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Katsuki F, Watanabe N, Kondo M, Sawada H, Yamada A. Remote family education and support program for parents of patients with adolescent and early adulthood eating disorders based on interpersonal psychotherapy: study protocol for a pilot randomized controlled trial. J Eat Disord 2024; 12:61. [PMID: 38760800 PMCID: PMC11102252 DOI: 10.1186/s40337-024-01013-z] [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: 02/07/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In cases of adolescent and early adulthood eating disorders, despite the importance of the patients' relationship with their parents, conflict and confusion frequently occur among them. Interpersonal psychotherapy (IPT) is a present-focused psychotherapy that emphasizes the interpersonal context of symptoms. We developed a remote family education and support program exclusively for parents of patients with eating disorders, based on the principle of IPT. The use of IPT is expected to reduce conflicts in the patient-parent relationship. Consequently, parents will be better able to listen to patients, and patients will be better able to express their thoughts and desires. In this study, we describe the protocol for a randomized controlled trial designed to examine the effectiveness of this program in promoting effective communication in their home based on active listening skills of parents of patients with adolescent and early adulthood eating disorders. METHODS Participants will be parents of patients aged 12-29 years with adolescent and early adulthood eating disorders. Individually randomized, parallel-group trial design will be employed. Seventy participants will be allocated to one of two treatment conditions: (1) remote family education and support program (four, 150 min weekly group sessions) for parents plus treatment-as-usual for patients (consultation by physicians or no treatment), or (2) waiting for the control condition (parents will wait to start the program for 8 weeks) plus treatment-as-usual for patients. The primary outcome measure will be parents' active listening ability as measured by the Active Listening Attitude Scale at 8 weeks after randomization. Additionally, perception of social support (Social Provision Scale-10 item), loneliness (UCLA Loneliness Scale), mental health status (K6), family function (Family Assessment Device), and parent-evaluated eating disorder symptoms (Anorectic Behavior Observation Scale) will be assessed. Data from the intention-to-treat sample will be analyzed 8 weeks after randomization. DISCUSSION This is the first study to evaluate the effectiveness of a family education and support program for parents of patients with adolescent and early adulthood eating disorders based on IPT. If this type of intervention is effective, although indirect, it could be a new support method for this patient population. TRIAL REGISTRATION Clinical Trials. gov ID NCT05840614.
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Affiliation(s)
- Fujika Katsuki
- Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate School of Nursing, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, 101 Shimotoba, Hiroosa-machi, Fushimiku, Kyoto, Japan
| | - Masaki Kondo
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, Japan
| | - Hanayo Sawada
- Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate School of Nursing, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Atsurou Yamada
- Department of Neurodevelopmental Disorders, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
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Rodríguez-Mondragón L, Moreno-Encinas A, Graell M, Román FJ, Sepúlveda AR. A case-control study to differentiate parents' personality traits on anorexia nervosa and affective disorders. FAMILY PROCESS 2024. [PMID: 38520285 DOI: 10.1111/famp.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
Eating disorders (ED) and affective disorders (AD) in adolescent population and several investigations have pointed out that specific family dynamics play a major role in the onset, course, and maintenance of both disorders. The aim of this study was to extend the literature of this topic by exploring differences between parents' personality traits, coping strategies, and expressed emotion comparing groups of adolescents with different mental conditions (anorexia nervosa vs. affective disorder vs. control group) with a case-control study design. A total of 50 mothers and 50 fathers of 50 girls with anorexia nervosa (AN), 40 mothers and 40 fathers of 40 girls with affective disorder (AD), and 50 mothers and 50 fathers of 50 girls with no pathology that conformed the control group (CG) were measured with the Temperament and Character Inventory (TCI), the COPE Inventory, the Family Questionnaire (FQ), and psychopathology variables, anxiety, and depression. Both parents of girls with AN showed a significant difference in personality, coping strategies, and expressed emotion compared to both parents in the CG, while they presented more similarities to parents of girls in the AD group. Identifying personality traits, expressed emotion, coping strategies, and psychopathology of parents and their daughters will allow improvements in the interventions with the adolescents, parents, and families.
