How can the self-help guidebook combined with professional institutions help people with eating disorders (15-35) in China establish healthy lifestyles within the family environment?

!!!UPDATE FROM THE AUTHOR on 2023/ 12/3: Due to technical issues, the images in this post are not displaying, Please click the link below and view the newest full article.!!!!!!

https://22036360.myblog.arts.ac.uk/2023/12/03/2023-11-12-final-paper-for-the-fourth-intervention/

———————————-Dividing Mark—————————-

My fourth intervention is a self-help guidebook. This guidebook focuses on people who have an eating disorder. This zine is currently in the process of being revised with expert input. Qinwen Zhang founded the nonprofit eating disorder organisation “ED HEALER” in China. She will be the expert for this part.  We decided to promote the guidebook at Wellington College International Shanghai’s Thanksgiving event on 23rd Nov.

Official website of Wellington College International Shanghai: https://shanghai.wellingtoncollege.cn/

Draft of the guidbook

11-15 Final vision

After Qinwen and Ding’s suggestion. The final vision is in below.

Further Plan

In future, I will keep cooperating with ED HEALER. So far, I have confirmed I’ll join the Wellington College International Shanghai Project as my fourth intervention. And I will join the Shanghai Mental Health Center Project, the Shanghai University of Political and Law Project and the University of Toronto Project.

Interview with Yin Ding

This week, I interviewed Yin Ding, a volunteer team leader of eating disorder support at Shanghai Mental Health Center. She appreciated my zine draft and was interested in collaborating with me. In response to my research, I asked her,

“What is different about localised treatment in China compared to Western treatment? “

Answer by Ding:

The development of eating disorder treatment abroad actually predates that of domestic treatment by 20-30 years. As a result, many of the current treatment methods in China are adaptations of international approaches, such as the psychosomatic model from Germany, and methods like Family-Based Treatment (FBT) and Dialectical Behavior Therapy (DBT) from the United States. The treatment approaches used in China are largely derived from these international methods.

The main challenge encountered is related to cultural differences. In China, eating disorders are predominantly focused on Anorexia Nervosa, Bulimia Nervosa, and Avoidant/Restrictive Food Intake Disorder (ARFID), while clinical cases of Binge-Eating Disorder (BED) are relatively rare. This pattern is influenced by Chinese cultural values that emphasize restraint, self-discipline, idealization, and perfectionism. Such excessive control can lead to the development of behaviors associated with restrictive eating and, even in cases of binge eating, may be accompanied by overwhelming feelings of guilt. Therefore, while treatment methods are similar, the cultural inclination may differ significantly. Additionally, because many treatment approaches originate from abroad, there may be differences in their effectiveness due to variations in family culture. Efforts are being made to find more culturally suitable solutions."

Do you think this zine combined with FBT works?

Answer by Ding:

"I feel that validation through practical application is necessary. Currently, it appears to lack systematicity, and there is a need for clear usage guidelines to complement it.

How can Chinese eating disorders (15-35) establish healthy lifestyles within the family environment via the self-guidebook?

Helping individuals in the age range of 15-35 with eating disorders in China establish healthy lifestyles within the family environment through a self-guidebook can be a constructive approach. Here are some steps to consider:

