{"id":3746,"date":"2015-05-25T08:05:07","date_gmt":"2015-05-25T06:05:07","guid":{"rendered":"http:\/\/mandometernyc.com.preview.binero.se\/?page_id=3746"},"modified":"2024-11-28T11:36:45","modified_gmt":"2024-11-28T10:36:45","slug":"the-four-cornerstones","status":"publish","type":"page","link":"https:\/\/mando.se\/en\/mandometer-method\/the-four-cornerstones\/","title":{"rendered":"The four cornerstones of treatment"},"content":{"rendered":"
[vc_row][vc_column width=”2\/3″][mk_title_box color=”” highlight_color=”#000000″ highlight_opacity=”0″ size=”16″ line_height=”26″ margin_bottom=”24″ font_family=”none”]It is important to change behaviour:
\nNormalising food intake, eating behaviour, activity levels, and sleep patterns provide the foundations for retuning activities of normal daily living. It is through restoration of these behaviours that one is able to return to school, work, socialising and leisure activities.[\/mk_title_box][vc_column_text margin_bottom=”5″]Patients learn to eat and identify signals of hunger and satiety by training to eat with the Mandometer\u00ae. Following meals, patients rest in a heated environment (warm room, heat blankets) to reduce the need to compensate for eating with physical activity, and to decrease anxiety. Patients who are underweight are always cold, and normal weight patients with bulimia nervosa are generally cold when they are not binge-eating. With time, patients learn to become comfortable with resting in heat and often fall asleep. As growth hormone is produced during sleep, this is particularly important for patients who have stopped growing due to starvation, but still have the potential to grow taller. Each patient is assigned a personal case manager who works intensively with the patient to build their confidence and motivate them towards recovery. Patients gain confidence which each step forward they take. Our case managers are very experienced and have the skills to handle any negative thoughts that may arise.
\nOur treatment is based on scientific studies.[\/vc_column_text][vc_accordions style=”simple-style” open_toggle=”-1″ container_bg_color=”rgba(220,219,221,0.55)” responsive=”false”][vc_accordion_tab icon=”mk-icon-quote-left” title=”Thoughts or cognitions are driven by behaviour not the reverse”][mk_font_icons icon=”mk-icon-quote-left” color=”#85c6c0″ align=”left” animation=”scale-up”][mk_title_box size=”13″ line_height=”16″ letter_spacing=”1″ font_family=”none”]\n

Thoughts or cognitions are driven by behaviour not the reverse. If you are uneasy or anxious about a particular situation, it is likely you will avoid that situation. Other similar situations may also trigger anxiety. As patients gradually face their anxiety surrounding food, the thoughts that\u00a0have been maintaining their disturbed eating behaviour begin to have less power. Progress is enhanced with a positive reward; as eating behaviour normalises, anxiety decrease and thoughts become normal.<\/em><\/p>\n[\/mk_title_box][mk_title_box size=”10″ line_height=”13″ margin_bottom=”10″ font_family=”none”]\n

Modjtaba Zandian, researcher at the Karolinska Institute and Quality Assurance at AB Mando (Mando).<\/p>\n[\/mk_title_box][\/vc_accordion_tab][\/vc_accordions][\/vc_column][vc_column width=”1\/3″][mk_gallery images=”7202,7203,7204,7201″ custom_links=”#Normalisering,#Aktivitet,#Vila,#Social” column=”2″ image_size=”full” item_spacing=”0″ orderby=”post__in” item_id=”1434110729-557acb09a2f6d”][\/vc_column][\/vc_row][vc_row id=”Normalisering”][vc_column][mk_divider style=”thin_solid” margin_top=”25″ margin_bottom=”45″][\/vc_column][\/vc_row][vc_row animation=”fade-in” id=”Normalisering”][vc_column width=”5\/12″ offset=”vc_hidden-xs”][mk_gallery images=”7446,7022,7023,4617″ column=”2″ item_spacing=”0″ margin_bottom=”10″ disable_title=”true” orderby=”post__in” item_id=”1434110729-557acb09a2f6d”][\/vc_column][vc_column width=”7\/12″][mk_image src=”https:\/\/mando.se\/wp-content\/uploads\/Mandometerklinikerna_4Hornstenar_eng_01_90.png” image_width=”90″ image_height=”90″ crop=”false”][vc_column_text]\n