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Affiliation(s)
- L Rodríguez-Mondragón
- Biological and Health Psychology Department, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - A Moreno-Encinas
- Biological and Health Psychology Department, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - M Graell
- Section Head of Child and Adolescent Psychiatry and Psychology, University Hospital Niño Jesús, Madrid, Spain
- CIBERSAM, Madrid, Spain
| | - F J Román
- Biological and Health Psychology Department, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - A R Sepúlveda
- Biological and Health Psychology Department, School of Psychology, Autonomous University of Madrid, Madrid, Spain
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Bohon C, Flanagan K, Welch H, Rienecke RD, Le Grange D, Lock J. Expressed emotion and early treatment response in family-based treatment for adolescent anorexia nervosa. Eat Disord 2024; 32:153-168. [PMID: 37942724 DOI: 10.1080/10640266.2023.2277054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This study examined the effect of pre-treatment levels of parental expressed emotion (EE) on early treatment response for adolescent anorexia nervosa (AN). Data were collected from 121 adolescents, ages 12-18, who met DSM-IV criteria for AN excluding the amenorrhea criterion, and their parents. Participants were randomized to family-based treatment (FBT) or adolescent-focused therapy (AFT). To examine the effects of different thresholds of EE, we used two different levels of EE in analyses. Results demonstrated that adolescents who had at least one parent with elevated EE indicated by a lower threshold (i.e. even mild levels) at baseline were less likely to achieve an early treatment response, suggesting that EE might interfere with treatment success from the start of treatment. When high EE was defined by a higher threshold, these effects were no longer significant, regardless of treatment type (FBT or AFT). These findings suggest that adolescents with AN may be more sensitive to EE than other mental illnesses, such that lower thresholds of EE impact the speed with which they are able to reduce symptoms and gain weight in treatment. It may be necessary to target parental EE prior to or early in treatment or pivot to parent-focused treatment to change the trajectory of treatment response. Future research is needed to explore ways parental EE can be reduced.
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Affiliation(s)
- Cara Bohon
- Eating Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
- Clinical, Equip Health, Inc, Carlsbad, California, USA
| | - Katie Flanagan
- Eating Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Hannah Welch
- Eating Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Renee D Rienecke
- Research, Eating Recovery Center/Pathlight Mood & Anxiety Centers, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA (Emeritus)
| | - James Lock
- Eating Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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Aarnio-Peterson CM, Grange DL, Mara CA, Modi AC, North EO, Zegarac M, Stevens K, Matthews A, Mitan L, Shaffer A. Emotion coaching skills as an augmentation to family-based therapy for adolescents with anorexia nervosa: A pilot effectiveness study with families with high expressed emotion. Int J Eat Disord 2024; 57:682-694. [PMID: 38318997 PMCID: PMC10947854 DOI: 10.1002/eat.24149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To examine the feasibility and acceptability of augmenting family-based treatment (FBT) for adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) with a parent emotion coaching intervention (EC) focused on reducing parent expressed emotion. METHOD In this pilot effectiveness trial, families of adolescents with AN/AAN exhibiting high expressed emotion received standard FBT with either (1) EC group or (2) support group (an attention control condition focused on psychoeducation). RESULTS Forty-one adolescents with AN or AAN were recruited (88% female, Mage = 14.9 ± 1.6 years, 95% White: Non-Hispanic, 1% White: Hispanic, 1% Bi-racial: Asian). Most study adolescents were diagnosed with AN (59%) while 41% were diagnosed with AAN. Participating parents were predominantly mothers (95%). Recruitment and retention rates were moderately high (76% and 71%, respectively). High acceptability and feasibility ratings were obtained from parents and interventionists with 100% reporting the EC intervention was "beneficial"-"very beneficial." The FBT + EC group demonstrated higher parental warmth scores at post-treatment compared to the control group (standardized effect size difference, d = 1.58), which was maintained at 3-month follow-up. Finally, at post-treatment, the FBT + EC group demonstrated higher rates of full remission from AN/AAN (40%) compared to FBT + support (27%), and were nine times more likely to be weight restored by 3-month follow-up. DISCUSSION Augmenting FBT with emotion coaching for parents with high expressed emotion is acceptable, feasible, and demonstrates preliminary effectiveness. PUBLIC SIGNIFICANCE Family based treatment for AN/AAN is the recommended treatment for youth but families with high criticism/low warmth are less likely to respond to this treatment. Adding a parent emotion coaching group (EC) where parents learn to talk to their adolescents about tough emotions is feasible and well-liked by families.
