The aim of the group is to enhance coping skills and reduce maladaptive strategies, in particular eating disordered behaviors. It is run by a group of staff trained in DBT. There are four modules: Mindfulness, Distress Tolerance, Emotional Regulation and Interpersonal skills. The central theme is mindfulness and each group starts with a mindfulness exercise. This is to encourage practice of the taking hold of the mind, rather than being preoccupied and distracted by unwelcome thoughts and to become more mindful of our actions and their consequences. The purpose of the group is to promote effective, non-judgmental attitudes to managing life’s challenges and become more resilient.

The group aims to help with unhelpful patterns of behaviours and thoughts.  The group is therefore primarily concerned with exploring unhelpful behaviours and thoughts that maintain low self esteem in addition to exploring how to change these.  The group also examines how low self esteem may have developed and looks at practical strategies to improve self esteem.  More specifically the group aims to cover the following key themes:

• What is low self esteem?
• How low self esteem develops
• What factors keep low self esteem going
• Changing behaviours and thoughts that maintain low self esteem
• How to combat self criticism
• How to enhance self acceptance

In addition to the above the group provides a forum for patients to discuss struggles they may be having with low self esteem and to gain support with these struggles.  Self Esteem group is based on cognitive-behavioural therapy.

Bodywise is a group aimed at helping patients understand what factors influence the maintenance of their body image. Individuals are given space to explore their distress regarding their changing body shape and are encouraged to explore the difference between satisfaction and acceptance. Finally, group members are given the opportunity to explore the role of body image in their eating disorder and how this may change over treatment and afterwards.

The psycho-educational group is primarily concerned with providing education about eating disorders and combines a mix of didactic teaching with discussion.  It examines the causes and consequences of eating disorders including the impact of starvation and unhelpful weight control strategies such as purging.  In addition, the group looks at ways in which recovery can be facilitated and the last session is concerned with relapse prevention.  More specifically, the group covers the following key topics:

• Definitions of eating disorders
• The physical, mental, emotional and social consequences of having an eating disorder
• The impact of starvation
• Vomiting, laxative abuse and diuretic abuse
• Set point
• Healthy exercise
• Relapse prevention

This group is facilitated by the dietician at Cotswold House Marlborough.  The sessions cover various aspects of nutrition from ‘why do we eat?’, ‘normal eating’ and then on to shopping, cooking and eating food out.  This group each week provides open discussions and tasks, and can provoke thoughts challenging eating disorder behaviours and beliefs.  The group also incorporates goals around eating using the same SMART model used in the goal setting group.  This gives patients the opportunity to identify issues they are looking to work on as individuals, and as a group discussing ways of doing this and sharing personal accomplishments.

This group is facilitated by the occupational therapy team on a weekly basis. Individuals have the opportunity to prepare sandwiches for their lunch in a supportive group setting. Members have the option to choose between two fillings. This activity enables group members to handle their own food, use all main food groups in preparation of a simple sandwich and facilitates individuals using adequate portion sizes. Support and guidance are provided by facilitators. It is expected that practical handling of food will increase individuals’ ability to prepare sandwiches and light meals for themselves on discharge. This group increases individuals’ exposure to a variety of foods and enables group members to become familiar with portion sizes they are expected to use at home.

The Relationship Group is a  weekly group run by the family therapist and cognitive behaviour therapist. It advocates that members take ownership of the group and is one that is interactive, thus members are expected to actively participate. The facilitators invite members to bring their own personal material to inform the agenda rather than material being presented by facilitators. Individuals are expected to be transparent and open about their progress in treatment and to talk about any issues this might present both to them and others. The group encourages the sharing of many different perspectives rather than one person having the right answer. This process helps to replicate the different perspectives that might be held in families. Through sharing different perspectives group members are able to see that there are many possibilities. Group members contribute their own strengths and resources to support and facilitate each other. The group also aims to provide a protected space whereby any issues pertaining to group dynamics and dilemmas can be openly addressed.

Goal-setting is a consistent weekly group run by the occupational therapy team. Held on a Monday afternoon, it enables members to choose a goal they wish to work towards in the coming week. The facilitator encourages members to set goals in the context of their medium to long term aims. In particular individuals are encouraged to challenge themselves to achieve a goal that their eating disorder has prevented them from completing, e.g. eating a difficult food, going for a meal with a friend or preparing a meal for themselves in Cotswold House.

This group is run by psychologists and based on the Motivational model. Rather than being aimed at problem solving or change, it is an opportunity for people to reflect on where they are at in the Motivational Cycle and to consider the role of their Eating disorder plays in their lives.

The exercises use a range of modalities including: group tasks, role plays, sculpts, letters, artwork and metaphors which are used to explore topics such as how life would be in the future with or without their Eating Disorder, how it impacts on choices, social life, their family and work. It validates the struggle treatment entails and the pros and cons engaging in this process.

Patient feedback for this group is always positive.