Yuk Makan! Program as an Application of Cognitive Behavioral Therapy Principle to Overcome Selective Eating Problem in a 7-Year-Old Child

Background. This study aims to see the effectiveness of Cognitive Behavioral Therapy (CBT) principle to overcome selective eating problem in a 7-year-old girl. The term ‘selective eating’ refers to eating behaviors with a narrow range of food preferences although neither growth deficiencies nor abnormal physical development appear. Other behaviors that are often associated with selective eating problems include unwillingness to try new foods, strong preferences or dislike of certain foods, and only eat foods with particular preparation process. These behaviors are shown by H, a 7-year-old girl. Her selective eating behavior made her parents overwhelmed and also caused problems at school lunch activities. Behavioral-based interventions are often used in dealing with children’s selective eating behavior of various age ranges. However, it is undeniable that cognitive processes have major involvement in the formation of selective eating behaviors. Forming appropriate cognitive structure is crucial for children in order to acquire autonomy and self-determination in the future. Based on above statement, the ideal intervention to overcome selective eating problem have to facilitate participants to access their full awareness and way of thinking about eating problems that they are facing. Therefore, the principle of CBT is considered as the most appropriate basis for addressing this case of selective eating.

Methods. This study is a quasi-experimental with single case subject (n=1). Participant was taken by accidental sampling. She is a client in Klinik Terpadu, Faculty of Psychology Universitas Indonesia. Researchers develop intervention program Yuk Makan! with references from The BUFFET Program by Kuschner et al. (2017). Yuk Makan! program has a total of 9 sessions, consisting of 5 psychoeducation sessions and 4 exposure sessions. The duration of each session ranges from 30-90 minutes. The program begins in the second week of July 2018 and will last until the second week of August 2018. Using pretest-posttest one-group research design, the measurements of selective eating behavior are performed at the baseline phase (pretest) and right after the last intervention session has given (posttest). The instruments used are Child Behavior Check List (CBCL) and Children's Eating Behavior Questionnaire (CEBQ). To see the effectiveness of the program, the pretest and posttest results are compared using the visual analysis method. Quantitatively, the final target of the intervention is the decrease in internalizing behavior score on CBCL, as well as the increase in enjoyment of food score and the decrease of food fussiness score on CEBQ. Qualitatively, participant is expected to be able to eat new food/disliked food in a whole form.

Results. Until the beginning of third week of July 2018, researchers have conducted baseline and the first session. At the first session, participant shared about the disliked food along with its characteristics (the food group, taste, smell, texture, and how to eat it). Furthermore, participant is directed to share her thoughts, feelings, and the effects felt on her body when she faced the disliked food. To help participant visualized the food easily, researcher provided real picture of the food. Participant is then invited to write down the reason for not liking the food in Makanan ini Musuhku section.

Conclusions. As participant succeeded to fulfill the success indicator of the first session, in the form of writing down the reason for not liking the food in Makanan ini Musuhku section, shows that participant has been able to identify negative thoughts that underlie her dislike of food. She was also able to identify what is felt in her body when facing her disliked food.

Added-Values. Application of CBT principles in the area of ​​eating behavior often used to overcome clinical eating disorders, such as anorexia. Those applications are also often aimed at adolescents and adults. Meanwhile, application of CBT principles for children is rarely found in ​​eating problems area, but rather in other problems such as trauma handling and anxiety. A CBT program targeting selective eating problem in children—which is used as reference by researcher—specifically targeted children with ASD and also performed in groups. Therefore, this study is expected to add information on the application of CBT principles to address selective eating problem in children with typical development, carried out individually, and also fully tailored to specific conditions of participant and habits that often appear in Indonesian society.

Keywords: CBT; selective eating; children

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