1. A psychological framework for use in the Regional Inpatient Unit?

2. Schema Therapy and Needs Research Schema Therapy -Unmet Core Psychological Needs Jeff Young Maslows Hierarchy of Needs Richard Ryan and Edward Deci – Social Psychology - developed Needs theory Applying to severe AN: Addition unmet Core Physical Needs Applying basic consistent approach across all members of the MDT

3. ANITT Core Needs Framework Core Psychological Needs: *Emotional Safety: need to feel safe, secure, stable *Agency: need to feel are competent, good enough, coping, ‘in control’ Nurturance: need for love, care, compassion, understanding Acceptance: need for self-acceptance, to feel accepted by others and to be accepting of imperfection, complexity, failure and risk in self, others and the world.

4. ANITT Core Needs Framework Core Physical Needs Physical safety: need for safety, security, protection eg. warmth, shelter, physical health etc *Activity: need for movement, activity, exercise Nutrition: need for minimum energy, spread of nutrients, hydration Rest: need for physical rest, including sleep

5. Prioritisation of Needs in AN Prioritise Emotional safety – feeling safe enough Agency – feeling in control enough Secondary effect Activity – excessive amount Neglect All the other needs Is severe AN a Self-Deprivation Disorder?

6. Function and purpose of AN To try to feel safe enough and ‘in control’ enough to try not to have vulnerable feelings, doubts, uncertainty etc. Partial meeting of Needs eg. Short-term reduction in anxiety, when avoid eating or burn off some calories eg. Short-term sense of achievement, when weight goes down or simply when resist urge to eat Cost of narrowing focus and limited, over-controlled life Medium term experience of failing to be normal/cope with living a normal life

7. How would an inpatient unit function informed by a Needs- based psychological framework?

8. Scenario 1 A patient at meal time is refusing to finish their meal: empathise with their instinct to try and control their fear and anxiety reinforce that they are not in danger, nothing terrible is going to happen if they finish it, even though it feels really wrong assert your need to try and help them pay attention to their other needs that will let them get their life back again accepting themselves as good enough whatever their weight training themselves to take the nutrition they need again to be physically strong enough to have a proper life letting you care for the Needs that they find it hard to look after, even if that feels wrong

9. Scenario 2 A patient in a group is not speaking or engaging at all and the key worker sits down to discuss this with them empathise with them feeling uncomfortable (vulnerable) and not wanting to say anything in case its wrong or gets misunderstood (out of control) validate it being normal to feel uncomfortable/anxious about what others will think, but that it is safe enough to say whatever she feels/thinks (trying to encourge self- acceptance, taking ‘risk’ of being criticised etc) Reinforce the value of being open about feelings so others get a chance to understand you and accept you