1. Develop a Self-Guidebook:
   • Create a comprehensive self-guidebook that covers various aspects of healthy lifestyles, including nutrition, exercise, mental well-being, and stress management. The guidebook should be culturally sensitive and easy to understand.
2. Nutrition Education:
   • Include information about balanced nutrition, portion control, and the importance of consuming a variety of foods. Explain how proper nutrition supports physical and mental health.
3. Meal Planning and Cooking:
   • Offer guidance on meal planning and cooking techniques. Encourage readers to involve family members in meal preparation, fostering a sense of collaboration and shared responsibility.
4. Mindful Eating:
   • Teach the principles of mindful eating, focusing on being present during meals, recognizing hunger and fullness cues, and avoiding emotional eating.
5. Exercise and Physical Activity:
   • Discuss the benefits of regular physical activity and provide suggestions for incorporating exercise into daily routines. Emphasize the importance of choosing activities that individuals enjoy.
6. Mental Health and Stress Management:
   • Address the significance of mental well-being and managing stress. Techniques like mindfulness, relaxation exercises, and seeking social support can be included.
7. Family Support:
   • Highlight the importance of family support in promoting a healthy lifestyle. Encourage open communication within the family and the understanding of the individual’s needs and challenges.
8. Goal Setting:
   • Help readers set realistic and achievable goals for adopting healthy habits. Encourage them to track their progress and celebrate their successes.
9. Seeking Professional Help:
   • Emphasize the importance of seeking professional assistance for individuals with eating disorders. The guidebook should provide information on how to access mental health services in China.
10. Cultural Sensitivity:
    • Ensure that the self-guidebook takes into account cultural norms and practices in China, as these can have a significant impact on eating habits and lifestyle choices.
11. Peer Support:
    • Encourage individuals to seek peer support through support groups or online communities. Sharing experiences and advice with others who have faced similar challenges can be empowering.
12. Regular Review:
    • Suggest regular review and reflection on personal progress. Encourage readers to revisit the self-guidebook and make adjustments to their goals and strategies as needed.
13. Family Involvement:
    • Promote the active involvement of family members in supporting the individual’s journey toward a healthier lifestyle. This may include participating in meal planning, cooking together, and providing emotional support.
14. Professional Feedback:
    • Encourage individuals to seek feedback from healthcare professionals or therapists as they progress in their journey towards a healthy lifestyle.
15. Accessibility:
    • Ensure that the self-guidebook is readily accessible in various formats, including print and digital, to reach a broader audience.

The self-guidebook should serve as a valuable resource to empower individuals and their families in China to make positive changes in their lives and support those dealing with eating disorders in establishing healthier lifestyles. It should be adaptable to the unique needs and preferences of each individual and family.

Appearances

This week, I’d start to think about the structure of the zine. So, a zine has 16 pages in total, including double-sided paint. And each page is A6 paper size.

I set up a 16-page A6 Indesign document.

The content structure includes:

• Coverpage – Page 1
• Foreword – Page 2
• Characters – Page 3
• Day 1 – Page 4
• Day 2 – Page 5
• Day 3 – Page 6
• Day 4 – Page 7
• Day 5 – Page 8
• Day 6 – Page 9
• Day 7 – Page 10
• Day 8 – Page 11
• Day 9 – Page 12
• Day 10 – Page 13
• Postscript – Page 14 to Page 15
• Backpage – Page 16

Content

Before starting the content part, I watched a documentary by researchers from the Eating Disorder Centre of Shanghai Mental Health Centre.

In this video (7:28), I find out that Dr. Chen-Director of the Eating Disorder Center, has mentioned:” A relatively effective treatment for eating disorders in adolescents called Family-Based Therapy (FBT). This method leverages the closeness and cohesion inherent in Eastern cultures, making family intervention particularly suitable in China. Parents often maintain a relatively close relationship with their children before marriage, a cultural aspect from the West.”

The Maudsley Method, also known as Family-Based Treatment, can be characterized by an intensive outpatient treatment where parents are integrated as an active and positive role.  The primary purposes of including parents in this approach are to incorporate and encourage participation in their child’s recovery journey.  This therapy method was originally formulated by Christopher Dare and his colleagues at the Maudsley Hospital in London in 1985.  Formerly proposed as a method for the treatment of anorexia nervosa in adolescents, it was devised as therapy that would occur in the home environment with therapeutic supervision by a trained professional.

Since then, the Maudsley Family Therapy approach has been adapted for bulimia nervosa, binge eating, and for older patients as well.  Generally, this treatment has three phases which occur over a period of 6-12 months, directed by a family-based therapist, and which involve the entire family in weekly sessions.  Parents are guided in the fundamentals of helping their loved one eat (and/or prevent purging and over-exercising) and siblings are supported in collaborating with the patient.  Sessions periodically entail a family meal under the guidance of a therapist who can assist in recognizing the various dynamics of the family around the meal.

The Three Phases of the Maudsley Family Approach are as follows:

Phase I – Weight Restoration:  In Phase I, a professionally trained therapist concentrates on the various effects associated with anorexia nervosa, particularly physiological, cognitive, and emotional.  A major focus of this phase is the restoration of the patient’s weight and the “re-feeding” component.  A crucial psychological feature of this primary phase is substantiating the illness.

