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Waples L, Giombini L, Wiseman M, Nesbitt S. Psychological changes in young people with anorexia nervosa during an inpatient treatment: exploration of optimal length of stay predictors. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:19-27. [PMID: 33871834 DOI: 10.1007/s40211-021-00390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The current study aimed to monitor psychological changes in young people (YP) with anorexia nervosa (AN) during a specialist inpatient treatment in order to explore possible predictors of an optimal length of stay. Outcome measures were analysed to determine if significant changes occur earlier or later on during the treatment. METHODS Eating Disorder Examination Questionnaire (EDE-Q), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory (STAI) and Compulsive Exercise Test (CET) measures administered to YP (n = 42) at three time points-admission, 85% ideal body weight (IBW) and discharge-were analysed using linear mixed effects model and regression analysis to determine change between the time points and possible predictors in length of stay. RESULTS Significant improvements occurred between admission and the mid time point of 85% IBW in the eating disorder (ED) symptomology outcome measures of EDE‑Q (mean difference [MD] = 1.066 ± 0.259) and CET (MD = 1.743 ± 0.627). A significant improvement occurred in the CDI (MD = 7.714 ± 2.343), and STAI (MD = 5.292 ± 2.121) measures between admission and discharge. CONCLUSIONS Psychological changes occur at different stages of treatment. Although it was difficult to determine what factors may predict the length of stay from the variables explored, it was observed that a lower weight at admission impacted negatively on the improvement of ED and anxiety symptoms, which may lead to stay in treatment for longer. Also, higher levels of compulsive exercise and depression were associated to worse outcomes. LEVEL IV Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
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Affiliation(s)
| | - Lucia Giombini
- Eating Disorders Service for Children and Adolescents, Elysium Healthcare, Rhodes Wood Hospital, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Malcolm Wiseman
- Eating Disorders Service for Children and Adolescents, Elysium Healthcare, Rhodes Wood Hospital, London, UK
| | - Sophie Nesbitt
- Eating Disorders Service for Children and Adolescents, Elysium Healthcare, Rhodes Wood Hospital, London, UK
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102
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Flatt RE, Miller AJ, Foreman T, Shannon J. Considerations for Athletes with Eating Disorders Based on Levels of Care. Curr Sports Med Rep 2022; 21:92-99. [PMID: 35245244 DOI: 10.1249/jsr.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT This article provides an overview of levels of care for eating disorders (EDs) and considerations that are specific to elite athletes. We discuss the following levels of care in terms of ED pathology and treatment aspects that may be unique to athletes: 1) inpatient and residential care, 2) intensive outpatient and partial hospitalization treatment, and 3) outpatient. Illustrative case studies also are presented to highlight distinctions between levels of care and athlete-specific nuances to treatment approaches and health care teams. Finally, we review aspects of return to play plans for elite athletes with EDs.
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Affiliation(s)
| | - Alexandra J Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tonya Foreman
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeni Shannon
- Department of Sports Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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103
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Simic M, Stewart CS, Konstantellou A, Hodsoll J, Eisler I, Baudinet J. From efficacy to effectiveness: child and adolescent eating disorder treatments in the real world (part 1)-treatment course and outcomes. J Eat Disord 2022; 10:27. [PMID: 35189967 PMCID: PMC8862310 DOI: 10.1186/s40337-022-00553-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Findings from randomised control trials inform the development of evidence-based eating disorder (ED) practice guidelines internationally. Only recently are data beginning to emerge regarding how these treatments perform outside of research settings. This study aimed to evaluate treatment pathways and outcomes for a specialist child and adolescent ED service across a five-year period. METHODS All consecutive referrals between August 2009 and January 2014 seen at the Maudsley Centre for Child and Adolescent Eating Disorders in London were included. Data are reported on for all young people who were offered treatment (N = 357). RESULTS Most young people referred to the service were diagnosed with anorexia nervosa (AN)/Atypical AN (81%). Treatment for AN/Atypical AN (median 11 months) was predominantly ED focused family therapy (99%). Treatment for bulimia nervosa (BN)/Atypical BN (median seven months) was most commonly a combination of cognitive behavioural therapy and ED focused family therapy (87%). At discharge, 77% of the AN/Atypical AN group had a good or intermediate outcome and 59% of the BN/Atypical BN group reported no or fewer than weekly bulimic episodes. 27% of the AN/Atypical AN group had enhanced treatment with either day- and/or inpatient admissions (AIM group). The %mBMI at 3 months of treatment was strongest predictor of the need for treatment enhancement and more modestly EDE-Q and age at assessment. The AIM group at assessment had significantly lower weight, and higher ED and comorbid symptomatology and went on to have significantly longer treatment (16 vs. 10 months). At discharge, this group had significantly fewer good and more poor outcomes on the Morgan Russell criteria, but similar outcomes regarding ED and comorbid symptoms and quality of life. When analysis was adjusted for %mBMI at assessment, 1 and 3 months of treatment, differences in Morgan Russell outcomes and %mBMI were small and compatible with no difference in outcome by treatment group. CONCLUSIONS This study shows that outcomes in routine clinical practice in a specialist community-based service compare well to those reported in research trials. The finding from research trials that early weight gain is associated with improved outcomes was also replicated in this study. Enhancing outpatient treatment with day treatment and/or inpatient care is associated with favourable outcome for most of the young people, although a longer duration of treatment is required.
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Affiliation(s)
- Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| | - Catherine S Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - John Hodsoll
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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104
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Eating Disorder Day Programs: Is There a Best Format? Nutrients 2022; 14:nu14040879. [PMID: 35215529 PMCID: PMC8878899 DOI: 10.3390/nu14040879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
The use of a Day Program (DP) format (i.e., intensive daily treatment with no overnight admission) has been shown to be an effective treatment for eating disorders (EDs). The disadvantages, however, include higher cost than outpatient treatment (including costs of meals and staff), greater disruption to patients’ lives, and the use of a highly structured and strict schedule that may interrupt the development of patients’ autonomy in taking responsibility for their recovery. This study investigated whether reducing costs of a DP and the disruption to patients’ lives, and increasing opportunity to develop autonomy, impacted clinical outcomes. Three sequential DP formats were compared in the current study: Format 1 was the most expensive (provision of supported dinners three times/week and extended staff hours); Format 2 included only one dinner/week and provision of a take-home meal. Both formats gave greater support to patients who were not progressing well (i.e., extended admission and extensive support from staff when experiencing feelings of suicidality or self-harm). Format 3 did not provide this greater support but established pre-determined admission lengths and required the patient to step out of the program temporarily when feeling suicidal. Fifty-six patients were included in the analyses: 45% were underweight (body mass index (BMI) < 18.5), 96.4% were female, 63% were given a primary diagnosis of anorexia nervosa (or atypical anorexia nervosa), and mean age was 25.57 years. Clinical outcomes were assessed using self-reported measures of disordered eating, psychosocial impairment, and negative mood, but BMI was recorded by staff. Over admission, 4- and 8-week post-admission, and discharge there were no significant differences between any of the clinical outcomes across the three formats. We can tentatively conclude that decreasing costs and increasing the opportunities for autonomy did not negatively impact patient outcomes, but future research should seek to replicate these results in other and larger populations that allow conclusions to be drawn for different eating disorder diagnostic groups.
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105
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Reilly EE, Brown TA, Arunagiri V, Kaye WH, Wierenga CE. Exploring changes in alexithymia throughout intensive dialectical behavior therapy for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2022; 30:193-205. [PMID: 35137501 DOI: 10.1002/erv.2887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Alexithymia is proposed as a prominent clinical feature of eating disorders (EDs). However, despite theoretical reason to believe that alexithymia could interfere with the success of treatments, few studies have tested whether alexithymia changes over the course of treatment. The goals of the current study were to evaluate (a) changes in alexithymia over the course of intensive Dialectical Behaviour Therapy (DBT) for EDs, and (b) associations between alexithymia and ED symptoms over time. METHOD A mixed-diagnostic group of patients with EDs (N = 894) completed the Eating Disorders Examination-Questionnaire (EDE-Q) and the Toronto Alexithymia Scale (TAS-20) throughout intensive treatment and at various lengths of follow-up (6, 12, 24 months). RESULTS Results suggested that even after controlling for relevant covariates, there were significant decreases in alexithymia from intake to discharge and discharge to follow-up. Models exploring changes in self-reported ED symptoms indicated that TAS-20 scores significantly related to ED symptoms across timepoints, such that greater alexithymia was associated with greater severity of symptoms. CONCLUSIONS Altogether, findings support an association between alexithymia and ED symptoms over treatment and suggest that emotion-focussed therapies like DBT may result in decreases in alexithymia. Future research should explore whether this effect is consistent across therapies without an emotional focus.
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Affiliation(s)
- Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA.,Eating Disorders Center for Treatment and Research, University of California, San Diego, San Diego, California, USA
| | - Vinushini Arunagiri
- Department of Psychology, Hofstra University, Hempstead, New York, USA.,Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | - Walter H Kaye
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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106
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Gil M, Simões MDM, Oliveira-Cardoso ÉAD, Pessa RP, Leonidas C, Santos MAD. Percepção de familiares de pessoas com transtornos alimentares acerca do tratamento: uma metassíntese da literatura. PSICOLOGIA: TEORIA E PESQUISA 2022. [DOI: 10.1590/0102.3772e38417.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumo Relações familiares parecem ter uma contribuição relevante na etiopatogenia dos transtornos alimentares (TAs), o que faz com que as diretrizes internacionais de tratamento recomendem a participação da família. Esta metassíntese teve como objetivo sintetizar e reinterpretar os resultados de estudos qualitativos primários sobre a percepção de familiares de pessoas com TAs acerca do tratamento. A estratégia de busca foi organizada utilizando-se a ferramenta SPIDER e as análises foram realizadas por dois revisores independentes. A partir de 1.115 estudos originariamente recuperados de 6 bases de dados (CINAHL, LILACS, PsycINFO, PubMed, Scopus e Web of Science), foram selecionados 19 artigos. Os resultados convergem para o reconhecimento de que a família é parte do processo saúde-doença e precisa ser considerada como destinatária de cuidados, não apenas como coadjuvante/acompanhante no cuidado à pessoa acometida. Como a dinâmica familiar tem contribuição relevante no desenvolvimento e na manutenção dos TAs, é necessário investir na transformação das relações familiares para que se possam obter ganhos mais efetivos e duradouros no tratamento.
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107
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Runge E, Jensen EK, Mathiasen K, Larsen PV, Hertz SPT, Holmberg TT, Tarp K, Linnet J, Lichtenstein MB. Early development of treatment motivation predicts adherence and symptom reduction in an internet-based guided self-help program for binge eating disorder. Front Psychiatry 2022; 13:969338. [PMID: 36276339 PMCID: PMC9583526 DOI: 10.3389/fpsyt.2022.969338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/14/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Lack of motivation is widely acknowledged as a significant factor in treatment discontinuity and poor treatment outcomes in eating disorders. Treatment adherence is lower in internet-based treatment. The current study aimed to assess the relationship between treatment motivation and treatment outcomes in an internet-based therapist-guided intervention for Binge Eating Disorder (BED). METHOD Adults (N = 153) with mild to moderate symptoms of BED participated in a 10-session internet-based treatment program. Baseline and between-session scores of "Readiness to change" and "Belief in change" were used to predict treatment completion and eating disorder symptom reduction (EDE-Q Global, BED-Q, and weekly number of binge eating episodes) at post-treatment. RESULTS Baseline treatment motivation could not predict treatment completion or symptom reduction. Early measures of treatment motivation (regression slope from sessions 1-5) significantly predicted both treatment completion and post-treatment symptom reduction. "Belief in change" was the strongest predictor for completing treatment (OR = 2.18, 95%-CI: 1.06, 4.46) and reducing symptoms (EDE-Q Global: B = -0.53, p = 0.001; number of weekly binge eating episodes: B = 0.81, p < 0.01). DISCUSSION The results indicated that patients entering online treatment for BED feel highly motivated. However, baseline treatment motivation could not significantly predict treatment completion, which contradicts previous research. The significant predictive ability of early measures of treatment motivation supports the clinical relevance of monitoring the development of early changes to tailor and optimize individual patient care. Further research is needed to examine treatment motivation in regard to internet-based treatment for BED with more validated measures.
