Cwmt slides king edward's parents jenny langley

King Edward VI School Parent Session Understanding Eating Disorders and Self Harm Jenny Langley Spring 2016

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About CWMT - Vision A world where people understand and talk openly about depression, where young people know how to maintain mental wellbeing, and where the most appropriate treatment is available to everyone who needs it.

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About Me

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My Interest in Understanding Eating Disorders & Self Harm: • My son had anorexia age 12

• Raising Awareness that Boys get Eating Disorders www.boyanorexia.com

• Support for families in the South East • Maudsley Eating Disorder research team

• Education in schools and the local community www.cwmt.org.uk

My son Joe

Suddenly developed anorexia age 12 Came out of the blue He was a happy sporty boy He became a very different person We worked closely with his school and medical team  He has made a full recovery!     

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My son Joe

 Desire to be a better sportsman It started with over exercise and then he stopped eating as well  “Mummy I thought if I lost some weight I would be able to play football better, and I wanted to win the school cross country run.” www.cwmt.org.uk

Joe’s description  “Mummy I have become obsessed about losing weight and I don’t know how to stop. I thought if I lost some weight I would be able to play football better, and I wanted to win the school cross-country run. Now I can’t even play football or run.”  At this stage he could hardly walk up a flight of stairs www.cwmt.org.uk

Joe’s Weight Loss 44 42 40 Joe Average 9th centile

38 36 34 32 30 Nov

Dec

Jan

Feb

March

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What this session covers • • • • •

What are eating disorders & self harm?

Why do some people develop them?

Can you spot the early signs?

Can you reduce the risks?

What can parents do?

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What are eating disorders?

• Mental illnesses, which affect physical health too • Complex, with no single cause

• Treatable conditions • Recovery is possible

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Types of eating disorder Anorexia Nervosa – – – –

15% of all cases 80% people affected are girls and young women 1220 Characterised by weight loss or failure to gain weight (in children) BMI of <17.5 would indicate likelihood

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Types of eating disorder Bulimia Nervosa – – – – –

Most common eating disorder – accounts for 45% of cases Average age of onset is later People affected may not be underweight or their weight fluctuates Attempt to control weight gain by purging after meals May undertake obsessive exercise

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Types of eating disorder Binge Eating Disorder – – –

– –

Less well known, thought to be around 10% cases Evenly spread mem and women Affects people at a later age, who may have had anorexia or bulimia People affected eat very large amounts of food, often in secret They do not purge and can become obese

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Types of eating disorder OSFED â&#x20AC;˘

The diagnosis given to people who do not exhibit all the specific symptoms required to diagnose Anorexia, Bulimia or BED.

Other disordered eating

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Self harm?

Self harm is misunderstood amongst professionals, teachers and parents who don’t know how to respond and may react inappropriately, making children reluctant to seek help It’s a behaviour not an illness

Food for Thought “ Every behaviour has a positive intention” So let us try to understand the intention and maybe we can help that young person to achieve that goal in a different way!

This is not the same as searching endlessly for the causes www.cwmt.org.uk Manual page no.

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Cutting, burning, embedding

Harm to oneself in order to cope

Overdosing, consuming poison Scratching, banging Punching, hitting, biting

Eating disorders, drugs, alcohol www.cwmt.org.uk

Self harm can be direct or indirect e.g. cutting vs risk taking

Self harm can be transient or longer term

Self harm is usually conducted at times of anger, distress, fear or worryâ&#x20AC;Ś

â&#x20AC;Śand is a way of coping with these feelings

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NICE guidelines Respect, Understanding and Choice â&#x20AC;&#x153;People who have self harmed should be treated with the same care, respect and privacy as any patient. In addition, healthcare professionals should take full account of the likely distress associated with self harm.â&#x20AC;?

