Therapeutic writing in a programme for binge eating disorder-A tool to come closer to clarifying feelings

INTRODUCTION

Therapeutic writing involving affect consciousness (AC) can be used to put difficult topics into words. In this study, we investigated how patients with binge eating disorder (BED) experienced therapeutic writing and AC in the context of cognitive behavioural therapy. The elements were included in an existing cognitive behavioural therapy group programme and the participants' experiences investigated qualitatively.

AIM

To investigate therapeutic writing as experienced by patients in the context of a BED group programme focusing on AC.

METHOD

A phenomenological, hermeneutic design with semi-structured interviews was employed. Eight participants were recruited after completing the BED programme at a Community Mental Health Centre on the West Coast of Norway.

FINDINGS

Four sub-themes emerged: Struggling to achieve a flow in the writing process, Deeper understanding of eating patterns through writing, Moving specific feelings towards the surface by writing and Greater insight into oneself as a human being by shared writing. Based on the sub-themes, one main theme was developed: Therapeutic writing in a binge eating disorder programme means focusing on oneself as a human being by becoming closer to one's feelings.

CONCLUSION

Therapeutic writing offered in treatment for BED involves individual movements at different levels, including processes of awareness of feelings, cognitions and oneself as a human being.

The ups and downs of lifestyle modification: An existential journey among persons with severe obesity

Background

Maintaining a healthy living after the end of a lifestyle intervention is a challenge for persons with severe obesity. Measurable outcomes are often emphasised, but there is a need for understanding the process of lifestyle change and the long‐term perspectives among persons with severe obesity.

Aim and objective

To describe and deepen the understanding of how persons with severe obesity experience making and maintaining lifestyle changes in everyday life three years after lifestyle intervention.

Methodology and methods

The study used a hermeneutic phenomenological approach. A purposive sample of seven adults with BMI ≥ 40 was recruited from a lifestyle intervention programme. Data were generated through individual follow‐up interviews. The analysis was based on theoretical framework on dwelling and mobility. Ethical approvals were received from the Danish Data Protection Agency and the ethical principles of the Declaration of Helsinki were followed.

Results

One overarching theme emerged: ‘The journey of ups and downs’. Three sub‐themes were: ‘Living with and tackling the demands of life's hassles’, ‘Deliberating the fight for weight loss’ and ‘Needing a trusted person to feel met as a human being’.

Conclusions

Everyday life among persons with severe obesity is experienced as a dynamic process of shifting experiences of dwelling and mobility. Sustained lifestyle changes require ongoing adjustments of action, which healthcare providers can influence in ways that either support or obstruct. Collaboration and a humanised approach across disciplines and sectors are suggested to promote sustained healthy living.

Living with obesity - existential experiences

Aims and objectives: The aim was to gain in-depth understanding about individuals’ existential experiences of living with obesity.

Background: People living with obesity face great vulnerability and existential challenges. The different treatments offered do not seem to meet the individual needs of persons with obesity. A deeper understanding of existential experiences from an individual perspective is needed to individualize treatment.

Design: An exploratory phenomenological–hermeneutical design was used to gain a greater understanding of the existential experiences involved in living with obesity.

Methods: The participants represented a convenient sample. 18 qualitative interviews were conducted and subjected to phenomenological–hermeneutical analysis.

Results: Four themes emerged: shaped by childhood; captured by food; depressed by the culture; and judged by oneself.

Conclusions: The burden of being obese can be experienced as being objectified and alienated as a human being. We need to turn towards a life-world perspective, seeing each human being as a living body to overcome objectification and alienation, and then move them towards becoming subjects in their own lives, through giving space for self-love. Health care workers need to assist persons living with obesity to reduce objectification and alienation. It is important to develop intervention that has an individual, holistic approach.

Living With Obesity: Expressions of Longing

Those who are obese experience complex moral distress. The norm in Western societies is to be slim, and people living with obesity experience challenges under the gaze of society. They feel great vulnerability and the available treatments seldom meet individual needs. New concepts of embodiment need to be developed to include phenomenological investigations. There is limited knowledge about longing among those suffering from obesity. A deeper understanding of longing from an individual perspective is required to improve treatment. The aim of this study was to gain an in-depth understanding of the experiences of longing by those suffering from obesity. The research was approved by the Norwegian Regional Committees for Medical and Health Research Ethics. An explorative phenomenological–hermeneutical design was used. Qualitative interviews were conducted with 18 participants, all with body mass indexes in the range of 30 to 45, which were then analyzed using a phenomenological–hermeneutical approach. Three main dimensions of longing were revealed: longing for normality, longing for what was lost, and longing for simplicity in life. The health service needs to understand better the longings of obese individuals to help them live their lives in greater freedom, based on their own longings and self-care. Focusing on longing may reveal a person’s true desires, and the longing may be a form of resistance to the disciplination of society.

Aspects of well-being when struggling with obesity

Purpose: We aimed to gain deeper insight into how people struggling with obesity handle their life situation by addressing how well-being might unfold. For many people, obesity becomes a lifelong condition characterized by repeated weight fluctuations while their weight increases gradually. From an existential perspective, constantly waiting for weight loss can cause an experience of not reaching one's full potential. How people with obesity experience well-being, within their perceived limitations, is less reflected in previous research.Methods: We established a qualitative study using in-depth interviews with seven men and 14 women with obesity (body mass index 335 kg/m2) aged 18-59 years. The study had an exploratory design including a phenomenological-hermeneutic perspective, with a lifeworld approach.Results: Three themes describing aspects of well-being were developed: coming to terms with the body, restoring the broken relational balance and reorienting the pivot in life. The thematic findings were abstracted into a main theme: striving to make living bearable. The movement towards well-being can be seen as a struggle towards an experience of balance to make bearable living.Conclusions: We suggest that well-being as a dialectic between vulnerability and freedom might become a health-facilitating experience for people struggling with obesity.