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Affiliation(s)
- Claire M. Aarnio-Peterson
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Department of Psychiatry and Neurosciences, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Constance A. Mara
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Avani C. Modi
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Emily Offenbacker North
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
| | - Miriam Zegarac
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Kimberly Stevens
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Abigail Matthews
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Laurie Mitan
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Division of Adolescent Medicine, Cincinnati, OH USA
| | - Anne Shaffer
- Department of Psychology, University of Georgia, Athens, GA, USA
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Baudinet J, Hodsoll J, Schmidt U, Simic M, Landau S, Eisler I. Moderators of treatment effect in a randomised controlled trial of single- and multi-family therapy for anorexia nervosa in adolescents and emerging adults. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 38009702 DOI: 10.1002/erv.3050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/13/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Multi-family therapy for anorexia nervosa (MFT-AN) is a novel, group-based intervention that intensifies single-family therapy for anorexia nervosa (FT-AN), with the aim of improving outcomes. The current study explored treatment moderators in a randomised controlled trial (N = 167) of FT-AN and MFT-AN for young people (adolescents/emerging adults aged 13-20 years) with anorexia nervosa. METHODS Data were analysed using multiple linear regression. Six hypothesised baseline participant and parent factors were tested as possible moderators of treatment effect on end-of-treatment and follow-up percentage of median Body Mass Index (%mBMI); age, eating disorder symptom severity, perceived family conflict (young person and parent ratings) and parent-rated experiences of caregiving (positive and negative). RESULTS Greater parent-rated positive caregiving experiences moderated treatment outcomes at follow-up (β = -0.47, 95%CI: -0.91, -0.03, p = 0.04), but not end-of-treatment. Participants who had fewer parent-rated positive caregiving experiences at baseline had higher weight at follow-up if they had MFT-AN compared to FT-AN. No other hypothesised baseline factors moderated treatment outcome (p's > 0.05). DISCUSSION The current study suggests MFT-AN may be indicated for families who present with fewer positive caregiving experiences to treatment. The MFT-AN group context may help to promote mentalisation and hope for these families, which may be harder to achieve in single-family treatment. Future research is needed to empirically evaluate how and why MFT-AN supports this group more. TRIAL REGISTRATION ISRCTN registry: ISRCTN11275465, registered 29 January 2007.