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Why do young people self harm? _ Bullying or conflict _ Bereavement, parentsâ&#x20AC;&#x2122; divorce _ Traumatic experiences, physical/sexual or emotional abuse _ Being in the criminal justice system _ Feeling rejected, poor self image, self-blame and punishment _ To feel something, to exert control or manage suicidal thoughts _ Alcohol and drug misuse _ Pressure to do well at school _ Have a learning disability _ Problems to do with race, culture or religion _ Unwanted pregnancy or concerns about sexuality _ Being part of a normalising culture of behaviour, may also be influenced by media and peer groups

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Self harm facts and figures _ The UK has the highest rates of self harm in Europe. (The Samaritans) _ About 1 in 10 young people have self harmed. (Royal College of Psychiatrists) _ Itâ&#x20AC;&#x2122;s more common in veterans, young people, women, LGBT community, prisoners, asylum seekers, and those whoâ&#x20AC;&#x2122;ve been abused (Royal College of Psychiatrists)

_ 28% of young women and 10% of young men have self-harmed (Youth Index 2014)

_ 68% increase of young people being admitted to hospital for self harm in 10 years. YoungMinds (2011) _ Childline reported 41% increase in self harm, the highest was 12 year olds Child Line (2012/13) _ People who self-harm for 15 years or more are over 50 times more likely to die by suicide (Royal College of Psychiatrists)

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Frequently Asked Questions About Joe • • • • •

Why did your son have anorexia?

What were the signs?

What did you do?

Could you have nipped it in the bud?

How did he recover?

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Possible Answers • Why did your son have anorexia?

– Genetics – Biology – Personality type – Peer pressure - sport – Academic pressure – Culture

• Look Forward Not Back...................... www.cwmt.org.uk

Nature, nurture and self esteem?

Nature (DNA)

Trigger

Nurture The environment

Coping Strategies: • Healthy & helpful • Unhealthy & un- helpful • Dangerous & harmful

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What helped maintained my son’s unhealthy coping strategies?

•Exercise •Restricted Eating

• • • • • •

Family Friends Holidays Sports Food Hobbies

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My son’s world contracted “Before anorexia came to visit I loved football, cricket, sailing, skiing and messing about with my mates...... The anorexia tries to steal all that from you and makes you feel so sad and depressed and lonely.

You think you are in control, but the anorexia ends up controlling you more.” www.cwmt.org.uk

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Possible Answers • What were the signs?

– Exercise – Mood – Weight – Food – Body Checking

• Write everything down that you observe • This can help get an early diagnosis www.cwmt.org.uk

Warning Signs • Social isolation • Performance anxiety • Increased perfectionism • Narrowing of interests • Low mood and self esteem • Procrastination/avoidance • Unemployment/drop out of studies • Inability to learn from mistakes • Inability to tolerate uncertainty These can all be signs of emerging depression, eating disorders, self harm & chronic fatigue www.cwmt.org.uk

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How we felt to start with

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Our Natural Reactions • On the one hand we crept around our son trying not to upset him further......like treading on eggshells. It was like the eating disorder was controlling us too.

• On the other hand we were like rabbits in the headlights.....”frozen with fear”, which handicapped our ability to think straight. www.cwmt.org.uk • Neither reaction helped!

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Possible Answers • What did you do?

• 1. Panic • 2. Tried to persaude Joe to stop exercising and to eat more. He didn’t!!

• 3. Learn • 4. Panic again • 5. Learn some more • 6. Worked with medical team and school www.cwmt.org.uk

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Could you have nipped it in the bud?

• Diagnosis isn’t easy, especially for boys • Initially the young person looks great • How do you distinguish between normal teenage behaviour and anorexia?

• BUT • We know the earlier the diagnosis and treatment the better the outcome.

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But not many people get eating disorders.......

• The Department of Health estimates that approx. 4 million people in the UK are struggling with an eating disorder • The highest rates of new cases are boys aged 10 to 14 • 25% of teenage girls say they have an eating disorder • 25% of teenagers admit to using purging to try to control their weight • 1/3 of girls and nearly 1/4 boys place great importance on weight or shape • 40% of girls & 26% boys show signs of body disturbance • Anorexia causes more deaths in those under 18 than any other psychological disorder • Close friends and teachers will also be affected

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The Eating Disorder Sucks Everyone In • The eating disorder behaviours can easily become all consuming to everyone involved.

