Cassie An Jeng

River Hill High School, Clarksville MD

G/T Independent Research I
Ms. Mary Jane Sasser
Susan Kierr, BC-DMT, NCC, AD, MA
Andree Schelleschi, RICA DMT

May 27, 2018

Aditya Mehrotra and Jenny Sheng

Editors-in-Chief, The National High School Journal of Science

Dear Mr. Mehrotra and Ms. Sheng,

I hereby respectfully submit my original research manuscript, entitled “An Evolution of Eating
Disorder Treatment,” for consideration for publication in The National High School Science
Journal. The manuscript contains background research on the topic studied, as well as the research
method, procedures, and findings of the project. All of the figures included are original and any
references used throughout the research are listed in the works cited and works consulted at the
end of the document.

Thank you for your time and consideration.

Sincerely,

Cassie A. Jeng
River Hill High School
G/T Independent Research I
 Jeng 1

2018

The Transformation of Eating

Disorder Treatment
AN ORIGINAL RESEARCH MANUSCRIPT
CASSIE AN JENG
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An Evolution of Eating Disorder Treatment

Abstract

Mental health, especially eating disorders have become a huge concern, and there is an
increasing number of victims who suffer detrimental consequences because of a lack of
treatment. This happens mainly due to a lack of awareness of therapy or incompatibility with the
techniques. Through thorough research on cognitive behavioral therapy (CBT) and
dance/movement therapy (DMT) in relation to eating disorder treatment, an idea was proposed to
combine cognitive aspects of CBT and movement/body connection aspects of DMT. Both
cognitive behavioral therapists and dance/movement therapists were surveyed to inquire about
their familiarity with the opposite techniques, as well as their perspective on the proposal. While
it was found that therapists were not entirely familiar with the other practice, especially the
newer aspects of dance/movement therapy, upon survey, both fields were intrigued by the
collaboration concept and anticipated it to be influential for patients with this disorder. There
were some obstacles presented through the surveys about means for developing the new method,
however, the data showed an overall consensus of the potential of this proposal. Because of the
anticipated influence, the concept could allow for the development of a new type of therapy that
would reach patients whom had previously been unsuccessful with treatment, preventing the rise
in fatal or grave conditions from untreated eating disorders. The spread of the research will allow
for heightened awareness of eating disorder treatment in general and the incorporated techniques.
Due to the higher percentage of cases in adolescents, the research was presented to different
groups of adolescents in order to inform them of the availability and aspects of therapy.

Problem

Psychological disorders are very prevalent in our modern society, calling for effective
treatment methods to handle the variety of instances threatening lives around the world (“Eating
Disorders: Symptoms” 1). Eating disorders are a form of psychological disorder that are
characterized by irregular and damaging eating habits (“Eating Disorders” 1). The most common
types of eating disorders are anorexia nervosa, bulimia, and binge eating. While they primarily
focus on body image, weight, and shape, eating disorders are not just an issue with consuming
food. They “commonly coexist with other conditions, such as anxiety disorders, substance abuse,
or depression” (“Eating Disorders: Symptoms” 1). Often caused by an additional underlying
problem, such as being a victim in a bullying relationship, eating disorders have both external
motives that are easily recognizable and hidden ones that form the origin of the illness. Despite
popular stereotypes regarding this serious mental health concern, it is not solely teenage girls who
fall victim. It has been publicly reported that this illness is “a daily struggle for 10 million females
and 1 million males in the United States” alone, and such variety in the patients demands variety
in treatment methods (“Eating Disorder Statistics” 2).