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Affiliation(s)
- Julian Baudinet
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - John Hodsoll
- Department of Biostatistics and Health Informatics, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ivan Eisler
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
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Zeiler M, Philipp J, Truttmann S, Wittek T, Kopp K, Schöfbeck G, Mairhofer D, Auer-Welsbach E, Staab E, Karwautz A, Wagner G. Fathers in the spotlight: parental burden and the effectiveness of a parental skills training for anorexia nervosa in mother-father dyads. Eat Weight Disord 2023; 28:65. [PMID: 37526742 PMCID: PMC10393897 DOI: 10.1007/s40519-023-01597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE Research on the engagement of fathers in the treatment of childhood psychiatric disorders is scarce. This study aims to investigate differences between mothers and fathers of adolescents with anorexia nervosa regarding parental burden and effectiveness of a parental skills training. METHODS Ninety-one mother-father dyads caring for a child with anorexia nervosa participated in an 8-week parental skills training and completed a set of questionnaires assessing parental psychopathology, eating disorder related burden, caregiver skills and expressed emotion at baseline and post-intervention. RESULTS Fathers showed lower levels of general psychological distress, depression, anxiety and eating disorder related burden as well as lower emotional overinvolvement compared to mothers. The skills training was effective in reducing parental psychopathology, eating disorder-related burden and emotional overinvolvement as well as in increasing caregiver skills with no differences between mothers and fathers. However, session adherence and the willingness to practice skills between the sessions were slightly lower in fathers. CONCLUSIONS These findings show that fathers are a great resource for the child's eating disorder treatment as they may counterbalance maternal emotional overinvolvement and over-protection. Furthermore, this is the first study demonstrating that fathers can profit from a parental skills training for anorexia nervosa in a similar way as mothers. LEVEL III Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Michael Zeiler
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Philipp
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefanie Truttmann
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Tanja Wittek
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Konstantin Kopp
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gabriele Schöfbeck
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dunja Mairhofer
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ellen Auer-Welsbach
- Department for Neurology and Psychiatry of Children and Adolescents, Klagenfurt am Wörthersee, Austria
| | - Eva Staab
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Andreas Karwautz
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gudrun Wagner
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Aarnio-Peterson CM, Mara CA, Modi AC, Matthews A, Le Grange D, Shaffer A. Augmenting family based treatment with emotion coaching for adolescents with anorexia nervosa and atypical anorexia nervosa: Trial design and methodological report. Contemp Clin Trials Commun 2023; 33:101118. [PMID: 37008797 PMCID: PMC10064114 DOI: 10.1016/j.conctc.2023.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
This article characterizes the design, recruitment, methodology, participant characteristics, and preliminary feasibility and acceptability of the Families Ending Eating Disorders (FEED) open pilot study. FEED augments family-based treatment (FBT) for adolescents with anorexia nervosa (AN) and atypical anorexia nervosa (AAN) with an emotion coaching (EC) group for parents (i.e., FBT + EC). We targeted families high in critical comments and low warmth (assessed by the Five-Minute Speech Sample), known predictors of poor response in FBT. Eligible participants included adolescents initiating outpatient FBT, diagnosed with AN/AAN, ages 12-17, with a parent high in critical comments/low in warmth. The first phase of the study was an open pilot which demonstrated feasibility and acceptability of FBT + EC. Thus, we proceeded with the small randomized controlled trial (RCT). Eligible families were randomized to either 10 weeks of FBT + EC parent group treatment or the 10- week parent support group (control condition). The primary outcomes were parent critical comments and parental warmth, while our exploratory outcome was adolescent weight restoration. Novel aspects of the trial design (e.g., specifically targeting typical treatment non-responders), as well as recruitment and retention challenges in the context of the COVID-19 pandemic are discussed.
