Understanding the phenomenological experiences of schema therapy for those with an eating disorder

Submitted: 8 April 2023
Accepted: 5 July 2024
Published: 12 September 2024
Abstract Views: 232
PDF: 126
Supplementary Materials: 3
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Schema therapy expands traditional cognitive-behavioral models, weakening early maladaptive schemas and schema modes while strengthening adaptive modes. This study investigated participant experiences of schema therapy for eating disorders, focusing on schema modes and the eating disorder voice, how these maintained disordered eating, and how therapy helped. Semistructured online video interviews with clients receiving schema therapy for eating disorders (N=10) were analyzed using interpretative phenomenological analysis. Four group experiential themes were developed: (1) adverse experiences, typically in childhood and adolescence, (2) interpersonal relationships, especially with primary caregivers and the benefits of a good therapeutic relationship, (3) self-awareness of schema modes and the eating disorder voice and their impact on participants’ eating disorders, and (4) recovery using schema concepts, including finding one’s inner child, better self-management, and ambivalence about recovering. Overall, schema therapy was perceived as beneficial, specifically regarding participants’ awareness of their inner child, development of their eating disorder, and awareness of their eating disorder voice. Participants expressed a growing positive sense of agency, connecting with their inner child’s needs and developing a connection to their healthy adult mode. They also felt that schema therapy had equipped them with the tools to strengthen their healthy adult mode, while simultaneously weakening their maladaptive modes.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Allen, K. L., & Schmidt, U. (2017). Risk factors for eating disorders. Eating disorders and obesity: A comprehensive handbook, 254.
Aya, V., Ulusoy, K., & Cardi, V. (2019). A systematic review of the ‘eating disorder voice’ experience. International Review of Psychiatry, 31(4), 347-366. DOI: https://doi.org/10.1080/09540261.2019.1593112
Bateman, A., Fongay, P. (2016). Mentalization based treatment for personality disorders: A practical guide. Oxford University Press. DOI: https://doi.org/10.1093/med:psych/9780199680375.001.0001
Barazandeh, H., Kissane, D. W., Saeedi, N., & Gordon, M. (2018). Schema modes and dissociation in borderline personality disorder/traits in adolescents or young adults. Psychiatry Research, 261, 1-6. (Doctoral dissertation, Doctoral Thesis). DOI: https://doi.org/10.1016/j.psychres.2017.12.023
Bowker, C. A. (2021). Schema Modes in Eating Disorders: An Interpretative Phenomenological Analysis (Doctoral dissertation, Doctoral Thesis. Makhanda: Rhodes University).
Edwards, D. J. A. (2017). An interpretative phenomenological analysis of schema modes in a single case of anorexia nervosa: Part 1 – Background, method, and child and parent modes. Indo-Pacific Journal of Phenomenology, 17(1), 13 pp. DOI: https://doi.org/10.1080/20797222.2017.1326728
Edwards, D. J. A. (2017). An interpretative phenomenological analysis of schema modes in a single case of anorexia nervosa: Part 2. Coping modes, healthy adult mode, superordinate themes, and implications for research and practice. Indo-Pacific Journal of Phenomenology, 17(1). DOI: https://doi.org/10.1080/20797222.2017.1326730
Fairburn, C. G., Cooper D Phil, Dip Psych, Z., Doll D Phil, H. A., O’Connor, M. E., Bohn D Phil, Dip Psych, K., Hawker, D. M., & Palmer, R. L. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry, 166(3), 311-319. DOI: https://doi.org/10.1176/appi.ajp.2008.08040608
Fox, A. P., Larkin, M., & Leung, N. (2011). The personal meaning of eating disorder symptoms: An interpretative phenomenological analysis. Journal of Health Psychology, 16(1), 116-125. DOI: https://doi.org/10.1177/1359105310368449
Friars, D., Walsh, O., & McNicholas, F. (2023). Assessment and management of cardiovascular complications in eating disorders. Journal of Eating Disorders, 11(1), 1-12. DOI: https://doi.org/10.1186/s40337-022-00724-5
Gadamer, H. G. (1975). Hermeneutics and social science. Cultural Hermeneutics, 2(4), 307-316. DOI: https://doi.org/10.1177/019145377500200402
Goddard, H., Hammersley, R., & Reid, M. (2022). Schema Modes, Trauma, and Disordered Eating. Journal of Cognitive Psychotherapy, 36(1), 70-95. DOI: https://doi.org/10.1891/JCPSY-D-20-00050
Gorrell, S., & Murray, S. B. (2019). Eating disorders in males. Child and Adolescent Psychiatric Clinics, 28(4), 641-651. DOI: https://doi.org/10.1016/j.chc.2019.05.012
Harre, R. and Moghaddam, F.M., 2012. Psychology for the third millennium: Integrating cultural and neuroscience perspectives. New York edn. SAGE Publications. DOI: https://doi.org/10.4135/9781446288542
Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. Guilford press.
Maher, A., Cason, L., Huckstepp, T., Stallman, H., Kannis‐Dymand, L., Millear, P., ... & Allen, A. (2022). Early maladaptive schemas in eating disorders: A systematic review. European Eating Disorders Review, 30(1), 3-22. DOI: https://doi.org/10.1002/erv.2866
Noordenbos, G., Aliakbari, N., & Campbell, R. (2014). The relationship among critical inner voices, low self-esteem, and self-criticism in eating disorders. Eating Disorders, 22(4), 337-351. DOI: https://doi.org/10.1080/10640266.2014.898983
Olofsson, M. E., Oddli, H. W., Hoffart, A., Eielsen, H. P., & Vrabel, K. R. (2020). Change processes related to long-term outcomes in eating disorders with childhood trauma: An explorative qualitative study. Journal of Counseling Psychology, 67(1), 51. DOI: https://doi.org/10.1037/cou0000375
Pietrabissa, G., Rossi, A., Simpson, S., Tagliagambe, A., Bertuzzi, V., Volpi, C., ... & Castelnuovo, G. (2020). Evaluation of the reliability and validity of the Italian version of the schema mode inventory for eating disorders: short form for adults with dysfunctional eating behaviors. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 25(3), 553-565. DOI: https://doi.org/10.1007/s40519-019-00644-5
Pugh, M. (2019). Resolving ambivalence and overcoming blocks to change. Schema Therapy for Eating Disorders: Theory and Practice for Individual and Group Settings. DOI: https://doi.org/10.4324/9780429295713-11
Pugh, M., & Rae, S. (2019). Chairwork in schema therapy: Applications and considerations in the treatment of eating disorders. In Schema Therapy for Eating Disorders (pp. 102-120). Routledge. DOI: https://doi.org/10.4324/9780429295713-8
Rabito-Alcón, M. F., Baile, J. I., & Vanderlinden, J. (2020). Child Trauma Experiences and Dissociative Symptoms in Women with Eating Disorders: Case-Control Study. Children, 7(12), 274. DOI: https://doi.org/10.3390/children7120274
Simpson, S. G., Morrow, E., & Reid, C. (2010). Group schema therapy for eating disorders: a pilot study. Frontiers in Psychology, 1, 182. DOI: https://doi.org/10.3389/fpsyg.2010.00182
Simpson, S. G., Pietrabissa, G., Rossi, A., Seychell, T., Manzoni, G. M., Munro, C., & Castelnuovo, G. (2018). Factorial Structure and Preliminary Validation of the Schema Mode Inventory for Eating Disorders (SMI-ED). Frontiers in Psychology, 9. DOI: https://doi.org/10.3389/fpsyg.2018.00600
Simpson, S., & Smith, E. (Eds.). (2019). Schema therapy for eating disorders: Theory and practice for individual and group settings. Routledge. DOI: https://doi.org/10.4324/9780429295713
Smith, J., Flowers P., & Larkin, M. (2009) Interpretative phenomenological analysis. Theory, method and research. SAGE Publications Ltd.
Smith, J. A., Flowers, P., & Larkin, M. (2022). Interpretative phenomenological analysis: Theory, method and research (Second ed.). SAGE Publications Ltd.
Taborelli, E., Easter, A., Keefe, R., Schmidt, U., Treasure, J., & Micali, N. (2016). Transition to motherhood in women with eating disorders: A qualitative study. Psychology and Psychotherapy: Theory, Research and Practice, 89(3), 308-323. DOI: https://doi.org/10.1111/papt.12076
Talbot, D., Smith, E., Tomkins, A., Brockman, R., & Simpson, S. (2015). Schema modes in eating disorders compared to a community sample. Journal of Eating Disorders, 3(1), 41. DOI: https://doi.org/10.1186/s40337-015-0082-y
Tierney, S., & Fox, J. R. (2010). Living with the anorexic voice: A thematic analysis. Psychology and Psychotherapy: Theory, Research and Practice, 83(3), 243-254. DOI: https://doi.org/10.1348/147608309X480172
Turner, H., Marshall, E., Stopa, L., & Waller, G. (2015). Cognitive-behavioral therapy for outpatients with eating disorders: Effectiveness for a transdiagnostic group in a routine clinical setting. Behavior Research and Therapy, 68, 70-75. DOI: https://doi.org/10.1016/j.brat.2015.03.001
Williams, S & Reid, M. (2009). Understanding the experience of ambivalence in anorexia nervosa: The maintainer's perspective. Psychology and Health, 25, 5, 551 - 567. DOI: https://doi.org/10.1080/08870440802617629
Williams, S. & Reid, M. (2012). ‘It’s like there are two people in my head’: A phenomenological exploration of anorexia nervosa and its relationship to the self. Psychology and Health, 27, 798-815. DOI: https://doi.org/10.1080/08870446.2011.595488
Young, J. E. (1990). Cognitive therapy for personality disorders: A schema-focused approach. Sarasota, FL: Professional Resource Exchange.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. Guilford Press.

How to Cite

Cunningham, Alice, Marie Reid, Stephanie Sayan, and Richard Hammersley. 2024. “Understanding the Phenomenological Experiences of Schema Therapy for Those With an Eating Disorder”. Qualitative Research in Medicine and Healthcare 8 (2). https://doi.org/10.4081/qrmh.2024.11376.