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Affiliation(s)
- Eik Runge
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark
| | - Esben Kjems Jensen
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kim Mathiasen
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pia Veldt Larsen
- Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Søren Peter Thygesen Hertz
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark
| | - Trine Theresa Holmberg
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark
| | - Kristine Tarp
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jakob Linnet
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Clinic on Gambling- and Binge Eating Disorder, Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Mia Beck Lichtenstein
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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108
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Gil M, Simões MDM, Oliveira-Cardoso ÉAD, Pessa RP, Leonidas C, Santos MAD. Perception of family members of people with eating disorders about treatment: a metasynthesis of the literature,. PSICOLOGIA: TEORIA E PESQUISA 2022. [DOI: 10.1590/0102.3772e38417.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract Family relationships seem to have a relevant contribution to the etiopathogenesis of eating disorders (EDs), which makes the international treatment guidelines recommend family participation. This study aimed to synthesize and reinterpret the findings of primary qualitative studies about the perception of family of people with EDs about treatment. The search strategy was organized using the SPIDER tool, and the analyzes were carried out by two independent reviewers. From 1115 studies originally retrieved from six databases (CINAHL, LILACS, PsycINFO, PubMed, Scopus and Web of Science), 19 articles were selected. The results converge to the recognition that the family is part of the process and also needs to be considered as a care recipient, not just as a coadjuvant/companion for the patient. Since family dynamics have a relevant contribution in the development and maintenance of EDs, it is necessary to invest in the transformation of family relationships so that more effective and lasting gains in treatment can be obtained.
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109
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Bijsterbosch JM, Keizer A, Boelen PA, van den Brink F, Danner UN, Sternheim LC. How deep is your thought? The relations between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa. J Eat Disord 2021; 9:164. [PMID: 34930469 PMCID: PMC8686596 DOI: 10.1186/s40337-021-00523-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Inherent to anorexia nervosa are repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. The relation between these cognitive processes and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study investigated associations between prospective (desire for predictability) and inhibitory (uncertainty paralysis) intolerance of uncertainty, and weight and shape concerns and the mediating role of worry in these associations. METHODS In a cross-sectional study, 93 adolescent girls with anorexia nervosa completed questionnaires measuring the variables of interest. A mediation model with worry as a mediator between inhibitory and prospective intolerance of uncertainty and weight and shape concerns was tested. RESULTS A total and direct effect of inhibitory intolerance of uncertainty on weight and shape concerns was found. Worry did not mediate this relation. CONCLUSIONS These results confirm the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls with anorexia nervosa. Adolescent girls with anorexia nervosa often experience repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and is often divided into two components; prospective intolerance of uncertainty (desire for predictability) and inhibitory intolerance of uncertainty (uncertainty paralysis). The relation between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study aims to investigate study relations between prospective and inhibitory intolerance of uncertainty, worry, and weight and shape concerns. A total of 93 adolescent girls with anorexia nervosa completed three questionnaires, measuring prospective and inhibitory intolerance of uncertainty worry, and weight and shape concerns, respectively. The results of this study confirmed the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls.
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Affiliation(s)
- Jojanneke M Bijsterbosch
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - Anouk Keizer
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- ARQ Centrum'45, Diemen, The Netherlands
| | - Femke van den Brink
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Unna N Danner
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Rintveld Center for Eating Disorders, Altrecht, Zeist, The Netherlands
| | - Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
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110
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McMaster CM, Wade T, Franklin J, Waller G, Hart S. Impact of patient characteristics on clinicians' decisions to involve dietitians in eating disorder treatment. J Hum Nutr Diet 2021; 35:512-522. [PMID: 34908196 DOI: 10.1111/jhn.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS Dietetic involvement in eating disorder (ED) treatment is often initiated by other members of a patient's treating team. This study aimed to examine the impact of patient characteristics on clinicians' decisions to involve a dietitian in a patient's ED treatment, as well as the influence of clinician characteristics on their decision-making. METHODS ED clinicians were recruited to complete an online survey, which used case vignettes to assess their likelihood of referring patients to a dietitian or consulting with a dietitian for guidance. Questions were also included measuring clinician anxiety, beliefs about the therapy they deliver, beliefs about dietitians and views on evidence-based practice, to determine if these were related to their responses to case vignettes. RESULTS Fifty-seven clinicians completed the survey, with the largest group being clinical psychologists (n=22, 39%). ED diagnosis, weight status, medical co-morbidities and progress in treatment were all shown to be influential on whether clinicians involved dietitians in ED treatment. Clinician characteristics and their beliefs about dietitians were generally not correlated with the likelihood of seeking dietetic input. CONCLUSIONS This study indicates that clinicians' decisions to involve dietitians in ED treatment are systematic rather than random decisions influenced by individual clinician characteristics. Clinicians require further education on the potential for malnutrition regardless of patients'ED diagnosis or weight status, and the dietitian's role in addressing this. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Caitlin M McMaster
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
| | - Tracey Wade
- Blackbird Initiative, Órama Institute, Flinders University, Adelaide, South Australia, Australia
| | - Janet Franklin
- Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Susan Hart
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, New South Wales, Australia.,Nutrition and Dietetics Department, St Vincent's Hospital, Sydney, New South Wales, Australia
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111
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Cascino G, Marciello F, Abbate-Daga G, Balestrieri M, Bertelli S, Carpiniello B, Corrivetti G, Favaro A, Renna C, Ricca V, Salvo P, Segura-Garcia C, Todisco P, Volpe U, Zeppegno P, Monteleone P, Monteleone AM. How Is the History of Early Traumatic Exposure Associated With the Psychopathological Outcomes of COVID-19 Related Lockdown and Subsequent Re-opening in People With Eating Disorders? Front Psychiatry 2021; 12:789344. [PMID: 34955933 PMCID: PMC8692284 DOI: 10.3389/fpsyt.2021.789344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
The negative impact of COVID-19 pandemic on people with Eating Disorders (EDs) has been documented. The aim of this study was to evaluate whether a history of traumatic experiences during childhood or adolescence was associated with a higher degree of psychopathological worsening during COVID-19 related lockdown and in the following re-opening period in this group of people. People with EDs undergoing a specialist ED treatment in different Italian services before the spreading of COVID-19 pandemic (n = 312) filled in an online survey to retrospectively evaluate ED specific and general psychopathology changes after COVID-19 quarantine. Based on the presence of self-reported traumatic experiences, the participants were split into three groups: patients with EDs and no traumatic experiences, patients with EDs and childhood traumatic experiences, patients with EDs and adolescent traumatic experiences. Both people with or without early traumatic experiences reported retrospectively a worsening of general and ED-specific psychopathology during the COVID 19-induced lockdown and in the following re-opening period. Compared to ED participants without early traumatic experiences, those with a self-reported history of early traumatic experiences reported heightened anxious and post-traumatic stress symptoms, ineffectiveness, body dissatisfaction, and purging behaviors. These differences were seen before COVID-19 related restrictions as well as during the lockdown period and after the easing of COVID-19 related restrictions. In line with the "maltreated ecophenotype" theory, these results may suggest a clinical vulnerability of maltreated people with EDs leading to a greater severity in both general and ED-specific symptomatology experienced during the exposure to the COVID-19 pandemic.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Turin, Italy
| | | | - Sara Bertelli
- Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Angela Favaro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Caterina Renna
- Mental Health Department, Center for the Treatment and Research on Eating Disorders, ASL Lecce, Lecce, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Pierandrea Salvo
- Eating Disorders Centre Portogruaro, AULSS 4 Veneto Orientale, San Donà di Piave, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura “Villa Margherita”, Arcugnano, Italy
| | - Umberto Volpe
- Section of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Università Politecnica delle Marche, Ancona, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatry Institute, Università del Piemonte Orientale, Novara, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
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112
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Baudinet J, Eisler I, Dawson L, Simic M, Schmidt U. Multi-family therapy for eating disorders: A systematic scoping review of the quantitative and qualitative findings. Int J Eat Disord 2021; 54:2095-2120. [PMID: 34672007 PMCID: PMC9298280 DOI: 10.1002/eat.23616] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study reviewed the quantitative and qualitative evidence-base for multi-family therapy (MFT) for eating disorders regarding change in physical and psychological symptoms, broader individual and family factors, and the experience of treatment. METHOD A systematic scoping review was conducted. Four databases (PsycInfo, Medline, Embase, CENTRAL) and five grey literature databases were searched on 24th June 2021 for relevant peer-reviewed journal articles, book chapters, and dissertations. No beginning time-point was specified. Only papers that presented quantitative or qualitative data were included. No restrictions on age or diagnosis were imposed. Studies were first mapped by study design, participant age, and treatment setting, then narratively synthesized. RESULTS Outcomes for 714 people who received MFT across 27 studies (one mixed-method, 17 quantitative and nine qualitative) were synthesized. MFT is associated with improvements in eating disorder symptomatology and weight gain for those who are underweight. It is also associated with improvements in other individual and family factors including comorbidities, self-esteem, quality of life, and some aspects of the experience of caregiving, although these findings are more mixed. MFT is generally experienced as both helpful and challenging due to the content addressed and intensive group process. DISCUSSION MFT is associated with significant improvements in eating disorder symptoms across the lifespan and improvement in broader individual and family factors. The evidence base is small and studies are generally underpowered. Larger, higher-quality studies are needed, as is research investigating the unique contribution of MFT on outcomes, given it is typically an adjunctive treatment.
