Ngaba iya kusebenza ilungu lam losapho?
Ulwaphulo olusekelwe kwintsapho (i-FBT, ekwabizwa ngokuba yi-Maudsley indlela) yonyango olukhokelayo kwiintsholongwane zokutya ezibandakanya i- anorexia nervosa , i- bulimia nervosa , kunye nezinye izilwanyana ezixeliweyo okanye ukutya okunesifo (OSFED ).
Yonyango olusesikweni olunikezwa ngabaqeqeshi abaqeqeshiwe. Ngokuyinhloko kuhanjiswe kwizicwangciso zesifo , nangona kukho ezinye iinkqubo zokuhlala nezibhedlele zezibhedlele (PHP) ezibandakanya i-FBT.
Nangona i-FBT ingenako yonke intsapho, uphando lubonisa ukuba lusebenza kakuhle kwaye lukhawuleza ukwenza izinto kunamanye amaninzi unyango. Ngoko ke kufuneka kuthethwa njengendlela yokuqala yokunyanga abantwana, abaselula kunye nabanye abantu abadala.
Uphulo oluvela kwiiNdlela zeNdabuko
I-FBT ibonisa ukuhamba ngokugqithiseleyo kwiinkqubo zonyango. Iingcamango ezindala malunga ne-anorexia kunye nokuphazamiseka kokutya, eziphakanyiswe nguHilde Bruch kunye nabanye, zichazwe ukuba zivela kwi-family enmeshment okanye enye ingasebenzi. Oomama babekholelwa ukuba yimbangela ebalulekileyo yokukhathazeka kokutya kwabantwana babo, njengoko bekunjalo kwimeko ye-schizophrenia ne-autism. Uhlobo olulindelekileyo lwabazali oluyalela ukuba baphambuke baze baphenduke abantwana babo nge-anorexia kwiinkonzo zonyango okanye kwiindawo zokuhlala zonyango-indlela esazi ngayo ukuba, kwimeko ezininzi, yingozi kwazo zonke iintsapho kunye nezigulane.
Uphando olutshanje luye lwafaka ingcamango yeengcamango zabazali zokuphazamiseka kokutya, njengokuba kunayo i-schizophrenia ne-autism. Ucwaningo lwe-Genetic lubonisa ukuba malunga ne-50 ukuya kwi-80 epesenti yomngcipheko womntu wesifo sokutya ngenxa yemfuza. Uncwadi luye lwafumana kwakhona uphando lwendlala lwangaphambili olubonisa ukuba uninzi lweziphathamandla ze-anorexia empeleni zibangelwa ukungondleki okuhamba kunye ne-anorexia .
Kukholelwa ukuba abaninzi beeklinikhi benza iphutha lokukhethwa kwezinto ezikhethekileyo: ukujonga iintshukumo zeentsapho njengoko befuna unyango, oogqirha ngokuqhelekileyo babone iintsapho zivalelwe emzabalazweni wobomi kunye nokufa. Lo mzabalazo, kodwa ke, uphawu lwe-disorder, kungekhona imbangela-kwiminyaka eyandulela ukugula kwesifo, i-dynamics yabo yayingaboni ngenye indlela kunezinye iintsapho.
Ukuvuma ukuba ubunzima bobufakazi bebuguqukile, ngo-2010, i-Academy for Disorders Disorders yashicilela iphepheni yesikhundla ngokukhawuleza iphikisa ingcamango yokuba izinto zentsapho ziyinkqubo ephambili ekuphuhliseni ingxaki yokutya. Oku kuguquka kakuhle kuba sele kubangele ukubandakanywa kwabazali ekwenzeni unyango ngokubanzi kunye nokwamkelwa kweFBT.
I-FBT Ayinjalo Yonyango Njengonyango
I-FBT akufanele idideke kunye neendlela ezichazwe ngokufanayo kodwa ezinokuthi zenzeke ngokungafaniyo phantsi kwe-sambuli yonyango lwentsapho. Ulwaphulo lwezonyango lwentsapho luhlala lubona ukuba umntwana onenkinga yokutya ubonisa ingxaki yentsapho. Ijolise ekuqaliseni nasekuzisombuleni loo ngxaki ukuze uphilise ingxaki yokutya. Le ndlela ayixhaswanga yiphando kwaye inzima ngumaphepha we-AED.
Ngama-1970 kunye nakwiminyaka ye-1980, iiklinikhi kwisibhedlele saseMaudsley eLondon, eNgilani, zafumana uhlobo oluthile lwazo unyango lwentsapho, baphatha abazali njengoluvimba, kungekhona umonakalo. Ithimba le-Maudsley liye laqhubeka nokuphuhlisa nokufundisa indlela, abaye bathambekele ekubhekiselele kuyo njengendlela ye-Maudsley, kodwa njengendlela yokwenza unyango lwentsapho lwe-anorexia nervosa. Dkt. UDaniel Le Grange noJacob Lock bachazwe ngendlela yokufumana incwadana (eyapapashwa ngo-2002 kwaye yahlaziywa ngo-2013), ebiza igama labo ngokubhaliweyo lwe-Family Based Based Treatment (FBT).