• The sufferer feels their whole identity depends on them keeping the eating disorder • Everyone can inadvertently help to maintain the eating disorder • BUT a little understanding and knowledge can really help to break this vicious cycle. www.cwmt.org.uk

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Possible Answers • How did he recover?

– Collaborative care as an in patient and then as an out patient – Family therapy – School involved at every stage – A lot of hard work and determination on his part – A great deal of patience and empathy from us www.cwmt.org.uk

What helped my son to recover?

Family & friends focusing on the person, not the illness. Lots of listening and guiding gently and doing normal happy things Professional multidisciplinary team

•Exercise •Restricted Eating

• • • • • •

Family Friends Holidays Sports Food Hobbies

www.cwmt.org.uk

We needed professional help..

Dietician CBT

Psychotherapy

Art therapy

Family therapy

Group therapy

Balanced with Self Help and Supportive Family & Friends www.cwmt.org.uk

Crap Day Exercise â&#x20AC;&#x201C; How would you feel?

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Recovery requires re-feeding plus understanding and emotional support • Many of the strange and difficult behaviours are caused by the physical effect of starvation • Re-feeding is crucial, but also needs to be accompanied by emotional support to establish more healthy coping strategies • Beat recovery booklet can be a useful tool for sufferers, peers and staff. www.cwmt.org.uk

Recovery is really tough • The starved brain leads to numb emotions • When you re-feed the brain those emotions reappear • Re-feeding requires so much food • It is often very traumatic and hard to face up to • Emotional support is essential • A student in recovery can be incredibly challenging www.cwmt.org.uk

Recovery is Tougher than you might think

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Practical Advice for Parents

• “Give more attention to behaviours you like and less attention to those you don’t” • But get professional help for the illness asap.

• “Talk to the person, not the illness” • “Listen carefully for opportunities to talk” • “Praise the effort rather than criticising the behaviour”

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Instinctive Caring Reactions to a child who is highly anxious

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What works best…………..?

Gentle nudging and guidance Open questions, listening and reflecting Praising the effort (and not criticising the behaviour) Noticing the emotion (behind the behaviour) Unconditional love www.cwmt.org.uk

PARENTS QUICKLY LEARN WHAT THEY CAN DO EVEN WHEN THEIR LOVED ONE SEEMS TO BE STUCK

Unconditional love

Externalise the illness

Praise for the tiniest efforts Series of small experiments to adapt carer behaviour

Education

Roll with resistance

Smile more Gentle support & guidance

Non judgemental listening Focus on the person not the illness

Role model self care

Be aware of medical risk

Calm observations of impact of www.cwmt.org.uk ED

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â&#x20AC;˘ Road to Recovery Video Created by Beat Young Ambassadors

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Social Factors in Joe’s Recovery • Joe’s determination and passion for football • Education within close family • Close family working together • Supportive family and friends • Supportive school • Speed of decline and subsequent recovery www.cwmt.org.uk

Family Factors in Joe’s Recovery Singing from the same songsheet We all had to change a little bit We had to learn when to back off We had to let Joe take responsibility for his nutrition • We had fun!

• • • •

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My son’s message “Never

give up hope.

Remember all those things you used to enjoy before anorexia came to visit. For me it was ..............