Every treatment is structured to focus on different characteristics of the disorder and to

ultimately uncover the internal motive for adapted eating habits. Just as some people are visual
learners and some are auditory learners, some patients are more responsive to certain techniques
than others. Thus, there must be a variety of different treatment methods, and the individual
 Jeng 3

therapists must be able to adapt their sessions to the patients, so each can achieve the same
treatment satisfaction. A major concept that requires adapting is the type of eating disorder present.
Each type will require different treatment because each is based on a different way of perceiving
the body; “there are different patterns and behaviors for each type of eating disorder. Anorexia is
restrictive, black and white thinking. A bulimic is very impulsive or might look to doing a lot of
exercise…” (Kleinman, Personal Interview 2). Eating disorders do not exhibit the same symptoms;
treatment activities for someone who is bulimic will not be as successful as with a different patient
suffering from anorexia nervosa. A variety of therapy choices allows different patients with
different disorders the necessary separate activities to understand the source of their illness. While
there are traditional effective methods for treating mental health, newer, broader, and non-
traditional methods of care can widen the opportunities for health for caregivers. Specifically,
regarding patients with eating disorders, there are benefits to combining classic with less
traditional treatments.

Introduction

As one of the most traditional methods regarding eating disorders, cognitive behavioral
therapies (CBT) work to help with treatment through active discussions between the patients and
the therapists. This type of therapy focuses more on the verbal expression of feelings in order to
access hidden emotions. Family-based therapy (FBT), a historical cognitive behavioral therapy
type, is still one of the most common eating disorder treatments today. This style is based off of
the incorporation of family into treatment sessions rather than having one on one conversations
between the patient and the therapist and “has proven to be an important element in the treatment
of patients with eating disorders” (The Center 1). The structure of family-based therapy “considers
the parents as a resource and essential in successful treatment for anorexia nervosa” (Le Grange
2) because the patient will have less feelings of being stranded, alone, or interrogated. FBT helps
patients rationalize patterns of thought and behavior that influence their life and disorder. Having
family incorporated in the sessions allows them to voice their observances and help to work
together to progress the treatment and discussions in a positive direction. In addition, the
incorporation of the outside perspective offered by the therapist and the family allows for the
refuting and discussion of patterns. Without this, it becomes harder for the patient to fight and
overcome their own fears by their own logic. Family-based therapy and other cognitive therapies
prove to the patients that there are better ways of handling themselves and issues other than their
adapted eating habits.

In contrast to the more traditional and widely known technique of CBT, dance/movement
therapy (DMT) is a more recently developed method that builds off of the idea that physical
activity can be used as treatment for mental disorders (Scully 112). This type of therapy works
with the patient to reconnect the mind and body, incorporating the body into the actual treatment
activities. An advantage to this form of therapy is that is exists as one of the few options that
bypasses language for expression for those who are naturally less verbal. Some individuals
struggle naturally with expression of emotions, and dance/movement therapy provides a way to
show their feelings through behavior, so they do not have to communicate by talking. The first
step is being aware of one’s own body by the process of kinesthetic awareness: the awareness of
oneself and their own body in relation to how and where they exist. Dance/movement therapy
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strengthens the patients’ kinesthetic awareness by interacting directly with the body to become
aware of what they are actually feeling “as dancing requires you to stay conscious of your whole
body” (Ladock 3). It is also a way to use these connections to reflect everyday movement as
expressive communication. The dancing activities during sessions works to draw out inner
emotions to understand the source of the anxiety and stress causing the disorder. Every movement
that the body takes is for a distinctive reason, whether subconscious or conscious, and reveals a
part of the psyche. Through direct incorporation of body and movement, dance/movement therapy
embraces and builds off the idea of interpersonal connections and expression from within the soul.

Both family-based therapy and dance/movement therapy have many benefits as eating
disorder treatments. However, it would be much more successful if the two therapies were used
together for individuals suffering from this mental illness. Different treatments work better for
different people, and this combination would serve as another option for people working towards
recovery. Both CBT and DMT have their own slight disadvantages in comparison to other existing
methods, and thus combining them could work to limit these obstacles. Since eating disorders are
largely body image related, without working directly with the body with CBT, the patient loses
the opportunity to make those connections and realizations through feeling their body rather than
thinking. With dance/movement therapy alone, the patient is working mostly with expressive
movement, and therefore not focused as much on discussing what they are relieving. Therefore,
the combination of family-based therapy and dance/movement therapy would create the
opportunity to incorporate the most beneficial aspects of both into a single therapy method.
Cognitive behavioral therapies like FBT are better at introducing and incorporating the outside
perspective and support. DMT works better with identifying hidden patterns by using movement
to access the subconscious. Working together, the two therapies can create a new method that
could significantly help add to the effectiveness of eating disorder treatment.

