Clinical psychological intervention techniques for obese patients: cognitive behavioral therapy, dialectical behavior and group therapy
IV. Psychological Intervention Methods for Obese Patients Currently, there are many misunderstandings about the treatment of obesity in society. Many believe that weight problems can be solved simply through dieting and exercise, neglecting psychological intervention. This misconception leads many obese patients to fail to take timely and effective treatment measures, ultimately not only failing to lose weight but also causing more physical and psychological problems. Medical staff need to promptly identify and recognize the psychological problems of obese patients during the consultation process and implement individualized psychological treatment plans based on specific circumstances.
Cognitive Behavioral Therapy (CBT) is a systematic psychotherapy approach based on cognitive therapy techniques and incorporating and complementing cognitive and behavioral theories. CBT corrects negative emotions and behaviors by altering a person's objective cognition and beliefs. During the consultation, medical staff first help patients develop a correct understanding of obesity, correct any cognitive misconceptions, and provide emotional support and encouragement. Secondly, using behavioral therapy methods, they help patients establish reasonable weight loss goals and guide them in self-monitoring (including diet, exercise, and emotional management). CBT is currently the most commonly used method in the psychotherapy of obese patients.
Dialectical Behavior Therapy (DBT): Evolved from traditional cognitive behavioral therapy, DBT emphasizes the balance between acceptance and change, and is a novel psychotherapy characterized by dialectics. Based on biosocial theory and dialectics, it integrates psychoanalytic dynamics, cognitive therapy, and interpersonal therapy within the framework of behavioral therapy. DBT has a positive effect on obese patients, primarily by reducing eating-related disordered behaviors, especially binge eating. It can also reduce symptoms of psychotic hostility. Furthermore, DBT is effective for patients with comorbid borderline personality disorder, reducing eating disorders and self-harm/suicidal behavior.
Supportive psychotherapy: Supportive psychotherapy involves psychologists applying psychological knowledge and methods, using approaches such as persuasion, guidance, encouragement, support, empathy, reassurance, and addressing concerns to help and guide patients in understanding their current problems. The main role of supportive psychotherapy is to positively influence the personality, coping styles, cognitive patterns, and emotions of obese patients during treatment, improving their adherence to the weight loss plan and their trust in medical staff.
Psychodynamic therapy: Psychodynamic therapy primarily focuses on the patient's past experiences, examining their behavioral patterns and expectation models, and interpreting their defense mechanisms and transference. Psychodynamic treatment methods mainly include support, direct influence, and exploratory-descriptive-catharsis. Direct influence specifically includes five methods: emphasis, suggestion, advice, persistence, and intervention. Exploratory-descriptive-catharsis refers to the therapist exploring the obese patient's problems through their descriptions and explanations, and providing opportunities for emotional catharsis to resolve their emotional conflicts.
Group psychotherapy: Group psychotherapy refers to a psychotherapeutic method that brings together multiple individuals for a common purpose. It is widely used in the treatment of various diseases, including psychosomatic illnesses, mental illnesses, and obesity. The benefits of group therapy include: ① Hope restoration: Group psychotherapy can help obese patients regain hope and confidence. ② Universal identification: When obese patients see others with similar struggles and life experiences within the group, they realize they are not alone and feel relieved. ③ Instructional guidance and direct advice: In addition to providing mutual support, the group also conducts cognitive behavioral therapy, imparting knowledge about the disease to obese patients. ④ Altruism: In group therapy, obese patients benefit from their contributions. ⑤ Behavioral modeling: By providing valuable role models, patients can learn from each other at any time. ⑥ Group cohesion: It enhances patients' social adaptability.
Interpersonal psychotherapy (IPT): IPT analyzes the link between a patient's mental symptoms and their interpersonal relationship problems to develop corresponding psychotherapy strategies. Medical staff may require the patient's family and friends to accompany them to appointments. During the intervention process, IPT helps patients rebuild positive relationships with family and friends, providing them with greater psychological support. Multiple studies have confirmed that IPT can improve interpersonal relationships in obese children and adolescents and alleviate negative psychological problems such as depression and anxiety.
Drug treatment: When obese patients experience severe psychological problems, drug treatment may be used. There are generally two types of medications-antidepressants and anti-anxiety medications. When choosing antidepressants, those with minimal impact on weight should be selected; common examples include fluoxetine, verazordone, levamisole, and vortioxetine. When choosing anti-anxiety medications, obese patients must meet the diagnostic criteria for anxiety disorder. Common anti-anxiety medications include benzodiazepines, buspirone, and venlafaxine. Monotherapy is generally recommended; combination therapy with two antidepressants with different mechanisms of action should only be considered when two medications with different mechanisms of action, taken at adequate doses and for an adequate course of treatment, prove ineffective. Specific medication use should be under the guidance of a professional psychiatrist.
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