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Thompson-Brenner H, Singh S, Gardner T, Brooks GE, Smith MT, Lowe MR, Boswell JF. The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment. Front Psychiatry 2021; 12:641601. [PMID: 33746797 PMCID: PMC7973044 DOI: 10.3389/fpsyt.2021.641601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The Renfrew Unified Treatment for Eating Disorders and Comorbidity (UT) is a transdiagnostic, emotion-focused treatment adapted for use in residential group treatment. This study examined the effect of UT implementation across five years of treatment delivery. Methods: Data were collected by questionnaire at admission, discharge (DC), and 6-month follow-up (6MFU). Patient outcomes were measured by the Eating Disorder Examination-Questionnaire, Center for Epidemiologic Studies-Depression Scale, Brief Experiential Avoidance Questionnaire (BEAQ), Anxiety Sensitivity Index, and Southampton Mindfulness Scale. Data were analyzed for N = 345 patients treated with treatment-as-usual (TAU), and N = 2,763 treated with the UT in subsequent years. Results: Results from multilevel models demonstrated a significant interaction between implementation status (TAU vs. UT) and time, both linear and quadratic, for the depression, experiential avoidance, anxiety sensitivity, and mindfulness variables. Patients treated with the UT showed more improvement in these variables on average, as well as more rebound between DC and 6MFU. Results from multilevel models examining eating disorder outcome showed no significant difference between the TAU and UT for the full sample, but a significant three-way interaction indicated that the UT produced more improvement in the EDE-Q relative to the TAU particularly for patients who entered treatment with high levels of experiential avoidance (BEAQ score). Conclusion: This long-term study of a transdiagnostic, evidence-based treatment in residential care for eating disorders and comorbidity suggests implementation was associated with beneficial effects on depression and emotion function outcomes, as well as eating disorder severity for patients with high levels of baseline emotion regulation problems. These effects did not appear to diminish in the 5 years following initial implementation.
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Affiliation(s)
| | - Simar Singh
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | | | | | | | - Michael R. Lowe
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - James F. Boswell
- Department of Psychology, University at Albany, Albany, NY, United States
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Boswell JF, Anderson LM, Oswald JM, Reilly EE, Gorrell S, Anderson DA. A preliminary naturalistic clinical case series study of the feasibility and impact of interoceptive exposure for eating disorders. Behav Res Ther 2019; 117:54-64. [PMID: 30797537 DOI: 10.1016/j.brat.2019.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 01/24/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
Recent literature suggests that individuals with eating disorders demonstrate altered interoceptive processing, which may relate to the maintenance of symptoms and thus represent a salient treatment target. Adopting treatment techniques effective for other conditions characterized by disturbed interoceptive processes (e.g., anxiety disorders) could aid in improving the outcomes of psychological interventions for eating disorders. The current investigation was a naturalistic case series (N = 4) that examined adjunctive interoceptive exposure (IE) for eating disorders, with an emphasis on evaluating the feasibility, acceptability, and impact of this intervention on anxiety sensitivity, interoceptive deficits, and eating disorder symptoms. Results suggested that all individuals who received 4 consecutive sessions of traditional and eating-disorder-specific IE exercises demonstrated decreases in interoceptive deficits and subjective distress. Results for anxiety sensitivity and eating disorder symptoms were encouraging yet more mixed. Findings also generally suggested that the intervention was feasible and acceptable, yet between-session practice compliance varied considerably among participants. Overall, we describe how IE may be used to target interoceptive deficits in eating disorders and provide preliminary evidence of how this may be accomplished within naturalistic intensive outpatient settings.
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Affiliation(s)
- James F Boswell
- Department of Psychology, University at Albany, State University of New York, USA.
| | | | - Jennifer M Oswald
- Department of Psychology, University at Albany, State University of New York, USA
| | - Erin E Reilly
- Department of Psychiatry, University of California, San Diego, USA
| | - Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, USA
| | - Drew A Anderson
- Department of Psychology, University at Albany, State University of New York, USA
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Thompson-Brenner H, Boswell JF, Espel-Huynh H, Brooks G, Lowe MR. Implementation of transdiagnostic treatment for emotional disorders in residential eating disorder programs: A preliminary pre-post evaluation. Psychother Res 2018; 29:1045-1061. [DOI: 10.1080/10503307.2018.1446563] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - James F. Boswell
- Department of Psychology, University at Albany, SUNY, Albany, NY, USA
| | | | | | - Michael R. Lowe
- Department of Psychology, Drexel University, Philadelphia, PA, USA
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Thompson-Brenner H, Brooks GE, Boswell JF, Espel-Huynh H, Dore R, Franklin DR, Gonçalves A, Smith M, Ortiz S, Ice S, Barlow DH, Lowe MR. Evidence-based implementation practices applied to the intensive treatment of eating disorders: Summary of research and illustration of principles using a case example. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12221] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Susan Ice
- The Renfrew Centers; Philadelphia PA USA
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Moessner M, Bauer S. Maximizing the public health impact of eating disorder services: A simulation study. Int J Eat Disord 2017; 50:1378-1384. [PMID: 29076172 DOI: 10.1002/eat.22792] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/04/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Although effective interventions for eating disorders (ED) are available, the impact of health care services on a population level is far from satisfactory. A mathematical model of how health care for ED affects the population's disease burden can stimulate discussions and provide guidance about promising strategies to reduce ED-related suffering on the population level. METHOD The current health care situation for ED is modeled taking into account the reach and effectiveness of prevention, treatment, and aftercare, as well as incidence rates, relapse rates, and rates for spontaneous remissions. A first-order Markov model is applied and the effect of changes in single service parameters on the populations overall disease burden are simulated. RESULTS Improvements of treatment utilization and the reach of prevention programs would have the largest effects on the population's disease burden. Improving the efficacy of treatment, prevention, and aftercare show only limited effects. DISCUSSION In order to maximize the public health impact of health care for ED new models of treatment delivery as well as public health approaches to the prevention of ED are critical.