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Affiliation(s)
- Julian Baudinet
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN)King's College LondonLondonUK,Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED)South London and Maudsley NHS Foundation TrustLondonUK
| | - Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN)King's College LondonLondonUK,Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED)South London and Maudsley NHS Foundation TrustLondonUK
| | - Lisa Dawson
- Eating Disorder ServiceWestmead Children's Hospital, Sydney Children's Hospital NetworkSydneyNew South WalesAustralia
| | - Mima Simic
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN)King's College LondonLondonUK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN)King's College LondonLondonUK,Adult Eating Disorders ServiceSouth London and Maudsley NHS Foundation Trust, De Crespigny ParkDenmark Hill, LondonUK
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113
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Baseline Predictors of Adherence in a Randomised Controlled Trial of a New Group Psychological Intervention for People with Recurrent Binge Eating Episodes Associated to Overweight or Obesity. Nutrients 2021; 13:nu13114171. [PMID: 34836429 PMCID: PMC8619452 DOI: 10.3390/nu13114171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose: Understanding the high rate of treatment adherence in trials of people with eating disorders is important as it can compromise the quality of the trials. In clinical practice, it may also contribute to illness chronicity, relapse, and costs. Thus, we investigated factors associated with adherence to a new treatment HAPIFED, which integrates cognitive behavioural therapy having extended sessions with body weight loss therapy compared to cognitive behavioural therapy with extended sessions alone, for individuals with Bulimia Nervosa or Binge Eating Disorder or other eating disorders comorbid with overweight or obesity. Methods: In total, 98 participants having bulimia nervosa, binge eating disorder and other specified and unspecified eating disorders were recruited with 50 randomised to HAPIFED and 48 to the control intervention CBT-E, all administered in groups of up to 10 participants. An investigator external to the site conducted the random allocation, which was concealed from the statistician involved in the analysis, and known only to the therapists until the finalization of the 12-month follow-up after the end of active treatment. Three scenarios in the timeline treatment of a total of 30 sessions were assessed: 33% or 60% or 75% of presence. Mixed-effects logistic regression analysis was performed to find the correlates of adherence after adjusting for clustering by number of group participants. To account for heterogeneity by types of eating disorders in the sample, the latter variable was considered as a control factor in the models. A subgroup analysis was performed for those with binge eating disorder as this was the largest (N = 66) eating disorder group. Results: None of the six variables—frequency of binge eating episodes, purging, eating disorder symptom severity, weight, illness duration and mental health-related quality of life—significantly predicted adherence at 33%, but longer illness duration predicted higher treatment adherence at both 60% and 75% presence of the interventions. Also for 75% presence, higher body weight predicted lower treatment adherence. For the subgroup analysis, those having higher illness duration had significantly higher odds of treatment adherence for 60% and 75% of the sessions. Conclusions: Higher adherence due to late treatment completion was associated with longer binge eating illness length and a lower body weight. More research is needed to recognize factors that may interfere with engagement in treatments aiming to avoid early dropout.
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114
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Asl EM, Mahaki B, Bardezard YA, Mohammadian Y. Eating Disorders Screening Tools: The Psychometric Properties of the Persian version of Eating Attitude Test. Int J Prev Med 2021; 12:122. [PMID: 34760133 PMCID: PMC8551774 DOI: 10.4103/ijpvm.ijpvm_355_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Screening for eating disorders via reliable instruments is of high importance for clinical and preventive purposes. Examining the psychometric properties of tools in societies with differing dynamics can help with their external validity. This research specifically aimed at standardization and validation of the eating attitude test (EAT-16) in Iran. Methods: The Persian version of the EAT-16 was produced through forward translation, reconciliation, and back translation. The current research design was descriptive cross-sectional (factor analysis). A total of 302 nonclinical students were selected through the convenience sampling method and completed a set of questionnaires. The questionnaires included, the EAT-16, eating beliefs questionnaire-18 (EBQ-18), difficulties in emotion regulation scale-16 (DERS-16), weight efficacy lifestyle questionnaire-short form, self-esteem scale, and self-compassion scale short-form. The construct validity of the EAT-16 was assessed using confirmatory factor analysis and divergent and convergent validity. Internal consistency and test–retest reliability (2 weeks’ interval) were used to evaluate the reliability. Data analysis was conducted using LISREL (version 8.8) and SSPS (version 22) software. Results: EAT-16 and subscales were found to be valid and reliable, with good internal consistency and good, test–retest reliability in a non-clinical sample. In terms of convergent validity, EAT-16 and subscales showed a positive correlation with the selfreport measures of EBQ-18 and DERS-16. EAT-16 and subscales showed a negative correlation with self-compassion, self-esteem and eating self-efficacy., Therefore, it demonstrated divergent validity with these constructs. The results of this study support the EAT-16 four-factor model. Conclusions: The EAT-16 showed good validity and reliability and could be useful in assessing eating disorders in Iranian populations. The EAT-16 is an efficient instrument that is suitable for screening purposes in the nonclinical samples.
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Affiliation(s)
- Esmaeil Mousavi Asl
- Department of Psychiatry, Golestan Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behzad Mahaki
- Department of Biostatistics, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yousef Asmari Bardezard
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Youkhabeh Mohammadian
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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115
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Why Do Women with Eating Disorders Decline Treatment? A Qualitative Study of Barriers to Specialized Eating Disorder Treatment. Nutrients 2021; 13:nu13114033. [PMID: 34836288 PMCID: PMC8623214 DOI: 10.3390/nu13114033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Despite the fact that eating disorders (EDs) are conditions that are potentially life-threatening, many people decline treatment. The aim of this study was to investigate why women decline specialized ED treatment, including their viewpoints on treatment services. Eighteen semi-structured qualitative interviews were conducted with women who had declined inpatient or outpatient specialized ED treatment. A thematic analysis revealed five main themes: (1) Disagreement on treatment needs, (2) rigid standard procedures, (3) failure to listen, (4) deprivation of identity, and (5) mistrust and fear. The women had declined ED treatment because they believed that treatment was only focused on nutritional rehabilitation and that it failed to address their self-identified needs. From their perspectives treatment was characterized by rigid standard procedures that could not be adapted to their individual situations and preferences. They felt that the therapists failed to listen to them, and they felt deprived of identity and reduced to an ED instead of a real person. This investigation is one of the first of its kind to provide clues as to how treatment could be moderated to better meet the needs of women who decline specialized ED treatment.
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116
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Quiles Y, Quiles MJ, León EM, Roncero M, Ruiz Á, España M, Romero C, Elvira V. Adaptation and Implementation of an Intervention Programme on Spanish Carers and Adolescent Patients With an Eating Disorder: Study Protocol of a Randomized Controlled Trial. Front Psychol 2021; 12:697916. [PMID: 34744864 PMCID: PMC8569943 DOI: 10.3389/fpsyg.2021.697916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: One of the major problems with inpatient treatment of adolescent girls with an eating disorder (ED) is that the strategies learned during their hospital stay are not easily applied or maintained in their daily lives, and this has been related to high rates of relapse and readmission. The ECHOMANTRA programme was developed to optimize outcomes during and following inpatient or day-patient treatment. ECHOMANTRA is based on interventions for carers (Experienced Carers Helping Others, ECHO) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA) and is developed from the cognitive interpersonal model of anorexia (Schmidt and Treasure, 2006; Treasure and Schmidt, 2013). This study aims to describe the study protocol of a randomized controlled trial (RCT) for evaluating the efficacy of an adaptation of a novel intervention for patients and carers (ECHOMANTRA) to be implemented as an add-on to treatment-as-usual (TAU). Method: In a multi−center pilot RCT, 80 female adolescent patients with a DSM-5 diagnosis of an ED and their carers will be invited to participate in the study. They will then be randomized to receive either the ECHOMANTRA intervention as an add-on to TAU or TAU alone. A repeated measures design will be conducted across four time points. Primary outcomes will be patient psychological well-being and eating disorder symptoms, and secondary outcomes will include body mass index, obsessive-compulsive symptoms, perfectionism, motivation to change and psychosocial adjustment. For carers, outcome variables will include psychological well-being, expressed emotion, accommodation and enabling behaviors, burden, and care skills. Discussion: The results from this trial will establish the effectiveness of ECHOMANTRA and may reveal whether and to what extent this novel intervention can optimize outcomes during and following inpatient treatment. This study will also provide the adaptation of the ECHOMANTRA in the Spanish context for inpatient/day-care treatment.
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Affiliation(s)
- Yolanda Quiles
- Department of Behavioral Sciences and Health, University Miguel Hernández, Elche, Spain
| | - María José Quiles
- Department of Behavioral Sciences and Health, University Miguel Hernández, Elche, Spain
| | - Eva María León
- Department of Behavioral Sciences and Health, University Miguel Hernández, Elche, Spain
| | - María Roncero
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Álvaro Ruiz
- Department of Behavioral Sciences and Health, University Miguel Hernández, Elche, Spain
| | - Maite España
- Department of Personality, Assessment and Psychological Treatment, University of Murcia, Murcia, Spain
| | - Cristina Romero
- Unit of Eating Disorders, University Hospital of San Juan de Alicante, Alicante, Spain
| | - Vicente Elvira
- Unit of Eating Disorders, University Hospital of San Juan de Alicante, Alicante, Spain
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117
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Peters K, Meule A, Voderholzer U, Rauh E. Effects of interval-based inpatient treatment for anorexia nervosa: An observational study. Brain Behav 2021; 11:e2362. [PMID: 34543514 PMCID: PMC8613410 DOI: 10.1002/brb3.2362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/24/2021] [Accepted: 09/02/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE After inpatient treatment for anorexia nervosa (AN), many patients relapse and need to be readmitted. To obtain a sustained improvement, a pre-planned multistep inpatient procedure might help to improve the patient's skills in dealing with symptoms and transdiagnostic problems, thus decreasing symptoms of AN. However, no data have been reported for such interval treatment yet. Therefore, this study examined effects of interval treatment in inpatients with AN. METHOD Data of adult women with AN (N = 304) who received inpatient treatment and either received interval treatment (n = 179) or not (n = 125) were analyzed. Of these, 225 patients completed a follow up measurement after an average of 25 months. Treatment outcome variables were body mass index and subscales of the Eating Disorder Inventory-2 at admission, discharge, and follow up. RESULTS Across measurements, the interval treatment group had larger increases in body mass index and larger decreases in drive for thinness and binge/purge symptoms than the no interval treatment group. These differences did not seem to be driven by longer treatment duration. DISCUSSION Our data suggest that interval treatment for AN is effective and may even be superior to conventional single inpatient treatment. Given the observational nature of this study, however, controlled studies are necessary to corroborate these findings.
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Affiliation(s)
- Kathrin Peters
- Schoen Clinic Bad Staffelstein, Bad Staffelstein, Germany.,Department of Pathopsychology, University of Bamberg, Bamberg, Germany
| | - Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| | - Elisabeth Rauh
- Schoen Clinic Bad Staffelstein, Bad Staffelstein, Germany
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118
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Abstract
PURPOSE OF REVIEW This review summarizes recent developments in cognitive-behavioural therapy for eating disorders (CBT-ED). More specifically, the past five years were covered, with the latest UK and Dutch guidelines for eating disorders as a starting benchmark, and with special consideration of the past 18 months. RECENT FINDINGS The new research can be divided into findings that have: (1) reinforced our existing understanding of CBT-ED's models and impact; (2) advanced our understanding and the utility of CBT-ED, including its application for the 'new' disorder Avoidant/Restrictive Food Intake Disorder (ARFID); (3) suggested new directions, which require further exploration in clinical and research terms. These include learning from the circumstances of the COVID-19 pandemic. SUMMARY CBT-ED has developed substantially in the past 5 years, with consolidation of its existing evidence base, further support for real-life implementation, extension of methods used, and the development of new approaches for working with younger people - particularly in the form of treatments for ARFID. Over the past 18 months, even more promising changes in delivery occurred in response to the COVID19 pandemic, showing that we can adapt our methods in order to work effectively via remote means. Challenges remain regarding poor outcomes for anorexia nervosa.