Indlela ye-FBT ixhomekeke kwiinkalo zonyango lokuziphatha, unyango lwamazwi, kunye nokonyango lwezonyango lwezakhiwo.
Ukukhusela kunye neLegrange baye bamisela iZiko loQeqesho loMntwana kunye neNtshontsho yokuTya, i-intanethi eqeqesha abagqirha kulolu unyango kwaye igcina uluhlu lwabagqirha abaqinisekisiweyo kunye nabagqirha ekuqeqesheni.
Imigaqo yeFBT
I-FBT ithatha imbonakalo ye-agnostic yesifo sokutya, oko kuthetha ukuba abaphengululi abazami ukuhlaziya ukuba kutheni ingxaki yokutya iphuhlisiwe. I-FBT ayigxeki iintsapho ngenxa yengxaki . Ngokuchasene noko, ixhamla ulwalamano olunamandla phakathi kwabazali nomntwana kwaye ixhobisa abazali ukuba basebenzise uthando lwabo ukuze bancede umntwana wabo. Abazali babonwa njengeengcali kumntwana wabo, inxalenye ebalulekileyo yesisombululo, kunye namalungu ekomiti yokonyango.
Kwi-FBT, ukuphazamiseka kwezidlo kubonwa njengamandla angaphandle aphethe umntwana. Abazali bacelwa ukuba bajoyine inxalenye enempilo yengane ngokuchasene nesifo sokutya esisongelayo ukuthatha umntwana wabo. Ukutya okupheleleyo kubonwa njengesinyathelo esibalulekileyo sokuqala; indima yabazali kukubonelela ngesondlo ngokunyusa umntwana wabo.
Iiseshoni ze-FBT zihlala zibandakanya intsapho yonke kwaye ziquka ubuncinane intsapho enye kwiphathi yophila. Oku kunika ithuba lophilo lokugcina iimpawu zokuziphatha kwamalungu entsapho ahlukeneyo ngexesha lokutya kunye nokuqeqesha abazali ukuba bancede abantwana babo badle. Ngenxa yokuba izigulane ezineengxaki zokutya zingabonisa ngeengxaki zonyango , kufuneka zihlolwe ngugqirha ngexesha lokunyanga.
Izigaba ezintathu ze-FBT
I-FBT inezigaba ezintathu:
- Isigaba 1: Ulawulo olupheleleyo lwabazali. Abazali bahlala bephethe ngokugqibeleleyo kokutya njengoko banceda umntwana wabo ukuba aphinde aphinde aphinde atye iipatheni zokutya kunye nokuphazamisa iingxaki zokutya eziphazamisayo ezifana nokuzibamba, ukuhlanjululwa kunye nokuxilisa. Ukuba uzuzo lwesisindo lubonisiwe, injongo i-1 ukuya kweyesi-2 iilidi ngeveki. Umgqirha usebenza ukuxhobisa abazali ukuba bathathe le mi sebenzi kwaye bancede abazali bafunde ukulawula umntwana ngexesha lokudla .
- Isigaba sesi-2: Ukubuya ngokukhawuleza kokulawula komntwana. Esi sigaba siqala ngokuqala xa ubunzima bubuyiselwa kakhulu, xa ukutya kuhamba ngokugqithiseleyo, kwaye xa iziphathamandla ziphantsi kolawulo. Ulawulo lugqithiselwa ngokukhawuleza kwintsholongwane ngendlela efanelekileyo yokudala: umzekelo, umntwana angase aqale ukufumana ukutya okanye ukutyhulwa ngaphandle komzali. Kukho ukubuyela emuva kwaye abazali banokubuyiselwa ukulawula rhoqo ngamaxesha ade umntwana ekulungele; le nxalenye yenkqubo.
- Isigaba 3: Ukuseka ukuzimela ngokuzimeleyo. Xa umntwana okhulayo ekwazi ukutya kunye nezinga elifanelekileyo lokuzimela kwaye akabonakalisi ukuziphatha kokuphazamiseka kwesifo, ingqwalaselo yonyango ishintshela ekubancedeni ukuvelisa ubunikazi obunempilo nokufumana ezinye iinkalo zophuhliso. Ezinye iingxaki ezidibeneyo zingaqwalaselwa. Intsapho incediswa ukulungiswa kwakhona ngoku ukuba umntwana unempilweni.
Izinzuzo zeFBT
Indlala yesibindi ingabangela i- anosognosia , ukungabi nalwazi lokuba umntu uyagula. Ngenxa yoko, kunokubakho ixesha elide ngaphambi kokuba iingqondo zabaselula ekubuyiseni zikwazi ukukhuthaza okanye ukuqonda ukuba zigcine zibuyiselwe. I-FBT inikela umsebenzi wokuguquka kokuziphatha nokutya okupheleleyo kwabazali kwaye ibanika izakhono kunye nokuqeqesha ukuhlangabezana nale njongo. Ngenxa yoko, inceda umntwana ukuba abuye abuye aphinde ayenakho amandla okwenza njalo.