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Affiliation(s)
- Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
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Waller G. Treatment Protocols for Eating Disorders: Clinicians' Attitudes, Concerns, Adherence and Difficulties Delivering Evidence-Based Psychological Interventions. Curr Psychiatry Rep 2016; 18:36. [PMID: 26893234 PMCID: PMC4759212 DOI: 10.1007/s11920-016-0679-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There are several protocols in existence that guide clinicians in the implementation of effective, evidence-based psychological interventions for eating disorders. These have been made accessible in the form of treatment manuals. However, relatively few clinicians use those protocols, preferring to offer more eclectic or integrative approaches. Following a summary of the research that shows that these evidence-based approaches can be used successfully in routine clinical settings, this review considers why there is such poor uptake of these therapies in such settings. This review focuses on the role of service culture and on clinicians' own attitudes, beliefs and emotions. Possible means of enhancing uptake are considered, but these cannot be considered to be ideal solutions at present.
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Affiliation(s)
- Glenn Waller
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield, S10 1NT, UK.
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Waller G, Turner H. Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behav Res Ther 2015; 77:129-37. [PMID: 26752326 DOI: 10.1016/j.brat.2015.12.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/08/2015] [Accepted: 12/13/2015] [Indexed: 12/22/2022]
Abstract
Therapist drift occurs when clinicians fail to deliver the optimum evidence-based treatment despite having the necessary tools, and is an important factor in why those therapies are commonly less effective than they should be in routine clinical practice. The research into this phenomenon has increased substantially over the past five years. This review considers the growing evidence of therapist drift. The reasons that we fail to implement evidence-based psychotherapies are considered, including our personalities, knowledge, emotions, beliefs, behaviours and social milieus. Finally, ideas are offered regarding how therapist drift might be halted, including a cognitive-behavioural approach for therapists that addresses the cognitions, emotions and behaviours that drive and maintain our avoidance of evidence-based treatments.
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Affiliation(s)
- Glenn Waller
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield, S10 2NT, UK.
| | - Hannah Turner
- Southern Health Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, UK
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Larrañaga A, Fluiters E, Docet MF, Fernández Sastre JL, García-Mayor RV. Comparative study of cognitive-behavioral psychotherapy and nutritional support in patients with different types of eating disorders. Med Clin (Barc) 2014; 143:196-200. [DOI: 10.1016/j.medcli.2013.05.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/24/2013] [Accepted: 05/30/2013] [Indexed: 11/29/2022]
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Juarascio A, Shaw J, Forman EM, Timko CA, Herbert JD, Butryn ML, Lowe M. Acceptance and Commitment Therapy for eating disorders: Clinical applications of a group treatment. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2013. [DOI: 10.1016/j.jcbs.2013.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Tharaldsen KB, Bru E. Evaluating the Mindfulness-based Coping Program: An Effectiveness Study Using a Mixed Model Approach. Ment Illn 2012; 4:e11. [PMID: 25478104 PMCID: PMC4253367 DOI: 10.4081/mi.2012.e11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/17/2012] [Accepted: 04/18/2012] [Indexed: 11/23/2022] Open
Abstract
Since more than 450 million people worldwide suffer from mental disorders, interventions that promote mental health have been called for. Mindfulness-based coping (MBC) is an intervention based on coping skills from cognitive behavioral therapy integrating mindfulness practices. The aim of this study was to examine the effectiveness of the MBC program for psychiatric outpatients. The study employed a mixed research method with a qualitative approach using semi-structured patient interviews and clinical assessments from patients' therapists and a quantitative approach using instruments measuring mindful coping, mental ill health, and life satisfaction. The study sample included 38 psychiatric outpatients from a district psychiatric outpatient service in Norway. Results suggested that although use of the different skills varied, participants had a positive experience with the program and positive changes in psychological functioning were observed. Findings provide knowledge regarding the design of interventions integrating mindfulness to promote more adequate psychological coping.
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Affiliation(s)
| | - Edvin Bru
- Stavanger University Hospital and University of Stavanger , Norway
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Klein AS, Skinner JB, Hawley KM. Adapted group-based dialectical behaviour therapy for binge eating in a practicing clinic: clinical outcomes and attrition. EUROPEAN EATING DISORDERS REVIEW 2012; 20:e148-53. [PMID: 22367862 DOI: 10.1002/erv.2165] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 01/22/2012] [Accepted: 01/27/2012] [Indexed: 11/10/2022]
Abstract
Research evidence has been accumulating for the efficacy of dialectical behaviour therapy (DBT) for binge eating. However, support for its effectiveness and transportability beyond efficacy trials is lacking. The current study evaluated the feasibility of group-based DBT for binge eating within the context of an operating community clinic. Women ages 24-49 (M = 39.60, SD = 9.53) with either subthreshold and full-threshold binge eating disorder or bulimia nervosa formed the group and comprised the sample (n = 5 treatment completers). Positive outcomes included significant improvement in both binge eating and secondary outcomes with the Eating Disorder Inventory subscales of Bulimia, Ineffectiveness, Perfectionism and Interpersonal Distrust. Attrition was elevated compared with previous efficacy trials, suggesting the need for increased attention to how to improve retention within routine practice settings. Given our limited sample size, these findings are viewed as promising but preliminary.
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