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Affiliation(s)
- Sandra Mulkens
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine, and Life Sciences, School for Mental Health and Neuroscience
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Glenn Waller
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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119
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Monteleone AM, Cardi V, Ambwani S, Cascino G, Albano G, Pellegrino F, Treasure J. Network intervention analysis to assess the trajectory of change and treatment effects associated with the use of online guided self-help for anorexia nervosa. Early Interv Psychiatry 2021; 15:1210-1216. [PMID: 33058456 DOI: 10.1111/eip.13064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/16/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to use the innovative technique of Network Intervention Analysis (NIA) to examine the trajectory of symptom change associated with the use of a digital guided self-help intervention (RecoveryMANTRA) to augment treatment as usual in adult anorexia nervosa. METHODS Self-reported eating disorder symptoms and mood (stress, anxiety and depression), work and social adjustment, motivation and treatment (Treatment as usual + RecoveryMANTRAand Treatment as usual) were included as nodes in the network and examined using NIA. Networks were computed at baseline (n = 88, 99), at end of treatment (6 weeks, n = 71, 75) and at 6- (n = 58, 63) and 12-month (n = 52, 63) follow-up. RESULTS RecoveryMANTRA was associated with a direct effect on anxiety, shape concern and restraint at the end of the intervention. This effect was not maintained at follow-up. There were no direct effects of RecoveryMANTRA on motivation, stress and depression. CONCLUSIONS These findings indicate that RecoveryMANTRA exerts a direct effect on eating disorder symptoms and anxiety. NIA is a promising method to evaluate trajectories of clinical change and direct and indirect effects of a therapeutic intervention compared to a control condition.
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Affiliation(s)
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Gaia Albano
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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120
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Grilo CM, Thompson-Brenner H, Shingleton RM, Thompson DR, Franko DL. Clinical moderators and predictors of cognitive-behavioral therapy by guided-self-help versus therapist-led for binge-eating disorder: Analysis of aggregated clinical trials. Int J Eat Disord 2021; 54:1875-1880. [PMID: 34472114 PMCID: PMC8492524 DOI: 10.1002/eat.23601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/06/2021] [Accepted: 08/24/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT)-therapist-led (CBTth) and guided-self-help (CBTgsh)-has efficacy for binge-eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods. METHOD Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treatments for BED in the U.S. Predictors and moderators of outcomes (treatment completion and binge-eating remission) were examined in N = 457 participants who received either CBTgsh (N = 164) or CBTth (N = 293). RESULTS Analyses, adjusting for demographic/clinical variables, indicated CBTth was significantly superior to CBTgsh for treatment completion (odds ratio [OR] = 20.0) and remission (OR = 14.6). For remission, analyses revealed significant predictors (age, treatment length, Weight Concern), a moderator (weight concern [OR = 5.13]), and a significant interaction between CBT-type and treatment length (OR = 2.66). For CBTgsh, longer treatment was associated with less remission, whereas for CBTth, longer treatment was associated with greater remission. For CBTgsh, 44.1% with low weight concern versus 56.3% with high weight concern achieved remission whereas for CBTth, 43.5% with high weight concern and 61.0% with low weight concern achieved remission. DISCUSSION Analyses of aggregated RCT BED data, adjusting for demographic/clinical characteristics, indicated superiority (large effect-sizes) in treatment outcomes of CBTth over CBTgsh and that Weight Concern moderated outcomes.
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Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | | | | | | | - Debra L. Franko
- Department of Applied Psychology, Northeastern University, Boston, MA
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121
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A randomized controlled trial of two 10-session cognitive behaviour therapies for eating disorders: An exploratory investigation of which approach works best for whom. Behav Res Ther 2021; 146:103962. [PMID: 34534858 DOI: 10.1016/j.brat.2021.103962] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Cognitive behaviour therapy for eating disorders (CBT-ED) outperforms other treatments for non-underweight eating disorders in adults, but we have limited ability to match CBT-ED to individual profiles. We examined if we could identify who benefits most from two forms of 10-session CBT-ED; one emphasizing early behaviour change with substantial content on improving body image (CBT-T), and the other including motivational work and no content on body image using chapters from self-help books (CBTm). Participants were 98 consecutive referrals to the Flinders University Services for Eating Disorders. Fourteen clinical psychology postgraduates delivered the treatment under expert supervision. Outcome measures were completed on five occasions: baseline, 4-, 10-, 14- and 22-weeks post-randomisation. Our primary outcome was global eating psychopathology. Moderators included motivation (readiness and confidence to change) and body avoidance and body checking. Intent-to-treat analyses showed no difference between the groups with a significant main effect of time associated with large effect size improvements, commensurate with longer forms of CBT-ED. Participants with lower readiness to change in CBTm had significantly greater decreases in disordered eating over follow-up compared to those with low motivation in CBT-T. People with lower readiness to change might benefit from the incorporation of motivational work in CBT-ED.
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122
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Austin A, Flynn M, Richards KL, Sharpe H, Allen KL, Mountford VA, Glennon D, Grant N, Brown A, Mahoney K, Serpell L, Brady G, Nunes N, Connan F, Franklin-Smith M, Schelhase M, Jones WR, Breen G, Schmidt U. Early weight gain trajectories in first episode anorexia: predictors of outcome for emerging adults in outpatient treatment. J Eat Disord 2021; 9:112. [PMID: 34521470 PMCID: PMC8439063 DOI: 10.1186/s40337-021-00448-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early response to treatment has been shown to be a predictor of later clinical outcomes in eating disorders (EDs). Specifically, early weight gain trajectories in anorexia nervosa (AN) have been shown to predict higher rates of later remission in inpatient treatment. However, no study has, as of yet, examined this phenomenon within outpatient treatment of first episode cases of AN or in emerging adults. METHODS One hundred seven patients with AN, all between the ages of 16 and 25 and with an illness duration of < 3 years, received treatment via the first episode rapid early intervention in eating disorders (FREED) service pathway. Weight was recorded routinely across early treatment sessions and recovery outcomes (BMI > 18.5 kg/m2 and eating psychopathology) were assessed up to 1 year later. Early weight gain across the first 12 treatment sessions was investigated using latent growth mixture modelling to determine distinct classes of change. Follow-up clinical outcomes and remission rates were compared between classes, and individual and clinical characteristics at baseline (treatment start) were tested as potential predictors. RESULTS Four classes of early treatment trajectory were identified. Three of these classes (n = 95), though differing in their early change trajectories, showed substantial improvement in clinical outcomes at final follow-up. One smaller class (n = 12), characterised by a 'higher' start BMI (> 17) and no early weight gain, showed negligible improvement 1 year later. Of the three treatment responding groups, levels of purging, depression, and patient reported carer expressed emotion (in the form of high expectations and low tolerance of the patient) determined class membership, although these findings were not significant after correcting for multiple testing. A higher BMI at treatment start was not sufficient to predict optimal clinical outcomes. CONCLUSION First episode cases of AN treated via FREED fit into four distinct early response trajectory classes. These may represent subtypes of first episode AN patients. Three of these four trajectories included patients with substantial improvements 1 year later. For those in the non-response trajectory class, treatment adjustments or augmentations could be considered earlier, i.e., at treatment session 12.
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Affiliation(s)
- A Austin
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK.
| | - M Flynn
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
| | - K L Richards
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
| | - H Sharpe
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - K L Allen
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - V A Mountford
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Maudsley Health, Abu Dhabi, UAE
| | - D Glennon
- South London and Maudsley NHS Foundation Trust, London, UK
| | - N Grant
- South London and Maudsley NHS Foundation Trust, London, UK
| | - A Brown
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - K Mahoney
- North East London NHS Foundation Trust, London, UK
| | - L Serpell
- North East London NHS Foundation Trust, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
| | - G Brady
- Central and North West London NHS Foundation Trust, London, UK
| | - N Nunes
- Central and North West London NHS Foundation Trust, London, UK
| | - F Connan
- Central and North West London NHS Foundation Trust, London, UK
| | | | - M Schelhase
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - W R Jones
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - G Breen
- Department of Social, Genetic & Developmental Psychiatry, King's College London, London, UK
| | - U Schmidt
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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123
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Stone KD, Dimitropoulos G, MacMaster FP. Food for Thought: A Dissonance Between Healthcare Utilization Costs and Research Funding for Eating Disorders in Canada. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:197-203. [PMID: 34381512 PMCID: PMC8315219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/15/2021] [Indexed: 06/13/2023]
Abstract
In this commentary, we present the premise that, in Canada, mental illness research specific to eating disorders is underfunded, and many Canadians are suffering the consequences of this underinvestment. We highlight three critical aspects of eating disorders: 1) the increasingly common yet potentially life-threatening nature of eating disorders, with an onset usually during adolescence; 2) the challenges and costs to treating eating disorders, with a discussion of current hospital-related costs across Canada; and 3) the glaring discrepancy between the money spent on eating disorder diagnoses/treatment and the funding dollars granted for eating disorder research in Canada (i.e. only $0.70 per affected Canadian in 2018). Research funding per affected individual for other psychiatric and neurodevelopmental conditions are used as comparisons (e.g. $50.17 per affected Canadian with schizophrenia). We suggest that it is time to revolutionize treatment for individuals with eating disorders and use our resources in a more efficient and effective manner, using current neuroimaging and neuromodulation methods as promising examples. We conclude by emphasizing the need for increased research funding in the field of eating disorders in Canada, as the current research-related investments hinder progress in developing neuroscientifically-sound treatments for these populations.
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Affiliation(s)
- Kayla D Stone
- Departments of Psychiatry and Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada
| | - Frank P MacMaster
- Departments of Psychiatry and Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada
- Provincial Addiction and Mental Health Portfolio, Alberta, Canada
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124
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Rose C, Bakopoulou I, Novak T. A case series of CBT-T in routine clinical practice. Int J Eat Disord 2021; 54:1549-1554. [PMID: 34137051 DOI: 10.1002/eat.23566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE CBT-T is a relatively new, brief cognitive behavioral therapy eating disorder treatment for non-underweight patients. This study evaluates CBT-T independently from the team that developed the protocol, and examines the relationship between eating disorder duration and CBT-T effectiveness. METHOD A case series design was used, comprising N = 40 adults with bulimia or atypical anorexia type eating disorders. CBT-T was delivered by CBT therapists in a specialist outpatient service. Mixed model analysis examined the interactions between eating disorder duration and change to eating disorder psychopathology and secondary impairment from pre-post treatment. Abstinence, good outcome, and remission rates were also provided. RESULTS Intervention effect sizes were large. Treatment completers reported abstinence from binge eating and purging over the final 28-days, and 7-days of treatment at 30.1%, and 73.1%, respectively; 76.9% reported good outcome; and 23.1% reported remission. No relationship between eating disorder duration and treatment effectiveness was found. DISCUSSION These findings build on existing evidence supporting provision of CBT-T in routine clinical practice, for patients with eating disorders of any duration. Replication, extension, and RCT will strengthen comparability with other evidence-based approaches.