Ngenxa yokuba usebenza ngokukhawuleza kunamanye unyango, i-FBT iyanciphisa iziphumo zonyango kwaye yandisa amathuba okubuyiswa okupheleleyo. Ivumela umntwana ukuba ahlale ekhaya nabazali bakhe kwaye ngokuqhelekileyo uninzi olunempumelelo kunokuba unyango lwendawo yokuhlala.
Uphando ngeFBT
Uphando lubonisile ukuba abantwana abaselula abafumana i-FBT bafumana amazinga aphakamileyo kunabantwana abaselula abafumana unyango olulodwa:
- Uphando oluvela kwiYunivesithi yaseChicago naseStanford lubonisa ukuba ekupheleni kwekhosi ye-FBT, i-sibini yesithathu yabantwana abaselula kunye ne-anorexia baye bafumana; Amaphesenti angama-75 ukuya kuma-90 ekhulwini anesisindo-afunyenwe kwiminyaka emihlanu yokulandelwa.
- Uphononongo olutshanje lufanisa i-FBT ne-bulimia nervosa kunye ne-CBT yeBulimia Nervosa. Ezi ziphumo zibonise ukuba i-FBT ikhokelela ekuhlaleni ngokukhawuleza kunye nokuzinyameka kwentlawulo yabantwana.
- Uphando oluphambili kunye neengxelo zecala zibonisa ukuba i-FBT yindlela eyamkelekileyo yabantu abadala.
I-FBT ibonakala iyasebenza kakhulu kwiintsapho apho ubude bokugula bungaphantsi kweminyaka emithathu. Ukusabela kwangaphambili kwindlela yokwenza unyango (ngokuqhelekileyo ngeveki ezine) kukuchazwa kwiphumo elide elide elide.
I-FBT Ayikho Yonke Intsapho
Abazali bandinika izizathu ezininzi ezikholelwa ukuba i-FBT ayiyi kubasebenzela. "Umntwana usemdala kakhulu." "Umntwana wam ukhululekileyo." "Andiyomelele ngokwaneleyo." "Sinyanzelekile." Andifumani nanye yale miba ukuba ibe ngumqobo wokuphumeza unyango lwe-FBT . Uphando kunye namava akho eklinikhi abonisa ukuba ezininzi iintsapho zikwazi ukuphumeza ngokuphumelelayo iFBT.
Nangona kunjalo, akuyiyo yonke intsapho. Kuqinileyo kwaye kufuna ukuzinikela okuqinileyo ngamalungu entsapho. Ayanconywa kwiintsapho apho abazali bahlala khona ngokwenyama okanye ngokuxhaphaza ngokwesini okanye ngokusetyenziswa kakubi kwezinto. Kwakungenako ukucetyiswa kwiintsapho apho abazali begxeka kakhulu.
Ezi zinto zingentla zimelela kuphela amancinci amatyala. Iintsapho eziye zasebenzisa le ndlela zidla kakhulu kwaye zinombulelo ukuba ziyinxalenye yesisombululo. Ndifumanisa ukuba intsebenziswano kunye neentsapho ezinokuzibophezela ekubuyiseleni komntwana kwazo zinomvuzo kum njengophilisi.
> Imithombo:
> Dimitropoulos, G., Lock, J., Le Grange, D., & Anderson, K. Ulwaphulo lwentsapho kwintshintsho yolutsha kwiNtsholongwane yoLuntu kwi-Adolescent Eating and Distress Disorders: Izicelo ezintsha, ezihlelwe nguKatherinerine L. Loeb, uDaniel Le Grange , UJacob Lock, u-2015 uRoutledge.
> Le Grange, DL, Lock, J., Agras, WS, Bryson, SW, & Jo, B. (2015). Uvavanyo lweNzululwazi oluLungelelweyo lweNyango olusisekelwe kwiNtsapho kunye neChnitive-Behavioral Treatment kwi-Adlimenti yaseBulimia Nervosa. Umbhalo we-American Academy of Child & Adolescent Psychiatry , 54 (11), 886-894.e2. http://doi.org/ 10.1016 / j.jaac.2015.08.008
> Vala J, Le Grange D, Agras W, Moye A, Bryson SW, & Jo B. (2010). Uvavanyo lweklinikhi olungalindelekanga ngokuthelekisa unyango olusisekelwe kwintsapho kunye nolwaphulo olujoliswe ngabantwana abaselula kunye ne-anorexia nervosa. IiNgcaciso zeeNgcaciso zengqondo , 67 (10), 1025-1032. http://doi.org/ 10.1001 / archgenpsychiatry.2010.128
> Thornton, LM, Mazzeo, SE, & Bulik, CM (2011). Ukulungelelaniswa kweengxaki zokutya: Iindlela kunye neziphumo ezikhoyo. Izihloko ezikhoyo kwiNzululwazi ze-Neuroscience , 6 , 141-156. http://doi.org/ 10.1007 / 7854_2010_91