Hypothesis

Cognitive-behavioral therapists do not know a sufficient amount about dance/movement

therapy since it is such a new technique, and dance/movement therapists are not aware of the
details of cognitive behavioral therapy. However, both will see the potential in the new proposed
method of using the two in collaboration.

Purpose

To analyze the methods of current eating disorder treatment techniques and propose a new
method that combines the beneficial aspects of dance/movement therapy and cognitive behavioral
therapy techniques. To evaluate whether this new method has a sufficient anticipated potential by
professionals in both techniques. To spread and question about awareness in order to collect
information about the average acceptance of the proposal for a new therapy by the experts who
currently study in the affected fields.
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Methods

Because of the structure of the research, there is no way for actual data to be collected
about the effectiveness of a proposed method for treatment without going through processes to
obtain permission to consult patients, patient files, or other specific confidential medical
information. Therefore, the project consisted of two surveys. Each was specifically designed to
be received by either cognitive-behavioral therapists or dance/movement therapists. The survey
for cognitive-behavioral therapy was centered around whether their field is aware that
dance/movement therapy is a developed option for eating disorder treatment and their opinions
on the proposed method. The survey for dance/movement therapy will focus on whether this new
field has ever worked collaboratively with cognitive-behavioral therapy before and their opinions
on the proposed method. The surveys were made a reasonable length in order to not take up too
much time from the professionals answering the questions. The surveys were adapted based on
the Likert-type scale response anchors provided by Kelly Morrison, Senior Account Executive
for MedSurvey (Vagias 1). There were responses received from 7 cognitive behavioral therapist
and 17 dance/movement therapists. The data collected provided insight into whether or not it
would be worthwhile to develop the new proposed style of eating disorder treatment that
combines the two pre-existing methods.

1. Read and analyze scholarly articles and journals regarding eating disorders, cognitive
behavioral therapy, and dance/movement therapy. Complete interviews with
dance/movement therapist and cognitive behavioral therapy experts about their profession
and treatment techniques.
2. Write a cohesive research paper to synthesize the information collected about both
therapies and the proposed method.
3. Create a survey with Likert-Scale questions. One for CBT that inquiries about their
knowledge of dance/movement therapy and their opinion on the new proposed method.
One for DMT that inquiries about their knowledge of cognitive behavioral therapy and
their opinions on the new proposed method.
4. Distribute surveys to appropriate audience. Allow advisors to help reach therapists through
professional media such as LISTSERV of associations.
5. Collect responses from survey. Analyze opinions of the proposed method and awareness
of the other therapy type.
6. Create presentations for dance and advanced placement psychology classes to introduce
this topic to high school student

Audience

The primary focus of this research project will be directed at professionals in both the
cognitive behavioral therapy field and the dance/movement therapy field, though the information
is also vital for the patients as well. The data collection focused on responses from professionals
and their opinions on this proposal, while the majority of the presentations of concluding thoughts
will be to adolescents to spread awareness about eating disorder treatment.
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Surveys

*Attached are images of the original survey created with reference to the Likert-type scale response
anchors as cited previously and distributed to both fields.

Survey distributed to Cognitive Behavioral Therapists:

Survey distributed to Dance/Movement Therapists:

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Data

*The following are graphs of the responses from the key questions of the survey. The graphs are
a comparison of the responses from CBT and DMT.
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Perceived Barriers Present? (open-ended question)

CBT Responses:

It would be dependent on the level of skill and understanding of the dynamics in eating disorders
by the movement/dance instructors as often the “dance world “increases and even enables
comparisons with body image/ body types. If dance instructors focus on body acceptance and
body connections it could be quite powerful. Eating disorder clients often are completely
disconnected from their bodies and also their bodies are a source of self-hatred so teaching an
appreciation and connection with their individual bodies is very important.