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Affiliation(s)
- Charlotte Rose
- First Step Primary Care Eating Disorder Service, Avon and Wiltshire Partnership NHS Trust, Bristol, UK
| | | | - Tamas Novak
- School of Education, University of Bristol, Bristol, UK
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125
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Grilo CM, Gueorguieva R, Pittman B. Examining depression scores as predictors and moderators of treatment outcomes in patients with binge-eating disorder. Int J Eat Disord 2021; 54:1555-1559. [PMID: 34137474 DOI: 10.1002/eat.23569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A substantial proportion of patients with binge-eating disorder (BED) do not derive sufficient benefits from available evidence-based psychological interventions. We examined depression scores as predictors and moderators of response to cognitive-behavioral therapy (CBT) and behavioral weight-loss (BWL) for BED. We explored associations between changes in depression scores and changes in treatment outcomes. METHOD Ninety adults with BED with obesity were randomized to CBT or BWL (6 months) and were evaluated independently throughout treatment, at posttreatment, and 12-month follow-up after treatments (18 months post-randomization). Pre-treatment depression scores, early changes in depression, and changes in depression from pre- to post-treatment were tested as predictors/moderators of outcomes (binge-eating frequency and eating-disorder psychopathology). RESULTS Baseline depression scores did not predict nor moderate outcomes at post-treatment or 12-month follow-up. Changes in depression scores (both early and throughout treatment) were not associated significantly with changes in binge-eating frequency or eating-disorder psychopathology at post-treatment or 12-month follow-up. DISCUSSION Findings suggest depression scores do not predict nor moderate acute- or longer-term outcomes in patients with BED receiving CBT or BWL. Findings reinforce need to improve treatments for BED overall, although they provide confidence that patients with elevated depression scores derive benefits from existing CBT and BWL interventions.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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126
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Simpson CC, Towne TL, Karam AM, Donahue JM, Hadjeasgari CF, Rockwell R, Kaye WH. Predictors of Stepping Up to Higher Level of Care Among Eating Disorder Patients in a Partial Hospitalization Program. Front Psychol 2021; 12:667868. [PMID: 34366985 PMCID: PMC8336564 DOI: 10.3389/fpsyg.2021.667868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
Partial hospitalization programming (PHP) is a treatment option available for individuals with eating disorders (ED) who have made insufficient progress in outpatient settings or are behaviorally or medically unstable. Research demonstrates that this level of care yields efficacy for the majority of patients. However, not all patients achieve recovery in PHP and later admit to a higher level of care (HLOC) including residential treatment or inpatient hospitalization. Although PHP is an increasingly common treatment choice for ED, research concerning outcome predictors in outpatient, stepped levels of care remains limited. Thus, the current study sought to identify the predictors of patients first admitted to PHP that later enter residential or inpatient treatment. Participants were 788 patients (after exclusions) enrolled in adolescent or adult partial hospitalization programs in a specialized ED clinic. When compared to patients who maintained treatment in PHP, a significantly greater proportion of patients who discharged to a HLOC had previously received ED residential treatment. Moreover, patients who discharged to a HLOC were diagnosed with a comorbid anxiety disorder and reported greater anxious and depressive symptomatology. A logistic regression model predicting discharge from PHP to a HLOC was significant, and lower body mass index (BMI) was a significant predictor of necessitating a HLOC. Supplemental programming in partial hospitalization settings might benefit individuals with previous ED residential treatment experience, higher levels of anxiety and depression, and lower BMIs. Specialized intervention for these cases is both practically and economically advantageous, as it might reduce the risk of rehospitalization and at-risk patients needing to step up to a HLOC.
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Affiliation(s)
| | | | | | | | | | | | - Walter H. Kaye
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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127
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Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria. J Clin Med 2021; 10:jcm10143190. [PMID: 34300355 PMCID: PMC8307185 DOI: 10.3390/jcm10143190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 12/12/2022] Open
Abstract
This study evaluated the short-term outcome of a multimodal inpatient treatment concept for adolescents with anorexia nervosa (AN). In this prospective observational study, a cohort of 126 female adolescents with AN (age range: 11–17, mean age: 14.83) was longitudinally followed from admission to discharge (average duration of stay: 77 days). We used gold-standard clinical interviews and self-report data, as well as DSM-5 remission criteria, to evaluate the treatment outcome. From admission to discharge, body-mass-index (BMI) significantly improved by 2.6 kg/m2. Data from clinical interviews and self-reports yielded similar improvements in restraint eating and eating concerns (large effects). Lower effects were observed for variables assessing weight/shape concerns and drive for thinness. At discharge, 23.2% of patients showed full remission of AN, 31.3% partial remission, and 45.5% no remission according to DSM-5 criteria. Differences in remission groups were found regarding AN severity, age at admission, and use of antidepressant medication. Living with both parents, longer duration of inpatient treatment and the use of antipsychotic medication were significantly associated with higher BMI change. The findings provide evidence for the short-term effectiveness of our inpatient treatment concept. We recommend using DSM-5 based remission criteria to evaluate the treatment outcome to improve the comparability of studies.
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128
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Ling NCY, Serpell L, Burnett-Stuart S, Pugh M. Interviewing anorexia: How do individuals given a diagnosis of anorexia nervosa experience Voice Dialogue with their eating disorder voice? A qualitative analysis. Clin Psychol Psychother 2021; 29:600-610. [PMID: 34269497 DOI: 10.1002/cpp.2652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/11/2022]
Abstract
A proportion of individuals given an eating disorder diagnosis describe the experience of an eating disorder 'voice' (EDV). However, methods for working with this experience are currently lacking. Voice Dialogue (Stone & Stone, 1989) involves direct communication between a facilitator and parts of the self to increase awareness, understanding, and separation from inner voices. Adapted forms of this method have shown promise in working with voices in psychosis. This study aimed to explore the experience and acceptability of Voice Dialogue amongst individuals with anorexia nervosa who experience an EDV. Nine women participated in a semistructured interview following a single Voice Dialogue session. Interview transcripts were analysed using interpretative phenomenological analysis (IPA). Three overarching themes were identified as follows: (i) "separating from the EDV"; (ii) "better understanding of the EDV"; and (iii) "hopeful, motivated, and afraid of recovery". The majority of participants found Voice Dialogue acceptable and helpful for exploring their EDV. Whilst preliminary, the results suggest that Voice Dialogue has potential in terms of helping individuals establish a more constructive relationship with their EDV and motivating change. Further research is needed to build upon these findings. Implications for addressing the EDV using voice-focused interventions are explored.
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Affiliation(s)
- Natalie Chua Yi Ling
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sarah Burnett-Stuart
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Matthew Pugh
- Central and North West London NHS Foundation Trust, London, UK
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129
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Petersson S, Birgegård A, Brudin L, Mantilla EF, Monell E, Clinton D, Björck C. Initial self-blame predicts eating disorder remission after 9 years. J Eat Disord 2021; 9:81. [PMID: 34233765 PMCID: PMC8261969 DOI: 10.1186/s40337-021-00435-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Research into predictors of outcome in eating disorders (ED) has shown conflicting results, with few studies of long-term predictors and the possible importance of psychological variables that may act as risk- and maintenance factors. AIM To identify baseline predictors of ED remission nine years after initial clinical assessment using self-report measures of ED psychopathology, psychiatric symptoms, and self-image in a sample of adult ED patients (N = 104) treated at specialist units in Stockholm, Sweden. Sixty patients participated in the follow-up, of whom 41 patients (68%) had achieved remission. RESULTS Results suggested that the only significant predictor of diagnostic remission after nine years was initial levels of self-blame. CONCLUSION In order to ensure long-term recovery in ED it may be important for clinicians to widen their therapeutic repertoire and utilise techniques that reduce self-blame and increase self-compassion. It is difficult to predict how an eating disorder will develop, and research has found varying factors that affect the outcome of the condition. Recovery rates vary from nearly nil to over 90%. This variation could be explained by different research factors, but are more likely due to varying definitions of 'recovery', with less stringent definitions yielding high recovery rates and more stringent definitions yielding lower rates. The present study investigated whether the severity of eating disorder symptoms and other psychiatric symptoms could predict recovery nine years from first admission to specialised eating disorder care. Sixty patients at three eating disorder treatment units participated, and their scores on self-report measures of symptoms were used as predictor variables. Forty-one participants had no eating disorder diagnosis at nine-year follow-up. Most participants with binge-eating disorder had recovered, while the poorest outcome was found for anorexia nervosa with slightly over half of patients recovered after nine years. The only predictor for the nine-year outcome was a higher initial rating of self-blame, measured with the Structural Analysis of the Social Behavior. It was concluded that it may be important for clinicians to detect and address self-blame early in the treatment of eating disorders in order to enhance the possibility of recovery. Treatment should focus on reducing self-blame and increasing self-acceptance.
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Affiliation(s)
- Suzanne Petersson
- Department of Rehabilitation, Kalmar Regional Council, Hus 13, plan 7, 391 85, Länssjukhuset, Kalmar, Sweden. .,Department for Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
| | - Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Region Kalmar County, Kalmar, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Emma Forsén Mantilla
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Centre for Psychiatry Research, Stockholm Health Care Services, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elin Monell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Clinton
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Institute for Eating Disorders, Villa Sult, Oslo, Norway
| | - Caroline Björck
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
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130
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Wang SB. Machine learning to advance the prediction, prevention and treatment of eating disorders. EUROPEAN EATING DISORDERS REVIEW 2021; 29:683-691. [PMID: 34231286 DOI: 10.1002/erv.2850] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Machine learning approaches are just emerging in eating disorders research. Promising early results suggest that such approaches may be a particularly promising and fruitful future direction. However, there are several challenges related to the nature of eating disorders in building robust, reliable and clinically meaningful prediction models. This article aims to provide a brief introduction to machine learning and to discuss several such challenges, including issues of sample size, measurement, imbalanced data and bias; I also provide concrete steps and recommendations for each of these issues. Finally, I outline key outstanding questions and directions for future research in building, testing and implementing machine learning models to advance our prediction, prevention, and treatment of eating disorders.
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Affiliation(s)
- Shirley B Wang
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
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131
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Ali SI, Bodnar E, Gamberg S, Bartel SJ, Waller G, Nunes A, Dixon L, Keshen A. The costs and benefits of intensive day treatment programs and outpatient treatments for eating disorders: An idea worth researching. Int J Eat Disord 2021; 54:1099-1105. [PMID: 33825216 DOI: 10.1002/eat.23514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022]
Abstract
Outpatient care (e.g., individual, group, or self-help therapies) and day treatment programs (DTPs) are common and effective treatments for adults with eating disorders. Compared to outpatient care, DTPs have additional expenses and could have unintended iatrogenic effects (e.g., may create an overly protective environment that undermines self-efficacy). However, these potential downsides may be offset if DTPs are shown to have advantages over outpatient care. To explore this question, our team conducted a scoping review that aimed to synthesize the existing body of adult eating disorder literature (a) comparing outcomes for DTPs to outpatient care, and (b) examining the use of DTPs as a higher level of care in a stepped care model. Only four studies met the predefined search criteria. The limited results suggest that the treatments have similar effects and that outpatient care is more cost-effective. Furthermore, no studies explored the use of DTPs as a higher level of care in a stepped care model (despite international guidelines recommending this approach). Given the clear dearth of literature on this clinically relevant topic, we have provided specific avenues for further research.
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Affiliation(s)
- Sarrah I Ali
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Emma Bodnar
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Susan Gamberg
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara J Bartel
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura Dixon
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Aaron Keshen
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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132
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Rousselet M, Reinhardt H, Forestier B, Eyzop E, Lambert S, Rocher B, Gailledrat L, Hardouin JB, Grall-Bronnec M. Are marked body shape concerns associated with poorer outcomes at the one-year follow-up in anorexia nervosa? Brain Behav 2021; 11:e02199. [PMID: 34037330 PMCID: PMC8323028 DOI: 10.1002/brb3.2199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Anorexia nervosa (AN) is a complex disease in which obsessive thoughts about body image, shape, or weight are expressed. The intensity of these concerns varies among individuals, and only a few studies have focused on their impact on patients' clinical course when patients are treated on an outpatient basis. Our study aimed to determine whether marked body concerns at inclusion were predictive of the one-year follow-up. METHOD Participants (N = 72) were women seeking treatment for AN in a specialized unit for eating disorder management. All participants were assessed at inclusion and at the 1-year follow-up. Clinical outcome was assessed using the Morgan & Russel Outcome Average Score (MROAS), and body concerns were assessed using the Body Shape Questionnaires (BSQ). RESULTS Marked body concerns (BSQ score >140) at inclusion were associated with a poorer outcome at the 12-month follow-up (lower MROAS "total score"). Other characteristics at inclusion that were predictive of a poorer outcome at 12 months were as follows: higher severity of ED at inclusion, longer hospitalization during follow-up, and experiencing a lower impact of the illness on school/work life. DISCUSSION The results confirmed the importance of a multifocal treatment that should address body concerns and motivation to change. Our results also highlighted the necessity of promoting the maintenance of school/work during the treatment course.