Normalising eating behaviour<\/h3>\n

Each patient is given an individualised meal plan and provided with a Mandometer; a medical\u00a0device that is used in treatment to teach patients how to eat and to recognise signals of hunger and satiety. The Mandometer is used at meals every day until eating behaviour normalises. It usually takes 3-4 months.<\/p>\n

Learn more about the Mandometer device\u00a0><\/strong><\/a>[\/vc_column_text][mk_custom_box padding_vertical=”5″ padding_horizental=”10″ margin_bottom=”5″ bg_color=”rgba(220,219,221,0.55)”][mk_font_icons icon=”mk-icon-quote-left” color=”#85c6c0″ align=”left” animation=”scale-up”][mk_title_box size=”13″ line_height=”16″ letter_spacing=”1″ font_family=”none”]\n

Our method of treatment is to normalise eating behaviour. This includes being able to sit at a table with others and eat a meal. We train our patients to change their behaviour in successive steps. For example, a patient may set the table but does not eat, a patient may fill a glass with water but does not drink, or a patient may put food on their plate but not eat any of the food on their plate. This is done until the patient takes their first bite of food. Training of eating behaviour is determined on an individual basis. I have seen patients who were unable to eat when they started treatment, eating in the dining room with others after only a few days of being here with us.<\/em><\/p>\n[\/mk_title_box][mk_title_box size=”10″ line_height=”13″ margin_bottom=”10″ font_family=”none”]\n

Modjtaba Zandian, researcher at the Karolinska Institute and Quality Assurance at Mando.<\/p>\n[\/mk_title_box][\/mk_custom_box][vc_accordions style=”simple-style” open_toggle=”-1″ container_bg_color=”rgba(220,219,221,0.55)” responsive=”false”][vc_accordion_tab icon=”mk-icon-quote-left” title=”The conflict between eating and not eating dominates the patient\u2019s thoughts”][mk_font_icons icon=”mk-icon-quote-left” color=”#85c6c0″ align=”left” animation=”scale-up”][mk_title_box size=”13″ line_height=”16″ letter_spacing=”1″ font_family=”none”]\n

The mindset relating to food and weight is the same for all patients. Patients are afraid of gaining weight, but at the same time are obsessed with food. The conflict between eating and not eating dominates the patient\u2019s thoughts all day long, regardless of age and gender. The contradiction in the conflict is that you eat nothing at all or you binge-eat, because food is simultaneously forbidden and desirable. A patient who is afraid of gaining weight is on a quest lose weight, no matter how much the patient weighs. It does not matter if weight is 27 or 87 kg, because weight gain is always feared. The fear and anxiety experienced by the patient give them an unrealistic and negative body image, leading to thoughts that the body and food intake must be combatted and mastered. When treating a patient with anorexia nervosa, it insufficient to just teach them to eat; you must also teach the patient to stop eating, because the alternative to not eat is to binge-eat. This is something that myself and other clinicians must take responsibility for. This is often lacking in treatment.<\/em><\/p>\n[\/mk_title_box][mk_title_box size=”10″ line_height=”13″ margin_bottom=”10″ font_family=”none”]\n

(from conversations with Clinical Psychologist Sven Holmgren, Hets\u00e4tarna, F\u00f6rfattarf\u00f6rlaget Stockholm 1984).<\/p>\n[\/mk_title_box][\/vc_accordion_tab][\/vc_accordions][\/vc_column][\/vc_row][vc_row id=”Vila”][vc_column][mk_divider style=”thin_solid” margin_top=”30″ margin_bottom=”45″][\/vc_column][\/vc_row][vc_row animation=”fade-in”][vc_column width=”5\/12″ offset=”vc_hidden-xs”][mk_gallery images=”7734,7026″ column=”2″ image_size=”full” item_spacing=”0″ margin_bottom=”10″ disable_title=”true” orderby=”post__in” item_id=”1434110729-557acb09a2f6d”][\/vc_column][vc_column width=”7\/12″][mk_image src=”https:\/\/mando.se\/wp-content\/uploads\/Mandometerklinikerna_4Hornstenar_eng_04_90.png” image_width=”90″ image_height=”90″ crop=”false”][vc_column_text]\n