Patient willingness, insurance reimbursement/patient's ability to afford

Willingness of PT engaging in practicing interventions

The primary barrier I would perceive would be body image issues. I don't think this would
prevent me encouraging a client to utilize dance and movement therapy, as I think it would be
impactful for their body image work; but it may be difficult for clients to have buy in.

May be difficult to find a provider for DMT.

DMT Responses:

Alternating from somatic to cognitive takes the client some practice. With an eating disorder
patient, you would be with soma (the body) using D/MT techniques, however they may take
some time to transition over to a cognitive space. In other words, it would not be immediate. The
time it takes can sometimes create a barrier in the recovery process within an organization that
demands productivity, especially one that is a time limited eating disorder recovery program. It is
the skilled and qualified therapist who can distinguish the timing. Incorrect timing e.g. too early
can lead to severe consequences of increasing overwhelming sensations felt in the rising chaos of
the patients' nervous systems, similar to a triggering feeling, which would thus need to be dealt
 Jeng 9

with in the moment. I suggest a combination of CBT and D/MT utilizing rhythm and talk, similar
to that which happens in EFT (emotional freedom technique) or in many drama therapy
activities.

ED is a challenging diagnosis where working with the body is essential but also very challenging
and takes skill and training to do.

Some practitioners may not understand or appreciate CBT yet.

Balance between mind/body approach becomes lopsided in favor of "mind".

CBT is very cognitive and top down in approach; it can thus interfere with DMT process,
depending on how CBT is integrated. It would take a skilled DMT to integrate CBT well.

Physical discomfort - emotional issues with body image

If someone is too disoriented or triggered

Some practices of CBT utilize homework strategy which, depending on the level of the eating
disorder, completing that change in perspective might not immediately be effective.
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Analysis and Conclusion

To evaluate the knowledge of other therapy techniques within eating disorder treatment
and to assess the success potential of a proposed new technique, two surveys were distributed to
professional therapists across the county. Responses from seventeen dance/movement therapists
from the American Dance Therapy Association (ADTA) and seven cognitive behavioral therapists
were recorded over the course of a one-month period of time. The surveys to the dance/movement
therapists were distributed through the LISTERV for the ADTA, and surveys to the cognitive
behavioral therapists were distributed through board-certified dance/movement therapist Susan
Kleinman, who had been assisting with the project data collection, and other colleagues.

Considering the very selective audience for the survey, not as many responses were
collected as originally intended for the evaluation of this research. The goal was to obtain at least
fifty responses within the month period, however, only a total of 24 therapists answered the two
surveys combined. While this is half of the initially estimated response rate, it is still good
experimental data and is valid for analysis because the survey was targeting professionals rather
than peers. Therefore, access to their time and contact is limited, making it harder to obtain
responses within a short period of time for data collection. The surveys were only distributed to
about 20 CBT, from which 7 responses were received, and around 80 DMT, from which 17
responses were received. In addition, creating the survey for distribution to professional offices
was a challenge during the process since they had to be developed from an accredited survey to fit
the specific questions of the research topic.

With analysis of the responses, it was found that the data supported most of the hypothesis. It
was originally hypothesized that CBT and DMT are not sufficiently aware of one another,
however both will support the concept of the integration. According to the data, it was correct
that cognitive behavioral therapists were not familiar with nor participated in dance/movement
therapy practices, however, the dance/movement therapists seemed to have a solid familiarity of
cognitive behavioral therapy. Regarding the proposed collaboration of techniques, it was found
that a majority of cognitive behavioral therapists and dance/movement therapists did, indeed,
agree with the concept and felt it would be influential for eating disorder treatment. There were
some barriers presented in the survey, however, the therapists still responded that they believed
this method would have a possibility of success and would be better than using either of the
therapeutic methods alone. From the responses to the survey, it can be gathered that it would be
both useful and supported to work to develop this integrated method for eating disorder
treatment. While there are still concepts within the idea that need to be refined, the barriers
mentioned were minor and, for the most part, did not affect the predicted success and influence
of the overall collaboration.
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