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Affiliation(s)
- Morgane Rousselet
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France.,UMR 1246, Nantes University and Tours University, Nantes, France
| | - Hélène Reinhardt
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | | | - Emeline Eyzop
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Sylvain Lambert
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Bruno Rocher
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Lucie Gailledrat
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | | | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France.,UMR 1246, Nantes University and Tours University, Nantes, France
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133
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Wade T, Ambwani S, Cardi V, Albano G, Treasure J. Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment. Int J Eat Disord 2021; 54:1278-1282. [PMID: 33760307 DOI: 10.1002/eat.23508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome. METHOD From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses (N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty-six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12-month follow-up data. Predictors included global EDE-Q, negative affect (Depression, Anxiety, and Stress Scales) and functional impairment (Work and Social Adjustment Scale). RESULTS Good outcome was achieved by 23% of patients and remission by 15%. Good outcome was predicted by less functional impairment at baseline. DISCUSSION Further work that can identify sub-groups of patients with anorexia nervosa who do not achieve good outcome after treatment will inform the development of targeted engagement approaches.
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Affiliation(s)
- Tracey Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, South Australia, Australia
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, Pennsylvania, USA
| | - Valentina Cardi
- Department of Psychological Medicine, Kings College London, London, UK.,Department of General Psychology, University of Padova, Padova, Italy
| | - Gaia Albano
- Department of Psychological Medicine, Kings College London, London, UK.,Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Janet Treasure
- Department of Psychological Medicine, Kings College London, London, UK
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134
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Espel-Huynh H, Zhang F, Thomas JG, Boswell JF, Thompson-Brenner H, Juarascio AS, Lowe MR. Prediction of eating disorder treatment response trajectories via machine learning does not improve performance versus a simpler regression approach. Int J Eat Disord 2021; 54:1250-1259. [PMID: 33811362 PMCID: PMC8273095 DOI: 10.1002/eat.23510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patterns of response to eating disorder (ED) treatment are heterogeneous. Advance knowledge of a patient's expected course may inform precision medicine for ED treatment. This study explored the feasibility of applying machine learning to generate personalized predictions of symptom trajectories among patients receiving treatment for EDs, and compared model performance to a simpler logistic regression prediction model. METHOD Participants were adolescent girls and adult women (N = 333) presenting for residential ED treatment. Self-report progress assessments were completed at admission, discharge, and weekly throughout treatment. Latent growth mixture modeling previously identified three latent treatment response trajectories (Rapid Response, Gradual Response, and Low-Symptom Static Response) and assigned a trajectory type to each patient. Machine learning models (support vector, k-nearest neighbors) and logistic regression were applied to these data to predict a patient's response trajectory using data from the first 2 weeks of treatment. RESULTS The best-performing machine learning model (evaluated via area under the receiver operating characteristics curve [AUC]) was the radial-kernel support vector machine (AUCRADIAL = 0.94). However, the more computationally-intensive machine learning models did not improve predictive power beyond that achieved by logistic regression (AUCLOGIT = 0.93). Logistic regression significantly improved upon chance prediction (MAUC[NULL] = 0.50, SD = .01; p <.001). DISCUSSION Prediction of ED treatment response trajectories is feasible and achieves excellent performance, however, machine learning added little benefit. We discuss the need to explore how advance knowledge of expected trajectories may be used to plan treatment and deliver individualized interventions to maximize treatment effects.
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Affiliation(s)
- Hallie Espel-Huynh
- Drexel University, Philadelphia, Pennsylvania
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - J. Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode Island
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135
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Moberg LT, Solvang B, Sæle RG, Myrvang AD. Effects of cognitive-behavioral and psychodynamic-interpersonal treatments for eating disorders: a meta-analytic inquiry into the role of patient characteristics and change in eating disorder-specific and general psychopathology in remission. J Eat Disord 2021; 9:74. [PMID: 34174942 PMCID: PMC8235811 DOI: 10.1186/s40337-021-00430-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/09/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cognitive behavior therapy (CBT) and psychodynamic-interpersonal therapies (PIT) are two widely used and conceptually different outpatient treatments for eating disorders (EDs). To better understand how these treatments works, for whom, and under what circumstances, there is a need for knowledge about how outcomes are affected by diagnosis, comorbidity, changes in psychopathology, and study design. METHOD Reports on the effects of CBT and PIT for eating disorders were searched. Rates of remission and changes in ED specific- and general psychopathology were computed. Regression models were made to predict event rates by changes in specific- and general psychopathology, as well as ED diagnosis and study design. RESULTS The remission rate of CBT for binge eating disorder was 50%, significantly higher than the effect for other diagnostic groups (anorexia = 33%, bulimia: 28%, mixed samples 30%). The number of studies found for PIT was limited. All effect sizes differed from zero (binge eating disorder = 27%, anorexia = 24%, bulimia = 18%, mixed samples = 15%), but the precision of the estimates was low, with some lower-bound confidence intervals close to zero. For CBT, change in ED specific psychopathology predicted remission only when controlling for ED diagnosis, while change in general psychopathology did not predict remission at all. The predictive value of change in psychopathology for PIT, and the potential impact of comorbid personality disorders could not be analyzed due to a lack of studies. There was no difference in effects between randomized controlled trials and observational studies. CONCLUSIONS CBT showed consistent remission rates for all EDs but left a substantial number of patients not in remission. Extant evidence suggest that PIT is not consistently effective in achieving remission for patients with EDs, although this finding is uncertain due to a small number of eligible studies. A group of patients with eating disorders may, however, require therapy aimed at strengthening deficits in self functions not easily ameliorable by cognitive behavioral techniques alone. Further research should be aimed at identifying treatment interventions that helps patients change behavior, while strengthening self-functions to substitute eating-disordered behavior in the long-term.
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Affiliation(s)
- Leif Tore Moberg
- Department of Psychology, UiT The Arctic University of Norway, Huginbakken 32, N-9037, Tromsø, Norway
| | - Birgitte Solvang
- Department of Psychology, UiT The Arctic University of Norway, Huginbakken 32, N-9037, Tromsø, Norway
| | - Rannveig Grøm Sæle
- Department of Psychology, UiT The Arctic University of Norway, Huginbakken 32, N-9037, Tromsø, Norway.
| | - Anna Dahl Myrvang
- Department of Psychology, UiT The Arctic University of Norway, Huginbakken 32, N-9037, Tromsø, Norway
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136
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Baudinet J, Eisler I, Simic M, Schmidt U. Brief early adolescent multi-family therapy (BEAM) trial for anorexia nervosa: a feasibility randomized controlled trial protocol. J Eat Disord 2021; 9:71. [PMID: 34134769 PMCID: PMC8206871 DOI: 10.1186/s40337-021-00426-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Multi-family therapy (MFT) is a recommended treatment for adolescent anorexia nervosa internationally. Despite recent significant advances in single-family therapy, the evidence base for MFT remains relatively small. Several individual and family factors have been associated with poorer outcomes in single-family therapy, many of which may be addressed or ameliorated by MFT if delivered early in treatment. This trial aims to determine the feasibility and acceptability of adding a five-day multi-family therapy group to the early stages of family therapy for anorexia nervosa. Secondary objectives are to explore effect size changes in key individual and family factors across treatment. METHODS This feasibility trial will use a randomised controlled design. Sixty adolescents (age 10-17 inclusive) with anorexia nervosa or atypical anorexia nervosa and their parents will be recruited from a community-based specialist eating disorder service in London, UK. Participants will be randomly allocated to receive six months of eating disorder focussed family therapy with a five-day MFT group (experimental group) or without (control group). Block randomisation will be conducted by the King's Clinical Trials Unit and researchers will be blind to participants' intervention allocation. Feasibility, acceptability and secondary outcomes measures will be collected at baseline, post-MFT, end of treatment, six-month and 12-month follow-up. Feasibility and acceptability will be assessed according to trial sign-up rates, retention, measure completion rates and satisfaction. Secondary outcomes include physical health improvements, changes in psychiatric symptoms, emotion regulation and reflective function capacity, expressed emotion, parental difficulties and therapeutic alliance. Descriptive data and exploration analysis of trends and effect sizes will be reported upon at trial completion. DISCUSSION The five-day MFT program developed for this study is novel, brief and more accessible than previous MFT models. The inclusion of a data collection point during treatment and follow-up will allow for an investigation of trends during and after treatment. This will allow exploration and comparison of future potential mediators and moderators of MFT and FT-AN outcomes and how these may differ between treatments. TRIAL REGISTRATION ISRCTN registry; ISRCTN93437752 , on 27 January 2021.
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Affiliation(s)
- Julian Baudinet
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| | - Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
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137
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Meneguzzo P, Tenconi E, Todisco P, Favaro A. Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit. EUROPEAN EATING DISORDERS REVIEW 2021; 29:770-782. [PMID: 34118097 PMCID: PMC8453548 DOI: 10.1002/erv.2848] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022]
Abstract
Objective Cognitive remediation therapy (CRT) has been proposed as an add‐on treatment approach that could increase the engagement in treatment of anorexia nervosa (AN) patients and reduce maintaining factors, but prior studies have evaluated CRT in individual and group settings, difficult protocols for rehabilitation settings. Our aim is to evaluate the CRT rolling protocol implementation in an inpatient specialised unit. Methods A historical longitudinal controlled study was designed to include 31 AN patients for the CRT program, and 28 AN patients treated as usual. The CRT rolling group was implemented in a multidisciplinary inpatient rehabilitation ward with both adolescent and adult patients and an 8‐weeks protocol. To evaluate the treatment implementation effect, different self‐administered questionnaires were used. Results The study found greater improvements of the CRT group in clinical symptomatology (p = 0.039), flexibility (p = 0.003), self‐confidence about the ability to change (p < 0.001), and less short‐term focus (p < 0.001), with no differences between restrictive and binge‐purging patients. Conclusion This study demonstrates that CRT rolling group protocol is feasible in an inpatient treatment setting and may improve a rehabilitation program's outcome. Our results have shown how CRT can influence cognitive styles considered AN maintenance factors, positively affecting both restrictive and binge‐purge type. Cognitive remediation therapy (CRT) could be implemented in an inpatient setting with a rolling protocol CRT improves flexibility, drive to change, and therapy engagement No differences between restrictive or binge/purge subgroups Both adolescent and adult patients improved their cognitive styles
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy.,Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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138
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Fumagalli G, Margola D. Is personality the key in cognitive-behavioural therapy for eating disorders? A review. Clin Psychol Psychother 2021; 29:164-177. [PMID: 34110647 DOI: 10.1002/cpp.2627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/13/2021] [Accepted: 06/03/2021] [Indexed: 11/08/2022]
Abstract
The efficacy of individual cognitive-behavioural therapy (CBT) for eating disorders can be assessed by investigating the potential predictors, mediators and moderators of treatment. The present review focused on personality since its crucial role has been emphasized both by research and practice. Sixteen studies were collected, and data were extracted through a highly operationalized coding system. Overall, personality disorders were the most investigated construct; however, their influence was somewhat contradictory. A more cogent result occurred for borderline personality disorder (BPD) when considered as a moderator (not a predictor nor a mediator). Patients with a more disturbed borderline personality benefited to a greater extent from treatments including booster modules on affects, interpersonal relationships and mood intolerance, rather than symptoms exclusively. Nine additional personality dimensions, beyond BPD, were investigated sparsely, and results regarding them were barely indicative in this review. However, some of these dimensions (e.g., affective lability and stimulus-seeking behaviours) could be traced back to BPD, thereby strengthening evidence of the role of borderline disorder as a moderator. Although research on the relationship between personality and eating disorders needs to be increased and methodologically improved, personality, taken as a whole, emerged as a promising variable for enhancing the efficacy of CBT.