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Affiliation(s)
- Claire M Aarnio-Peterson
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Constance A Mara
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Abigail Matthews
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Ave., San Francisco, CA, 94143, USA
- Department of Psychiatry and Neurosciences, University of Chicago, Chicago, IL, 60637, USA
| | - Anne Shaffer
- Department of Psychology, University of Georgia, Athens, GA, USA
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Rienecke RD, Gorrell S, Johnson M, Duffy A, Mehler PS, Le Grange D. Expressed emotion and treatment outcome in higher levels of care for eating disorders. Int J Eat Disord 2023; 56:628-636. [PMID: 36584076 PMCID: PMC9992295 DOI: 10.1002/eat.23890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Expressed emotion (EE) among caregivers toward the affected offspring is a negative prognostic indicator for adolescent patients with eating disorders (EDs) in outpatient treatment. Less research has examined its impact on adolescents in higher levels of care (HLOC). The current study examined differences in caregiver EE according to the subtype of anorexia nervosa (AN) (restricting [AN-R] versus binge/purge [AN-BP]), and level of care (LOC). We also examined the main effects of baseline caregiver EE (emotional overinvolvement [EOI] or criticism), AN subtype, and their interaction on eating pathology and depression at discharge. METHOD Adolescent patients (N = 203) receiving treatment at HLOCs completed measures of ED pathology (Eating Disorder Examination-Questionnaire) and depression (Patient Health Questionnaire-9) at baseline and discharge, and one caregiver of each patient completed a measure of EE (Family Questionnaire) at baseline. RESULTS No differences in caregiver EE were found between patients with AN-R versus AN-BP, or relative to LOC. Caregiver EE did not predict outcome for ED symptoms or depression at discharge. DISCUSSION The impact of high caregiver EE may be less substantial at HLOCs than outpatient care given that caregivers are less involved in treatment at HLOCs. Future research is needed to determine if high caregiver EOI leads to poor treatment outcome for adolescents as it does for adults, or whether it is an appropriate expression of care for patients who are ill enough to require HLOC treatment. PUBLIC SIGNIFICANCE STATEMENT High caregiver EE was not found to predict treatment outcome for adolescents with eating disorders in higher levels of care (HLOCs), possibly due to the limited involvement of caregivers in HLOCs. However, patients step down to outpatient treatment, where high caregiver EE can have a significant negative impact on outcome. HLOCs should incorporate efforts to reduce high caregiver EE in anticipation of step-down to outpatient treatment.
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Affiliation(s)
- Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Madelyn Johnson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Philip S. Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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Matthews A, Bruening AB, Aarnio-Peterson CM, Kramer R. Predictors of caregiver burden before starting family-based treatment for adolescent anorexia nervosa and associations with weight gain during treatment. Eat Weight Disord 2023; 28:21. [PMID: 36809428 PMCID: PMC9944026 DOI: 10.1007/s40519-023-01553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE Caregivers play a pivotal role in the success of family-based treatment (FBT) for anorexia nervosa (AN). Caregiver burden is frequently demonstrated in eating disorders (EDs) and may impact FBT outcomes. This study examined factors associated with caregiver burden before starting FBT and whether pre-treatment caregiver burden was associated with weight gain during FBT. METHODS Participants included 114 adolescents with AN or atypical AN (mean age = 15.6 years, SD = 1.4) and a primary caregiver (87.6% mothers) who received FBT in the United States. Before starting treatment, participants completed self-report measures of caregiver burden (via the Eating Disorder Symptom Impact Scale), caregiver anxiety, caregiver depression, and ED symptoms. Clinical characteristics and percentage of target goal weight (%TGW) at FBT session 1 and 3 and 6 months after starting treatment were obtained via retrospective chart review. Hierarchical regressions examined predictors of caregiver burden before FBT initiation. Associations between pre-treatment caregiver burden and %TGW gain at 3 and 6 months after starting FBT were assessed with hierarchical regressions. RESULTS Caregiver anxiety (p < 0.001), family history of EDs (p = 0.028), adolescent mental health treatment history (p = 0.024), and ED symptoms (p = 0.042) predicted caregiver burden before starting FBT. Pre-treatment caregiver burden was not associated with %TGW gain at 3 or 6 months. Males demonstrated less %TGW gain than females at 3 months (p = 0.010) and 6 months (p = 0.012). CONCLUSION Proactively evaluating caregiver burden before starting FBT is suggested. Providing recommendations and/or referrals for identified caregiver vulnerabilities could indirectly impact FBT progress. Males in FBT could require longer courses of treatment and extra vigilance to this demographic is suggested. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Abigail Matthews
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Amanda B Bruening