Phase II – Returning control over eating to the adolescent:  Phase II encompasses the patient learning to progressively regain control over their individual eating habits again.  This typically commences when the patient’s weight has reached approximately 87% of their ideal body weight.

Phase III – Establishing healthy identity:  This phase is initiated when the patient is sufficiently able to sustain their weight above 95% of ideal body weight independently and refrains from engaging in restrictive eating behaviors.  Focuses of treatments are primarily on the psychological consequences the eating disorder has had on the patient and the establishment of a healthier identity.

So, how do we make a change? According to the Transtheoretical Model and Stage of Change, TTM, also known as The Stage of Change Model,

The zine will focus on the Phase III of FBT. Of course, a small zine will not wholly change people, but I hope that zines can bring positive thoughts and warmth to people. It mainly focuses on “right mindfulness” (Buddhism), which means developing an accurate and precise awareness of the present moment uncoloured by ideas, memories, beliefs, expectations, etc., just the experience.

Venerable Nyanaponika Mahathera explains in The Road to Inner Freedom:

Right Mindfulness is the quality of awareness. It ensures complete awareness of all activities of the body as they occur, complete awareness of all sensations and feelings as they occur, complete awareness of all activities of the mind as they occur and complete awareness of all mental objects when the appropriate situations arise. This attitude of complete awareness brings about powerful results. It sharpens to the finest degree man’s powers of observation, induces the deepest calm and ensures that nothing is said or done or thought unguardedly or hastily, mechanically or without deliberation. He who develops this factor is able to take count of every single and minute activity of the mind, even such activities as are generally considered to occur when the mind is passive and receptive; so penetrating and powerful is his sense of awareness. (70)

Guide

Based on the above research, the zine’s content is divided into two parts: internal thinking and external connection. I set a ten-day journey with readers. The internal thinking part helps readers to focus on the right mindfulness. The external connection parts encourage readers to reach out to the outside world and build a comfortable, trusting external environment.

Characters

For the characters in the zine. I created six gentle and friendly animal characters. Have these characters lead the reader through self-healing activities

I got in touch with the Chinese eating disorder charity “ED HEALER,” and I will have a videoconference with the founder Qinwen and other members of the organisation on the 26th of October to discuss the zine. I will also participate in a painting exhibition about eating disorders in cooperation with Shanghai Mental Health Center at the end of this year or the beginning of next year. At the end of this year or next year, I will also participate in an exhibition of paintings about eating disorders in collaboration with ED HEALER and Shanghai Mental Health Center.

For the next intervention, I am going to make an digital zine to assist people with eating disorders to establish good habits in their daily lives.

So far, my experts include a sociologist from Tsinghua University, a psychiatry researcher from Sun Yat-sen University, and an expressive arts therapist in Macau. Volunteers team leader of Eating Disorder Centre of Shanghai Mental Health Centre.

Interview with Hux Hexiao Ding

Background of Ding:

Fellowship in Psychiatry in Sysu

Sun Yat-sen University (SYSU)- Public Health- 2020

The Hong Kong Polytechnic University (PolyU) – Medical Physics Lab- 2024

Ding was preparing to carry out research on eating disorders as opening material for his PhD. He came across my personal website through an internet search and therefore contacted me to express his interest in my project and to collaborate afterwards.

The following is my interview with Ding.

S: Hey, my name is Shuang Zheng. Currently, I am studying MA Applied Imagination at Central Saint Martins. I'd like to ask you about localised research on Eating Disorders (ED) in China.

D: Hey Shuang.I'm Ding. Unfortunately, China's research in this area is almost nil. I see you have art therapy workshops on your site, which is something that has been done and researched in other mood disorders, but Eating Disorder is still very much in its infancy and there is very little research on it, so to speak.

S:Yes, in fact, by the end of the day I felt that there were industry barriers to doing art therapy, after all, I was not educated in professional psychological research. Moreover, the information I have read so far is all interpreted in the context of Western psychology. I did a questionnaire during the summer holiday, and I felt that the word "eating disorder" is not well understood in China. There are regional differences, for example, developed cities on the southeast coast know more about it, but inland cities know very little about it.