You have to eat to have the strength to fight back. It was hard for me too, at times I felt like giving up and that nobody understood me, but with the support of my family and friends I did beat it.....completely.........and it hasn’t dared to come back. I am doing really well now and enjoying my sport and my life”

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Recovery can look like this

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My son said goodbye to his anxieties and his eating disorder • • • • • • •

Collaboration CBT and MI Oodles of TLC Courage and determination Patience and Empathy Series of little experiments Kindness and happy distractions www.cwmt.org.uk

Communication in the family – Summary • • • • • • • • • •

Talk about anxiety openly – the red balloon in the room LISTEN to your child carefully and identify emotions Focus on the blue balloon and talk to the child not the end goal Practice praising the effort rather than the absolute result Practice teamwork and helping others Encourage creativity and risk taking Lob in the unexpected now and then thus encouraging flexibility Explore learning from mistakes and dealing with failure Encourage curiosity and contingency planning Invite your child to give you feedback regularly

52 www.cwmt.org.uk

Schools Book & Further Resources Pooky Knightsmith has a whole array of resources and model policies for schools.

Visit her website: www.inourhands.com Details of this book: http://www.inourhands.com/books/ For further resources: http://www.inourhands.com/free-resources/ For guidance on teaching about emotional wellbeing: http://www.inourhands.com/skills-building/dfefunded-guidance-teaching-about-mental-health/ www.cwmt.org.uk

Further Resources •

Nick Luxmore http://www.amazon.co.uk/EssentialListening-Skills-SchoolStaff/dp/1849055653

•

Jenny Langley - www.boyanorexia.com

•

jenny@boyanorexia.com

•

New Maudsley

•

http://thenewmaudsleyapproach.co.uk/ 54

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Extra Slides for Information • Motivational Communication Skills can be really helpful when an eating disorder or self harm are present • The success of this approach lies in the fact it puts the young person in control of their own recovery • Using the skills helps you become a better listener and help you better understand your child www.cwmt.org.uk

Understanding a Young Person’s FeelingsHow can a parent help........

• Listen • Reflect • Challenge can help the young person feel less isolated and help build self esteem

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Using Motivational Language • Open questions: Skillful questioning style • Affirmations: Praise to build confidence and motivation • Reflective listening: Skillful listening style • Summarizing: Demonstrating you have understood • OARS helps you row the conversation in the direction you want it to go, rather than drifting along the usual current. www.cwmt.org.uk

Using Motivational Communication • Open Question – Help me understand why you are feeling so anxious.

– What can I do to help you………

• Affirmations – It takes courage to try new things and I know you can do it – If I were in your shoes I’m not sure I could manage nearly as well as you • Reflections – You are feeling anxious – It sounds as if …

• Summary – pulling the conversation together – We’ve covered a lot of ground and can we agree on the next steps – So let me see if I have understood everything so far www.cwmt.org.uk

Using Motivational Communication Person • Open Question centred – Help me understand why you are feeling so anxious.

– What can I do to help you………

Boost self • Affirmations esteem – It takes courage to try new things and I know you can do it – If I were in your shoes I’m not sure I could manage nearly as well as you I am listening and • Reflections noticing – You are feeling anxious your feelings – It sounds as if …

I want to • Summary – pulling the conversation together check you – We’ve covered a lot of ground and can we agreeare onhappy the next with this steps outcome – So let me see if I have understood everything so far www.cwmt.org.uk

Using Motivational Communication Person • Open Question centred for 3why reflections – Help meAim understand you are feeling for so anxious.

– What can I do to help you………

Boost self • Affirmations esteem Aim for the young – It takes courage to try new things and I know you can do it toI’mbe – If I wereperson in your shoes nottalking sure I could3x manage nearly as well as you I am listening and • Reflections noticing – You are feeling anxious your feelings – It sounds as if …

I want to • Summary – pulling the conversation together check you – We’ve covered a lot of ground and can we agreeare onhappy the next with this steps outcome – So let me see if I have understood everything so far

every open question. as much as you are

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Using Motivational Interviewing Language DEARS • • • • •

Develop Discrepancy Express Empathy Amplify Ambivalence Roll with Resistance Supporting Self Efficacy

• These techniques have been successfully rolled out to parents over the last ten years in several research programmes at the Maudsley www.cwmt.org.uk

Develop Discrepancy • Aiming to motivate your child to recognise there is a difference between their current behaviour and where they want to be: • I know you want to be football captain next term • YET • I have noticed that you seem to be struggling to stick to your meal plan and this is holding your recovery back • Would you like me to help you out. What would be helpful? www.cwmt.org.uk

