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WHAT ARE THE ACTIVE INGREDIENTS OF PEER SUPPORT FOR EATING DISORDERS?
The use of peer support in the case of eating disorders can be supported by initially understanding how it can play a role in addressing and alleviating several factors that act to augment and
sustain eating disorder pathology. In particular, according to the cognitive-interpersonal mode of eating disorders (9 and 10), eating disorders such as anorexia nervosa are maintain through
four key factors:
Positive beliefs about the utility of the illness
A rigid, detail focused thinking style
Avoidance of the experience and expression of emotion
Problematic interpersonal relationships
To combat these sustaining factors, peer support can be considered as a compassion-centred recovery approach that offers opportunities for sufferers to develop mutual understanding and trust.
This can be used to allow individuals with eating disorders to self-manage and be guided forward in their recovery alongside someone with lived experience of their illness and related thought
patterns. For example, according to the recovery approach philosophy in England and Scotland (National Institute of Mental Health in England, 2005), peer support is one of the five main pillars
and processes of recovery, alongside hope and optimism about the future, confidence or self-efficacy to change, development of identity, having a sense of meaning in life, and experiencing empowerment. In support of peer support, unlike general psychotherapy, its use allows a means of connecting with others who have encountered similar problems. In particular, self-disclosure
can allow mentees with eating disorders to feel more able to open up about their own personal problems and experiences, thereby facilitating the sharing of problem solving techniques, practical
skills and methods that promote recovery orientated goals. Moreover, the use of peer support is advocated from the lens of self-determination theory (. This psychological proposes that three key factors - autonomy, self-competence and relatedness (i.e. positive social connection) with others) are the foundations that drive internal motivation and personal growth. Considering that individuals going through recovery from an eating disorder are more likely to experience better outcomes if they are intrinsically motivated to get well (e.g. over being externally forced or bribed), peer support
can help individuals’ positively alter their motivational style, while also offering a sense of autonomy (e.g. personal control over their choices) and meaningful social connection. For example,
research in eating disorders has associated perceived autonomy support from peer mentors to higher motivation to change, as well as self-compassion (Carter & Kelly 2015;
Van Der Kaap-Deeder et al., 2014). Furthermore, considering that individuals suffering from an eating disorder often experience social isolation (i.e. a poor sense of relatedness),
peer mentoring can serve as a way of reducing individuals’ sense of loneliness and helplessness. Likewise, the sharing of experiences while knowing someone similar to one’s self has been able to recovery from an eating disorder can provide hope and optimism for getting well and reclaiming back life. Peer mentoring relationships may also help to alleviate symptoms of anxiety, stress and depression, which may otherwise work to augment eating disorder behaviours and other symptoms.
In the Nourishing Routes model of supporting recovery, peer support can take place one to one (in person or using ‘real time’ video messaging technology), as well as using visual, audio and video support materials (all created and delivered by someone with personal experiences of overcoming an eating disorder). In previous treat trials, it has been shown that watching videos, reading
inspiring blogs and listening to supportive audio resources has helped to improve positive mood, increase meal consumption, as well as reduce anxiety and negative thoughts around food and
body image (Cardi et al., 2012; Treasure et al., 2010).
Beresin, E. V., Gordon, C., Herzon, D. B. (1989). The process of recovering from anorexia nervosa. Journal of American Academy of Psychoanalysis, 17, 103-130.
Cardi, V., Ambwani, S., Crosby, R., Macdonald, P., Todd, H., Park, J,, Moss, S., Schmidt, U., & Treasure, J. (2015). Self-Help and Recovery guide for Eating Disorders (SHARED): study protocol for
a randomised controlled trial. Trials, 16-165.
Cardi, V., Kan, c., Roncero, M., Harrison, A., Lounes, N., Tchanturia, K, et al. (2012). Mealtime support in anorexia nervosa: a within-subject comparison study of a novel Vodcast intervention. Psychotherapy and Psychosomatics, 81, 54-55.
Carter, J .C. & Kelly, A. C. (2015). Auonomous and controlled motivation for eating disorders treatment: baseline predictors and relationship to treatment outcome. British Journal of Clinical
Psychology, 54(1), 76-90
Dawson, L., Rhodes, P. & Touyz, S. (2014). Doing the impossible: The process of recovery from chronic anorexia nervosa. Qualitative Health Research, 24, 494-505.
Fogarty, S., Ramjan, L., & Hay, P. (2016). A systematic review and meta-syntehsis of the effects and experience of mentoring in eating disorders and disordered eating. Eating Behaviours,
National Institute of Mental Health in England. NIMHE Guiding Statement on Recovery. Leeds; 2005 [http://studymore.org.uk/nimherec.pdf]
Perez, M., Van, Diest, A. K., Cutts, S. (2014). Preliminary examination of a mentor-based program for eating disorder. Journal of Eating Disorders, 2 -24.
Sledge, W. H., Lawless, M., Sells, D., Wieland, M., Oconnell, M. J. & Davidson, L. (2011). Effectiveness of peer support in reducing readmissions of persons with multiple psychiatric hospitalizations. Psychiatric Services, 62, 541 - 544.
Treasure, K., Macar, C., Mentxaka, I. O. & Harrison, A. (2010). The use of a Vodcast to support eating and reduce anxiety in people with eating disorders: a case series. European Eating Disorder Review, 18, 515-521.
Van der Kaap-Deeder, J., Vansteenkiste, M., Soenens, B., Verstuyf, K., Boone, L. & Smets, J. (2014). Fostering self-endorsed motivation to change in patients with an eating disorder: the role of perceived autonomy support and psychological need satisfaction. International Journal of Eating Disorder, 47, 585-600.