Accelerating Change, and Increasing Its Likelihood of Success

Author: Anna Oliver BSc, BPhEd, PGDipDiet, RD

For all of us, implementing change is rarely easy, and it is particularly intense for someone with an eating disorder. The Change Curve is a popular and powerful model used to understand the 4 stages most people go through as they adjust to change; which are similar to the stages of dealing with grief. You can see this in figure 1, below. It’s partly based on the work of psychiatrist Elisabeth Kubler-Ross.


Figure 1 – The Change Curve

When a change is first introduced, people's initial reaction may be shock or denial. They might even convince themselves that there won’t really be any change. This is stage 1 of the Change Curve.

Once the reality of the change starts to hit, people tend to react negatively and move to stage 2 of the Change Curve. They may fear the impact; feel angry; and actively resist or protest against the changes. Some will wrongly fear the negative consequences of change. Others will correctly identify real threats to their world. For those struggling with an eating disorder, as a result of this – their life can quickly spiral into chaos if they don’t get support.

For as long as people resist the change and remain at stage 2 of the Change Curve, the change will be unsuccessful. This is a stressful and unpleasant stage. For everyone, it is much healthier to move to stage 3 of the Change Curve, where pessimism and resistance give way to some optimism and acceptance.

At stage 3 of the Change Curve, people stop focusing on what they have lost. They start to let go, and accept the changes. They begin testing and exploring what the changes mean, and so learn the reality of what's good and not so good, and how they must adapt.

By stage 4, they not only accept the changes but also start to embrace them: they rebuild their ways of working. Only when people get to this stage can they really start to reap the benefits of change.

Continued in Part II.

What does it mean to 'Maintain an Agnostic Stance?'

In FBT the provider takes an agnostic view of the cause of the illness. 

Instead of identifying these various factors, energy is directed at what needs to be done to help the adolescent move forward towards recovery ASAP. Where there's blame, inevitably there's shame, inaction, or worse yet, avoidance. So no blaming the adolescent or the parents. Maintaining an agnostic view means making no assumptions about the potential cause of the illness. Especially if it distracts from the task at hand, re-nourishment.

I think of it like a sinking ship. We would waste precious time deliberating about why it is sinking or who is to blame. The more immediate task at hand is get everyone to safety!

What are the Tenets of Family Based Treatment (FBT)?

The following are the five tenets of Family Based Treatment (FBT):

Maintain agnostic stance

Externalize the illness

Maintain a non-authoritarian/consultative stance

Empower parents/caregivers

Prioritize weight restoration/symptom remission


Infographic

FBT is intended to be provided by qualified mental health providers experienced in the assessment and treatment of eating disorders (ED). They can access consultants, such as pediatricians, psychiatrist, dietitian/nutritionists (RDNs), etc. But if FBT trainings don't include RDNs, then how should RDNs address the need in their practices, where access to FBT therapists are limited? How do they collaborate with FBT therapists? Moreover, if they are tapped as consultants, are they practicing in a way that is consistent with the tenets of FBT? More to come! 

References:
Rienecke, R.D., Family-based treatment of eating disorders in adolescents: current insights. Adolesc Health Med Ther. 2017 Jun 1;8:69-79.
Lock, J., Le Grange, D. (2013). Treatment manual for anorexia nervosa: A family-based approach, 2nd ed.