change by describing a case study of a 24-year-old bulimic woman who participated in 14 months of individual dance movement therapy. Lemieux (2001), a dance movement therapist who has worked in an eating disorder clinic for nearly 20 years, states that the critical areas in the process of recovery for women with eating disorders include intimacy, contacting one's own center, maintaining a relationship with another and still honoring one's self, and sensing an accurate body image. Lemieux (p. 366) presents a case study using contact movement therapy with a woman who had been anorexic/bulimic for 17 years. This woman stated, “This is the most powerful and healing work that I'm doing or have ever done.” The current study sought to evaluate a prevention program for eating disorders using approaches (group discussions, relaxation training, and movement improvisation) similar to those that have met with some success in earlier research or case studies Fryer et al., 1997, Jones & Stone, 1992, Krantz, 1999, Lemieux, 2001, Smolak et al., 1998 and Totenbier, 1995. A similar, multidisciplinary group intervention conducted at the Bristol Eating Disorder Clinic was successful in reducing participants' anxiety, depression, and disordered eating patterns, although statistical analyses were not reported (Jones & Stone, 1992). In that intervention, each session was devoted to a relevant theme, and the participants were asked to keep a diary during the 13-week group intervention. The group sessions focused on themes related to BN, stress management, expressing feelings, body image, and dealing with unhelpful thoughts. In the current study, a similar program was developed in an attempt to decrease stress and to change attitudes and behaviors associated with BN through thematic small group interaction. Each theme was explored cognitively as well as through movement and relaxation. This study's hypothesis was that participants in this prevention program would show an increase in self-esteem and a reduction in anxiety and in symptoms of eating disorders, and that these changes would be greater than those for a control (C) group.