Heat and Rest<\/h3>\n

Heat has a relaxing and anti-anxiety (anxiolytic) effect, and helps patients relax and keep still without becoming overwhelmed with anxiety.\u00a0 Patients feel most compelled to move before meals (in order to allow themselves to eat), and after meals (to compensate for the food they just ate).\u00a0 Resting is very important because it encourages the patient to refrain from compensatory\/compulsive activity, and teaches patients to sit with their anxiety and challenge the eating disorder thoughts as they arise.<\/p>\n

The warm rooms at our Mandometer Clinics are decorated like small bedrooms with a comfortable bed to give the patient a warm and cozy feeling.\u00a0 Patients can self-regulate the heat up to 40\u00b0 C (F 104).\u00a0 We also provide our patients with heat blankets and jackets.[\/vc_column_text][mk_custom_box padding_vertical=”5″ padding_horizental=”10″ margin_bottom=”5″ min_height=”0″ bg_color=”rgba(220,219,221,0.55)”][mk_font_icons icon=”mk-icon-quote-left” color=”#e8b486″ align=”left” animation=”scale-up”][mk_title_box size=”13″ line_height=”16″ letter_spacing=”1″ margin_bottom=”0″ font_family=”none”]\n

It\u2019s great to rest. It\u2019s the best thing about this place. It\u2019s glorious to lie in a warm room. Sometimes you are very cold after eating. So it\u2019s a brilliant idea.<\/em><\/p>\n[\/mk_title_box][mk_title_box size=”10″ line_height=”13″ margin_bottom=”0″ font_family=”none”]\n

Sofie, 26 years old from Australia.<\/p>\n[\/mk_title_box][\/mk_custom_box][\/vc_column][\/vc_row][vc_row id=”Aktivitet”][vc_column][mk_divider style=”thin_solid” margin_top=”30″ margin_bottom=”45″][\/vc_column][\/vc_row][vc_row animation=”fade-in”][vc_column width=”5\/12″ offset=”vc_hidden-xs”][mk_gallery images=”7027″ column=”1″ image_size=”full” item_spacing=”0″ margin_bottom=”10″ disable_title=”true” orderby=”post__in” item_id=”1434110729-557acb09a2f6d”][\/vc_column][vc_column width=”7\/12″][mk_image src=”https:\/\/mando.se\/wp-content\/uploads\/Mandometerklinikerna_4Hornstenar_eng_02_90.png” image_width=”90″ image_height=”90″ crop=”false”][vc_column_text]\n

Decreasing physical activity<\/h3>\n

People with eating disorders are typically very physically active. This decreases food intake and body weight, but might increase body temperature: Most patients with anorexia nervosa are women, and women feel cold at all times when eating only little food. Men do not because they generate more heat; their body surface area is smaller than that of women in relation to body mass that generates the heat. It is very important to reduce physical activity in order to increase body weight and to stop binge eating and vomiting. A very high level of physical activity can prevent weight gain as much as disordered eating can, as well as impair heart function and weaken bones. It can even be life threatening.<\/p>\n

Physical activity is therefore reduced early on in treatment, to be gradually reintroduced and eventually restored to normal as health is regained.[\/vc_column_text][\/vc_column][\/vc_row][vc_row id=”Social”][vc_column][mk_divider style=”thin_solid” margin_top=”30″ margin_bottom=”45″][\/vc_column][\/vc_row][vc_row animation=”fade-in”][vc_column width=”5\/12″ offset=”vc_hidden-xs”][mk_gallery images=”7031,7030,7029,7028″ column=”2″ item_spacing=”0″ margin_bottom=”10″ disable_title=”true” orderby=”post__in” item_id=”1434110729-557acb09a2f6d”][\/vc_column][vc_column width=”7\/12″][mk_image src=”https:\/\/mando.se\/wp-content\/uploads\/Mandometerklinikerna_4Hornstenar_eng_05_90.png” image_width=”90″ image_height=”90″ crop=”false”][vc_column_text]\n

Social reconstruction<\/h3>\n

In addition to attending to our patients\u2019 nutritional needs and eating behaviour we help them accept and appreciate their bodies, understand the mechanisms underlying eating disorders and recognise warning signals, develop emotional regulation, and eventually, return to school or work. The treatment also focuses on improving self esteem and self awareness, building confidence and enjoyment, and managing social situations and interpersonal relationships.<\/p>\n