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Affiliation(s)
| | - Davide Margola
- Faculty of Psychology, Catholic University of Milan, Milan, Italy
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139
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Linardon J, King T, Shatte A, Fuller-Tyszkiewicz M. Usability Evaluation of a Cognitive-Behavioral App-Based Intervention for Binge Eating and Related Psychopathology: A Qualitative Study. Behav Modif 2021; 46:1002-1020. [PMID: 34075803 DOI: 10.1177/01454455211021764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite their promise as a scalable intervention modality for binge eating and related problems, reviews show that engagement of app-based interventions is variable. Issues with usability may account for this. App developers should undertake usability testing so that any problems can be identified and fixed prior to dissemination. We conducted a qualitative usability evaluation of a newly-developed app for binge eating in 14 individuals with a diagnostic- or subthreshold-level binge eating symptoms. Participants completed a semi-structured interview and self-report measures. Qualitative data were organized into six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Qualitative and quantitative results indicated that the app demonstrated good usability. Key advantages reported were its flexible content-delivery formats, level of interactivity, easy-to-understand information, and ability to track progress. Concerns with visual aesthetics and lack of professional feedback were raised. Findings will inform the optimal design of app-based interventions for eating disorder symptoms.
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Affiliation(s)
| | | | - Adrian Shatte
- Federation University, School of Engineering, Information Technology & Physical Sciences, Berwick, AU-VIC, Australia
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140
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Rapid response is predictive of treatment outcomes in a transdiagnostic intensive outpatient eating disorder sample: a replication of prior research in a real-world setting. Eat Weight Disord 2021; 26:1345-1356. [PMID: 32507929 PMCID: PMC7903880 DOI: 10.1007/s40519-020-00939-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE There is a growing call to identify specific outcome predictors in real-world eating disorder (ED) treatment settings. Studies have implicated several ED treatment outcome predictors [rapid response (RR), weight suppression, illness duration, ED diagnosis, and psychiatric comorbidity] in inpatient settings or randomized controlled trials of individual outpatient therapy. However, research has not yet examined outcome predictors in intensive outpatient programs (IOP). The current study aimed to replicate findings from randomized controlled research trials and inpatient samples, identifying treatment outcome predictors in a transdiagnostic ED IOP sample. METHOD The current sample comprised 210 consecutive unique IOP patient admissions who received evidence-based ED treatment, M(SD)Duration = 15.82 (13.38) weeks. Weekly patient measures of ED symptoms and global functioning were obtained from patients' medical charts. RESULTS In relative weight analysis, RR was the only significant predictor of ED symptoms post treatment, uniquely accounting for 45.6% of the predicted variance in ED symptoms. In contrast, baseline ED pathology was the strongest unique predictor of end-of-treatment global functioning, accounting for 15.89% of predicted variance. Baseline factors did not differentiate patients who made RR from those who did not. CONCLUSIONS Consistent with findings in more controlled treatment settings, RR remains a robust predictor of outcome for patients receiving IOP-level treatment for EDs. Future work should evaluate factors that mediate and moderate RR, incorporating these findings into ED treatment design and implementation. LEVEL OF EVIDENCE Level IV, uncontrolled intervention.
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141
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Haynos AF, Wang SB, Lipson S, Peterson CB, Mitchell JE, Halmi KA, Agras WS, Crow SJ. Machine learning enhances prediction of illness course: a longitudinal study in eating disorders. Psychol Med 2021; 51:1392-1402. [PMID: 32108564 PMCID: PMC7483262 DOI: 10.1017/s0033291720000227] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psychiatric disorders, including eating disorders (EDs), have clinical outcomes that range widely in severity and chronicity. The ability to predict such outcomes is extremely limited. Machine-learning (ML) approaches that model complexity may optimize the prediction of multifaceted psychiatric behaviors. However, the investigations of many psychiatric concerns have not capitalized on ML to improve prognosis. This study conducted the first comparison of an ML approach (elastic net regularized logistic regression) to traditional regression to longitudinally predict ED outcomes. METHODS Females with heterogeneous ED diagnoses completed demographic and psychiatric assessments at baseline (n = 415) and Year 1 (n = 320) and 2 (n = 277) follow-ups. Elastic net and traditional logistic regression models comprising the same baseline variables were compared in ability to longitudinally predict ED diagnosis, binge eating, compensatory behavior, and underweight BMI at Years 1 and 2. RESULTS Elastic net models had higher accuracy for all outcomes at Years 1 and 2 [average Area Under the Receiving Operating Characteristics Curve (AUC) = 0.78] compared to logistic regression (average AUC = 0.67). Model performance did not deteriorate when the most important predictor was removed or an alternative ML algorithm (random forests) was applied. Baseline ED (e.g. diagnosis), psychiatric (e.g. hospitalization), and demographic (e.g. ethnicity) characteristics emerged as important predictors in exploratory predictor importance analyses. CONCLUSIONS ML algorithms can enhance the prediction of ED symptoms for 2 years and may identify important risk markers. The superior accuracy of ML for predicting complex outcomes suggests that these approaches may ultimately aid in advancing precision medicine for serious psychiatric disorders.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Shirley B. Wang
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Sarah Lipson
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- The Emily Program, Minneapolis, MN, USA
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Katherine A. Halmi
- New York Presbyterian Hospital-Westchester Division, Weill Medical College of Cornell University, White Plains, NY, USA
| | - W. Stewart Agras
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott J. Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- The Emily Program, Minneapolis, MN, USA
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142
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Silén Y, Sipilä PN, Raevuori A, Mustelin L, Marttunen M, Kaprio J, Keski-Rahkonen A. Detection, treatment, and course of eating disorders in Finland: A population-based study of adolescent and young adult females and males. EUROPEAN EATING DISORDERS REVIEW 2021; 29:720-732. [PMID: 34008267 PMCID: PMC8349843 DOI: 10.1002/erv.2838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/22/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022]
Abstract
Objective: We assessed the detection, treatment and outcomes of DSM-5 eating disorders in a nationwide community setting. Method: The FinnTwin12 cohort comprises twins born in 1983–1987 in Finland (n = 5,600), with follow-up starting at age 12. We outline treatment and outcomes of the 127 females and 15 males diagnosed with a lifetime DSM-5 eating disorder in interviews conducted for a subsample (n = 1,347) in their early 20s. Results: Only 45 (32%) of those diagnosed with eating disorder in the interviews had their condition detected in healthcare, and even fewer received treatment (30% of females, 13% of males). Anorexia nervosa (AN), bulimia nervosa, and atypical AN were detected and treated more often than other eating disorders. Five years after disease onset, 41% of those diagnosed had recovered. There were no statistically significant differences in the course of different eating disorders (log-rank p = 0.66) but the outcome was more favourable among males (log-rank p = 0.008). The likelihood of 5-year recovery did not differ between those who had and who had not received treatment (41.1% vs. 40.5%, log-rank p = 0.66). Conclusion: Although eating disorders are common and symptoms are persistent for many, they remain under-diagnosed and under-treated. In real-world settings, effectiveness of provided treatments may be limited.
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Affiliation(s)
- Yasmina Silén
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pyry N Sipilä
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Linda Mustelin
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Mauri Marttunen
- Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Kaprio
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Anna Keski-Rahkonen
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
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143
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Reilly EE, Perry TR, Brown TA, Wierenga CE, Kaye WH. Intolerance of Uncertainty and Eating Disorder Symptoms Over the Course of Intensive Treatment. Behav Ther 2021; 52:698-708. [PMID: 33990243 DOI: 10.1016/j.beth.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 12/26/2022]
Abstract
There is a critical need to identify processes that may influence outcome in existing treatments for eating disorders (EDs). Intolerance of uncertainty (IU), which refers to excessive distress regarding uncertain situations, is a well-established feature of anxiety disorders. Emerging work suggests that IU decreases over the course of cognitive-behavioral treatments and may relate to better treatment outcomes. As some literature has suggested IU may functionally maintain ED symptoms, testing whether changes in IU over treatment relate to outcome may result in the identification of novel treatment targets. This study aimed to build upon past work documenting links between IU and ED symptoms by exploring changes in IU over treatment and links between early change in IU (1-month) and discharge symptoms. Participants (N = 274) receiving partial hospitalization treatment completed the Eating Pathology Symptoms Inventory and Intolerance of Uncertainty Scale at admission, 1-month post-admission, and discharge. Results suggested that IU significantly reduced from admission to discharge and that reductions in IU scores from admission to 1-month related to cognitive restraint, dietary restriction, and body image at discharge. However, this pattern did not hold for exercise, binge eating, or purging. Altogether, these results replicate past work supporting IU as a common feature across ED diagnoses and provide initial data suggesting that targeting IU early in treatment may enhance treatment outcomes.
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Affiliation(s)
| | - Taylor R Perry
- Eating Disorders Center for Treatment and Research, University of California, San Diego
| | - Tiffany A Brown
- Eating Disorders Center for Treatment and Research, University of California, San Diego
| | - Christina E Wierenga
- Eating Disorders Center for Treatment and Research, University of California, San Diego
| | - Walter H Kaye
- Eating Disorders Center for Treatment and Research, University of California, San Diego
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144
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Muzi L, Tieghi L, Rugo MA, Lingiardi V. Personality as a predictor of symptomatic change in a residential treatment setting for anorexia nervosa and bulimia nervosa. Eat Weight Disord 2021; 26:1195-1209. [PMID: 33048329 PMCID: PMC8062347 DOI: 10.1007/s40519-020-01023-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Although personality has been widely researched in patients with anorexia nervosa (AN) and bulimia nervosa (BN), the nature of this relationship has not yet been clearly articulated. The pathoplasty model theorizes that personality might shape symptomatic presentation and thus affect therapeutic outcomes, but more research is needed. The present study aimed at investigating the predictive value of a broad spectrum of personality traits in determining AN and BN treatment outcomes, considering both the statistical and clinical significance of the therapeutic change. METHODS Eighty-four female patients with AN and BN treated in a residential program were evaluated at treatment onset using the Shedler-Westen Assessment Procedure-200-a clinician-rated measure of personality disorders and healthy personality functioning. At both intake and discharge, patients completed the Eating Disorder Inventory-3 to assess eating symptoms and the Outcome Questionnaire-45.2 to evaluate overall impairment. RESULTS Considering overall ED symptomatic change, multiple regression analyses showed that, even when controlling for baseline symptoms and DSM-5 categories, schizoid (B = 0.41, p ≤ 0.01), avoidant (B = 0.31, p ≤ 0.05), and paranoid (B = 0.25, p ≤ 0.05) personality features predicted worse therapeutic outcomes. Similar results were found when applying the clinical significance approach, with the emotionally dysregulated factor as an additional negative predictor of significant/reliable change (B = - 0.09; p < 0.01). Healthy personality functioning predicted better therapeutic outcomes (B = - 0.34, p ≤ 0.001). CONCLUSIONS Pathoplastic models and personality-based research in this clinical population have the potential to inform effective treatment strategies by targeting relevant individual factors. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
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Affiliation(s)
- Laura Muzi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185, Rome, Italy.
