Home Health Eating Disorders and Obesity
The case of Ms. A illustrates the structure and course of the CBT-GSH program (i.e., 12 weeks, 8 sessions, 6 steps), the nature of guided support, and the content of typical sessions. Overall, Ms. A had made significant progress and improvements. Although she was not completely free of binge eating, the frequency of her bingeing had been reduced. She also began eating more regularly toward the end of the intervention. Through self-monitoring, Ms. A had identified several situational and emotional triggers to her binge eating, including bar outings, family gatherings, eating with her partner, stress, work environment, and poor planning. In terms of weighing, Ms. A was successful in decreasing the frequency of weighing from multiple times a day to once every 4 days, which reduced her anxiety about her weight gain.
Ms. A did experience challenges and setbacks during the 12-week course of the CBT-GSH intervention. For instance, her self-monitoring was erratic during and after the holidays because of limited access to her online records. When Ms. A started a new job, she took a short hiatus from the program and did not return any of the supporters phone calls. She attributed her disengagement to feeling overwhelmed by multiple responsibilities and getting discouraged after failed attempts to follow the program steps. Ms. A also missed several phone sessions without prior notice of cancellation, which prompted the supporter to make last-minute changes to accommodate rescheduled sessions and to combine two sessions into one at one time to stay within the 12-week program timeframe.
Ms. A faced tremendous barriers to seeking professional psychological help because of her feelings of shame, school and work hours, and lack of financial resources. The self-help intervention reduced or eliminated most of these barriers to treatment seeking. Self-help programs are brief, inexpensive, nonstigmatizing, and empowering and can be tailored to meet individual needs (Apfel, 1996; Garvin, Striegel-Moore, Kaplan, & Wonderlich, 2001), making it a feasible and appealing treatment option for clients such as Ms. A, who tend to underuse professional psychological services.
The culturally sensitive CBT-GSH program ensured that the contents and delivery of the intervention strategies (e.g., the nutrition guide, alternative activities to binge eating) were congruent and relevant to Ms. As worldview and life experiences. Although Ms. A initially did not find the vignettes and role-playing exercise helpful, she later acknowledged the challenge of negotiating cultural norms and interpersonal dynamics that influence her eating patterns and food choices and alluded to wanting more concrete examples to help her address these interpersonal dilemmas.
As discussed earlier, the focus of the support sessions was not to clinically resolve or work through any issues. Rather the supporter guided, encouraged, and motivated Ms. A to apply the knowledge and self-regulation skills acquired from the self-help manual. In addition, the supporter was responsive to the role of sociocultural factors in the development and maintenance of Ms. As eating problem, as well as in her treatment engagement. For instance, many of our pilot study participants, including Ms. A, came from low-income backgrounds; their life circumstances were marred by limited resources such as lack of healthy food options or safe places to exercise in their neighborhoods. Hence, our supporters had to be aware of the implications of these realistic challenges on Latinas' treatment trajectory and be creative in exploring alternative options (such as joining a low-cost food co-op that provides healthy food, starting a walking group with family members) that are not offered by the self-help manual.
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