Each patient works with their case manager to set up short term goals, such as visiting a friend or reading a book, and long term goals, such as going on a holiday or learning to drive. A structured plan, for returning to school or work, is arranged with the patient. We encourage our patients to resume social activities, such as meeting with friends, going to parties, or taking a summer job or volunteer role.<\/p>\n

As patients reach their goals their confidence increases, and in many cases a patient\u2019s confidence is better after Mandometer treatment than it was prior to becoming ill.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][mk_divider style=”thin_solid” margin_top=”30″][\/vc_column][\/vc_row][vc_row][vc_column width=”2\/3″][mk_custom_box padding_vertical=”0″ padding_horizental=”0″ margin_bottom=”0″][vc_row_inner][vc_column_inner width=”5\/12″ css=”.vc_custom_1461840712664{padding-left: 0px !important;}”][mk_image src=”https:\/\/mando.se\/wp-content\/uploads\/IVA_8146_crop.jpg” image_size=”full” group=”_general” link=”\/en\/mandometer-method\/individual-treatment-plan\/” align=”center” margin_bottom=”15″ crop=”false”][\/vc_column_inner][vc_column_inner width=”7\/12″][mk_icon_box icon=”no” title=”All patients have a personal case manager who takes care of them throughout the whole treatment” text_size=”24″ font_weight=”300″ read_more_txt=”Learn more about our treatment” read_more_url=”\/en\/mandometer-method\/individual-treatment-plan\/” icon_color=”#a1ce8e” icon_circle_color=”#a1ce8e” margin=”0″ el_class=”MandoIconBox”][\/mk_icon_box][\/vc_column_inner][\/vc_row_inner][\/mk_custom_box][mk_divider style=”thin_solid” margin_top=”0″ margin_bottom=”15″][mk_custom_box padding_vertical=”5″ padding_horizental=”10″ margin_bottom=”0″ bg_color=”#85c6c0″][vc_row_inner][vc_column_inner width=”5\/12″ css=”.vc_custom_1461840720350{padding-left: 0px !important;}”][mk_image src=”https:\/\/mando.se\/wp-content\/uploads\/Brain_illustr_s.png” image_size=”full” group=”_general” link=”\/en\/research-and-treatment-results\/research\/” align=”center” crop=”false”][\/vc_column_inner][vc_column_inner width=”7\/12″ css=”.vc_custom_1432114374526{padding-top: 5px !important;}”][mk_icon_box icon=”no” title=”Our treatment is based on many years of research carried out by the Karolinska Institutet” text_size=”21″ font_weight=”300″ read_more_txt=”Our research” read_more_url=”\/en\/research-and-treatment-results\/research\/” icon_color=”#a1ce8e” icon_circle_color=”#a1ce8e” title_color=”#ffffff” txt_color=”#ffffff” margin=”0″ el_class=”MandoIconBox”][\/mk_icon_box][vc_column_text][\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/mk_custom_box][mk_divider style=”thin_solid” margin_top=”0″ margin_bottom=”15″][\/vc_column][vc_column width=”1\/3″ el_class=”MandoRightColumn”][mk_custom_sidebar sidebar=”sidebar-19″][mk_custom_box padding_vertical=”0″ padding_horizental=”0″ margin_bottom=”25″][mk_image src=”https:\/\/mando.se\/wp-content\/uploads\/Jag-och-Maya.png” image_size=”full” group=”_general” link=”\/en\/apply-for-treatment\/” margin_bottom=”15″ crop=”false”][mk_title_box color=”#666666″ size=”21″ line_height=”15″ font_weight=”300″ margin_bottom=”0″ font_family=”none”]\n

We can help you too<\/p>\n[\/mk_title_box][mk_icon_box icon=”no” text_size=”21″ font_weight=”300″ read_more_txt=”Apply for treatment” read_more_url=”\/en\/apply-for-treatment\/” icon_color=”#a1ce8e” icon_circle_color=”#a1ce8e” margin=”0″][\/mk_icon_box][\/mk_custom_box][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"

[vc_row][vc_column width=”2\/3″][mk_title_box color=”” highlight_color=”#000000″ highlight_opacity=”0″ size=”16″ line_height=”26″ margin_bottom=”24″ font_family=”none”]It is important to change behaviour: Normalising food intake, eating behaviour, activity levels, and sleep patterns provide the foundations for retuning activities of normal daily living. 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