D:Yes, this disease was also included in the disease code the year before. (2021) It can be said to be in its infancy worldwide.

S:I feel that "art healing" has gained a lot of attention on the internet in China, but very few people are actually doing it for the purpose of helping patients, and basically it's all about making a profit. That's why I'm taking a step back and trying to popularise eating disorders.

D: Yes, this kind of PROGRAM needs money to start. We are usually get funds from the university. I think doing a QUALITATIVE RESEARCH and getting it published is a great POINT, and I've read that you've done a lot of interviews, which are actually still pretty good, and totally worth writing about.

S:I understand that Shanghai Mental Health Center opened an eating disorder clinic the year before last.

D:Yes, the country is still in its infancy, and many of us are at our wits' end when it comes to diagnosing eating disorders. The prevalence rate is still high, and it's hard to detect.I think sociologically you should interpret his symptoms, for example, the interviews you do can be written as qualitative research. for their motivation, is there a psychological model that can be quantified, that's what I'm thinking about. Sociological and psychological research methodologies are similar. I think, if you have an idea, you can start by putting together the interviews, many medical journals will accept qualitative research. that is, qualitative research. I think, if you have an idea, you can start by putting together interviews, and many medical journals will accept qualitative research. I think this makes a lot of sense, and I'm very encouraged by what you've written. Mainly I want to promote eating disorder in China.

According to experts and online resources, establishing healthy eating habits in a family environment, especially within a group that includes individuals with eating disorders, requires a sensitive and supportive approach. Here are some strategies that eating disorder support groups can consider to promote a healthier eating environment within families:

1. Education and Awareness:
   • Start by educating both individuals with eating disorders and their family members about the nature of eating disorders, their triggers, and the importance of healthy eating.
   • Raise awareness about the emotional and psychological aspects of eating disorders to foster understanding and empathy within the family.
2. Professional Guidance:
   • Encourage families to seek professional help from therapists, nutritionists, and dietitians who specialize in eating disorders. These experts can create personalized eating plans and provide guidance on recovery.
3. Open Communication:
   • Promote open and non-judgmental communication within the family. Encourage family members to express their concerns, feelings, and needs related to food and eating habits.
4. Family Meals:
   • Reintroduce regular family meals as a supportive and bonding activity. Ensure these meals are relaxed, enjoyable, and free from food-related stress.
5. Meal Planning:
   • Collaborate with a nutritionist or dietitian to create balanced meal plans for the entire family. Emphasize variety, moderation, and balanced nutrition.
6. Model Healthy Behaviors:
   • Parents and caregivers should model healthy eating behaviors themselves. Children often learn by observing adults, so setting a positive example is crucial.
7. Eliminate Trigger Foods:
   • Remove or limit access to foods that trigger eating disorder behaviors. Discuss these changes with the individual who has an eating disorder to ensure their comfort.
8. Avoid Food Comments:
   • Encourage family members to avoid making comments about body weight, appearance, or food choices. Negative remarks can contribute to anxiety and exacerbate eating disorders.
9. Supportive Environment:
   • Create a supportive atmosphere where individuals with eating disorders feel safe and understood. Encourage them to share their feelings and struggles without fear of judgment.
10. Gradual Changes:
    • Understand that change takes time. Progress may be slow, and relapses can occur. Be patient and continue to offer support and encouragement.
11. Seek Group Support:
    • Consider involving the family in support groups or therapy sessions tailored for families of individuals with eating disorders. These groups provide a safe space to discuss challenges and learn from others.
12. Celebrate Achievements:
    • Acknowledge and celebrate small victories and positive steps toward healthier eating habits. Positive reinforcement can motivate individuals in their recovery journey.
13. Set Realistic Goals:
    • Work with a therapist or counselor to set realistic goals for recovery. These goals should be achievable and adapted to the individual’s progress.

Each individual’s journey toward healthy eating habits is unique, and there is no one-size-fits-all approach. Professional guidance and a supportive, understanding family environment areessentialf recovery from eating disorders.