| | - Laura Tieghi
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | | | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185, Rome, Italy
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145
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Dardennes R, Tolle V, Lavoisy G, Grouselle D, Alanbar N, Duriez P, Gorwood P, Ramoz N, Epelbaum J. Lower leptin level at discharge in acute anorexia nervosa is associated with early weight-loss. EUROPEAN EATING DISORDERS REVIEW 2021; 29:634-644. [PMID: 33880836 DOI: 10.1002/erv.2830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Predictive values of acute phase metabolic abnormalities of anorexia nervosa (AN) have seldom been studied. As early postrestoration weight loss is associated with poor outcome, discharge biologic parameters were assessed to detect an association with 2-month follow-up weight loss as a proxy to poor outcome. METHOD Fasting plasma levels of leptin, acyl-ghrelin, obestatin, PYY, oxytocin and BDNF were measured in 26 inpatients, at inclusion, at discharge and 2 months later. A body mass index less than 18 2-month postdischarge was considered a poor outcome. RESULTS Nineteen patients (73%) had a fair outcome and seven (27%) had a poor one with a mean loss of 0.69 versus 4.54 kg, respectively. Only discharge leptin levels were significantly higher in fair versus poor outcome patients (14.1 vs. 7.0 ng/ml, p = 0.006). The logistic regression model using discharge leptin, acyl-ghrelin, obestatin, oxytocin, PYY and BDNF levels as predictors of outcome disclosed a nearly significant effect of leptin (p < 0.10). Receiver operating characteristic analysis showed 11.9 ng/ml was the best value of threshold. Neither clinical variables differed according to outcome. CONCLUSION Leptin level may be a biomarker of early weight relapse after acute inpatient treatment of AN. Its clinical usefulness in monitoring care in AN should further be determined.
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Affiliation(s)
- Roland Dardennes
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Virginie Tolle
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
| | - Guillaume Lavoisy
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Dominique Grouselle
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
| | - Nebal Alanbar
- Faculté de Médecine, Université de Paris Descartes, Paris, France
| | - Philibert Duriez
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Philip Gorwood
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Nicolas Ramoz
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
| | - Jacques Epelbaum
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
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146
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Chang PGRY, Delgadillo J, Waller G. Early response to psychological treatment for eating disorders: A systematic review and meta-analysis. Clin Psychol Rev 2021; 86:102032. [PMID: 33915335 DOI: 10.1016/j.cpr.2021.102032] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 04/04/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022]
Abstract
Early response is a well-established predictor of positive outcomes at the end of psychological treatments for common mental disorders. There is some prior evidence that this conclusion also applies to eating disorders, including three meta-analyses, but no moderators of that relationship have been identified. However, a number of further papers have been published since, which might influence the size of the effect of early response or the potential role of moderating factors. This pre-registered systematic review presents a comprehensive examination of this literature. Three databases were searched (Scopus, PsycInfo, PubMed). In total, 33 eligible studies were included in a narrative synthesis, and 25 studies were included in random-effects meta-analysis. The majority (91%) of studies were rated as having low or moderate risk of bias. Approximately half of patients across clinical samples showed early response to psychological therapy, which was most often defined as reliable symptomatic improvement during the first four sessions. A significant and moderate association was found between early response and post-treatment outcomes (r = 0.41 [95% CI: 0.32-0.481], p < .0001). Significant evidence of heterogeneity (Q[28] = 136.42, p < .0001; I2 = 80.2%) was evident. The review was limited by the exclusion of grey literature and only 76% of studies provided sufficient statistical information for meta-analytic synthesis, although we found no significant evidence of publication bias, χ2(1) = 0.001, p = .97. Overall, evidence accumulated over twenty years establishes early response as the most robust predictor of treatment outcomes in the field of eating disorders. However, only half of patients show early change in this way. Further research is needed to determine whether there are patient or clinician characteristics that predict early response to psychological treatment for eating disorders.
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Affiliation(s)
- Peter G R Y Chang
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Glenn Waller
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK.
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147
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Lydecker JA, Grilo CM. Psychiatric comorbidity as predictor and moderator of binge-eating disorder treatment outcomes: an analysis of aggregated randomized controlled trials. Psychol Med 2021; 52:1-9. [PMID: 33849682 PMCID: PMC8514588 DOI: 10.1017/s0033291721001045] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psychiatric comorbidity is common in binge-eating disorder (BED) but effects on treatment outcomes are unknown. The current study aimed to determine whether psychiatric comorbidity predicted or moderated BED treatment outcomes. METHODS In total, 636 adults with BED in randomized-controlled trials (RCTs) were assessed prior, throughout, and posttreatment by doctoral research-clinicians using reliably-administered semi-structured interviews, self-report measures, and measured weight. Data were aggregated from RCTs testing cognitive-behavioral therapy, behavioral weight loss, multi-modal (combined pharmacological plus cognitive-behavioral/behavioral), and/or control conditions. Intent-to-treat analyses (all available data) tested comorbidity (mood, anxiety, 'any disorder' separately) as predictors and moderators of outcomes. Mixed-effects models tested comorbidity effects on binge-eating frequency, global eating-disorder psychopathology, and weight. Generalized estimating equation models tested binge-eating remission (zero binge-eating episodes during the past month; missing data imputed as failure). RESULTS Overall, 41% of patients had current psychiatric comorbidity; 22% had mood and 23% had anxiety disorders. Psychiatric comorbidity did not significantly moderate the outcomes of specific treatments. Psychiatric comorbidity predicted worse eating-disorder psychopathology and higher binge-eating frequency across all treatments and timepoints. Patients with mood comorbidity were significantly less likely to remit than those without mood disorders (30% v. 41%). Psychiatric comorbidity neither predicted nor moderated weight loss. CONCLUSIONS Psychiatric comorbidity was associated with more severe BED psychopathology throughout treatment but did not moderate outcomes. Findings highlight the need to improve treatments for BED with psychiatric comorbidities but challenge perspectives that combining existing psychological and pharmacological interventions is warranted. Treatment research must identify more effective interventions for BED overall and for patients with comorbidities.
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Affiliation(s)
- Janet A Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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148
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Manwaring J, Blalock DV, Le Grange D, Duffy A, McClanahan SF, Johnson C, Mehler PS, Plotkin M, Rienecke RD. Motivation to recover for adolescent and adult eating disorder patients in residential treatment. EUROPEAN EATING DISORDERS REVIEW 2021; 29:622-633. [PMID: 33851492 DOI: 10.1002/erv.2828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/22/2021] [Accepted: 02/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess how baseline motivation to recover impacts eating disorder (ED) and comorbid symptoms at end-of-treatment (EOT) for adolescents and adults in inpatient/residential treatment. METHOD Two hundred and three adolescent (M = 15.90) and 395 adult (M = 25.45) patients with a Diagnostic Statistical Manual, 5th edition ED diagnosis completed the Decisional Balance Scale (DBS) at baseline, and psychosocial measures (ED symptoms, anxiety, depression, obsessive-compulsive disorder symptoms), and %body mass index (kg/m2 ; BMI) or median %BMI (for adolescents) at baseline and EOT. RESULTS The DBS Avoidance Coping and Burdens subscales at baseline were significantly lower for adolescents than adults (p < 0.001), whereas the DBS Benefits subscale at baseline did not significantly differ between subsamples (p = 0.06). Motivation to recover via DBS subscales was a more reliable predictor of EOT outcomes for both ED and comorbid psychopathology in adults (significant predictor in 19 of 54 total analyses, and 4 significant associations post-Bonferroni correction) than adolescents (significant predictor in 5 of 54 total analyses, and 1 significant association post-Bonferroni correction). CONCLUSIONS Baseline motivation to recover may be an important predictor of outcome for adult patients in inpatient/residential treatment but does not appear associated with outcomes for adolescent patients.
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Affiliation(s)
- Jamie Manwaring
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Susan F McClanahan
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA.,Department of Psychiatry, Rush University Medical Center, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Craig Johnson
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA.,ACUTE, Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Millie Plotkin
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
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149
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Fichter MM, Quadflieg N. How precisely can psychotherapists predict the long-term outcome of anorexia nervosa and bulimia nervosa at the end of inpatient treatment? Int J Eat Disord 2021; 54:535-544. [PMID: 33320351 DOI: 10.1002/eat.23443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the ability of psychotherapists to predict the future outcome for inpatients with anorexia nervosa (AN) and bulimia nervosa (BN). METHOD Psychotherapists rated the prognosis of the patient's eating disorder on a five point Likert scale on several dimensions at the end of inpatient treatment. Actual outcome was assessed about 10 years after treatment. The sample comprised 1,065 patients treated for AN, and 1,192 patients treated for BN. RESULTS Psychotherapists' rating of their patient's prognosis was not better than chance for good outcome in AN and BN and for poor outcome in BN. Prediction of poor outcome in AN was somewhat better with approximately two thirds of correct predictions. In logistic regression analysis, psychotherapists' rating of the patients' prognosis for AN contributed to the explained variance of long-term outcome, increasing the variance explained from 7% (by conventional predictors) to 8% after including psychotherapists' prognosis. In BN, there was no significant contribution of psychotherapists' prognosis to overall prediction. DISCUSSION Our current knowledge of risk and protective factors for the course of eating disorders is unsatisfying. More specialized research is urgently needed.
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Affiliation(s)
- Manfred M Fichter
- Ludwig-Maximilians-University (LMU), Munich, Department of Psychiatry and Psychotherapy, Munich, Germany.,Schoen Klinik Roseneck affiliated with the Medical Faculty of the University of Munich (LMU), Prien, Germany
| | - Norbert Quadflieg
- Ludwig-Maximilians-University (LMU), Munich, Department of Psychiatry and Psychotherapy, Munich, Germany
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150
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Accurso EC, Waller G. A brief session-by-session measure of eating disorder psychopathology for children and adolescents: Development and psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y). Int J Eat Disord 2021; 54:569-577. [PMID: 33331681 PMCID: PMC8262257 DOI: 10.1002/eat.23449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/19/2020] [Accepted: 12/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Despite evidence supporting the use of measures to track ongoing progress and outcome in treatment, there is a relative absence of measures that are appropriate for this purpose in youth with eating disorders. This study examined the psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y) scale, including its ability to detect short-term change in symptomatology. METHOD Youth (N = 203) ages 8-18 years completed self-report questionnaires and semi-structured diagnostic interviews upon initial presentation for an outpatient eating disorders assessment at an academic medical center. RESULTS The ED-15-Y demonstrated excellent reliability (internal consistency, split-half reliability) and high sensitivity to change early in treatment (change from sessions 1 to 8, adjusting for baseline score). Further, these data demonstrate that the ED-15-Y has excellent convergent validity, being highly correlated with a well-tested, longer measure of eating disorders psychopathology-the Eating Disorders Examination-Questionnaire (EDE-Q). These data also support good discriminant and concurrent validity, differentiating between youth without an eating disorder or with ARFID and youth with eating disorders involving weight and shape concerns (e.g., anorexia nervosa, bulimia nervosa). DISCUSSION The ED-15-Y may be a useful tool to briefly assess eating disorder psychopathology in youth as young as 8 years old. Its sensitivity to change very early in treatment suggests that it has the potential to be used as a routine outcome measure in the context of treatment.
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Affiliation(s)
- Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Glenn Waller
- Department of Psychology, The University of Sheffield, Sheffield, UK
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