Express Empathy • Young people who are self harm or have an eating disorder often feel very alone and that nobody understands them: • I can imagine you are feeling angry and confused at the moment • It must be hard to try and give up a coping strategy that you have been using for some time • You have seemed a little tired lately which is not surprising. Many students would feel pretty overwhelmed with trying to study and also recover from an illness. Perhaps I could give you a hand to sort through your schedule for this term. What would be helpful? www.cwmt.org.uk

Amplify Ambivalence

• Encouraging the child to see the negatives as well as the positives about their situation • It must be annoying and frustrating for you to see that most of your friends have more energy than you at the moment • I know you are upset because all your friends went to Glastonbury and you weren’t able to go with them this year • If you keep heading down the road you are on, where do you see yourself ending up? www.cwmt.org.uk

Rolling with Resistance • Often the child may be extremely anxious, angry and tearful and might need some space.

• I can see that you think I am making a fuss about nothing and that must be annoying for you. I am just concerned about you taking on too much and getting exhausted.

• Let’s focus on something else and come back to this later... www.cwmt.org.uk

Supporting Self Efficacy • Showing you believe they have the strength, determination and resources to take control of their own destiny • You are incredibly organised and resourceful and you manage to fit so many things in to your week, including your therapy sessions • Yes you have slipped up with a couple of things but you’ve had great success with others

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What are you really saying?

• By using MI techniques you are showing: – – – – •

that you believe in your child, that you are prepared to listen, that you empathise with the difficulties, that you would like to help, that you care.....

Gentle nudging and guidance Open questions, listening and reflecting Praising the effort (and not criticising the behaviour) Unconditional love

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Practical Scenario – SMART Baby Steps • Alex is caught up with maintaining an extremely high level of fitness which involves endless repetitive exercises in his bedroom. It has reached the stage that by the time he has finished his homework and exercise regime, he will never eat dinner before 10pm.

• His Mum learns about taking SMART baby steps and that success breeds success.

• She suggests “as an experiment could we try to have dinner one minute earlier each day for a month?”

• Alex thinks he might be able to try and agrees with his Mum that the worst thing that can happen is that he cannot manage it everyday.

• Secretly he is pleased to have permission to scale back his exercise regime slightly. www.cwmt.org.uk

Is it SMART? • Specific – one minute a day • Measurable – yes • Achievable – hopefully and Mum and Ellie have discussed it might not be every day • Realistic – it seems to be • Timeframe – review after one month www.cwmt.org.uk

After One Month • Alex is having dinner at 9.40pm and is willing to keep going with this experiment • Alex and Mum reflect about what worked well and what didn’t work so well • Mum praises the effort that Alex has put in to achieve this progress • Alex is pleased with his progress and determined to keep trying. If anything he is feeling more energised as he is getting to bed slightly earlier • Alex thinks he might be able to start to consider challenging some of his other rigid rules and come up with some alternative guidelines

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As a parent or teacher, what am I listening for.....

• “As listeners our first job is to try to understand how the student is feeling” • “Feeling understood is what most powerfully precipates change in human beings” • “Rather than asking lots of questions encourage the young person to tell you their story” • “It’s important to second guess the anxiety behind the behaviour” • “What’s the point is a very good question”

• Nick Luxmore – Essential Listening Skills for Busy School Staff www.cwmt.org.uk

But I don’t have time to listen.....

• “Good listening isn’t about how much time you’ve got. What matters is the quality...of your time” Families are often very busy and time spent listening may have to be boundaried, partly because the listeners are busy people....., and partly because even when people are distressed, they have to learn to wait their turn.”

• “ A good uninterrupted four minutes is better than forty minutes of being distracted” • “It’s important to develop a culture where it’s normal for people to be heard but not by shouting louder than anyone else.

• Nick Luxmore – Essential Listening Skills for Busy School Staff

www.cwmt.org.uk