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Claire M Aarnio-Peterson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rachel Kramer
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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10
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Socholotiuk KD, Young RA. Weight restoration in adolescent anorexia: parents' goal-directed processes. J Eat Disord 2022; 10:190. [PMID: 36476504 PMCID: PMC9730571 DOI: 10.1186/s40337-022-00676-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/16/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Parent-led weight restoration is a key intervention of family-based treatment, an empirically supported treatment for adolescent anorexia. Successful outcomes in family-based treatment depend almost entirely on parental action, yet current understandings of this intervention are primarily informed by professional theory and expert perspectives. Comparatively little is known about parents' goals and actions while implementing the treatment, despite goal-directed action being an explicit framework of family-based treatment. This study seeks to investigate parents' involvement in weight restoration from the perspective of the goal-directed actions they construct and engage in themselves and with others. This study focuses on the phenomenon of parent-led weight restoration as a project and addresses the following research question: "How do parents participate in the weight restoration of their adolescent as the adolescent recovers from anorexia nervosa?". METHOD This multicase study used the action project method and conceptual framework of contextual action theory to examine four cases of five parents engaged in actions to help their adolescent regain weight and recover from anorexia. Data were collected using multi-part interviews and analyzed according to the action project method and the multicase approach. RESULTS Parents' weight restoration projects were identified and grouped based on three common a themes. The primary theme, progressing toward health and well-being, was supported by three key processes: maintaining a holistic focus, trusting, and monitoring progress. Two secondary themes captured actions that were integral to the parents' projects, but with less prominence. Secondary themes were creating capacity, which was supported by three processes (managing emotions to maintain a helpful focus, personal work, and resourcing time and finances), and coordinating and negotiating partnerships. The socio-cultural valuing of the thin ideal emerged as a unique process salient in one case. This study presents a goal-directed and contextual perspective on how parents translated the principles of family-based treatment into their daily lives. It joins a small but growing body of work concerned with generating new understandings and frameworks for practitioners and researchers to enhance the effectiveness of family-based treatment in community settings.
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Affiliation(s)
- Krista D Socholotiuk
- Faculty of Education, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Richard A Young
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, 2125 Main Mall, Vancouver, BC, V6T 1Z4, Canada
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Lafrance A, Strahan EJ, Stillar A. Treatment-engagement fears in family-oriented interventions: validation of the caregiver traps scale for eating disorders. Eat Disord 2022; 30:670-685. [PMID: 34743672 DOI: 10.1080/10640266.2021.1993706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As more caregivers of children (of any age) struggling with an eating disorder are recruited as partners in care, it is important to identify potential barriers to such involvement. The Caregiver Traps Scale for Eating Disorders (CTS-ED) was developed as a measure of caregiver fears with respect to treatment-engagement. The purpose of this study was to evaluate its psychometric properties. One hundred and twenty four parents of children with ED participated in the validation of this instrument. Data were analyzed through exploratory factor analysis. The exploratory factor analysis revealed one factor, accounting for 39% of the variance, with a mean of 3.99 (scale from 1 to 7), indicating that caregivers endorsed clinically significant fears relating to their involvement in their child's treatment. The scale yielded high internal consistency (α = .89). As expected, the CTS-ED was significantly positively correlated with a measure of accommodating and enabling of ED symptoms, and negatively correlated with a measure of parental self-efficacy. This scale shows promise as a measure for clinicians and researchers to identify parental fears that could potentially fuel accommodating, enabling or treatment-interfering behaviors. Suggestions for its utility as a clinical and supervision tool are also provided.Clinical SignificanceDevelopment of an assessment tool to identify caregiver fears with respect to therapy engagement in the context of family-oriented interventions for eating disordersTool has the potential to increase the positive involvement of caregivers to support their child (of any age) with an eating disorderTool can be used clinically and to support self-reflective practices to improve compassionate clinician engagement of caregivers struggling to support their child.
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Affiliation(s)
- Adele Lafrance
- Department of Rural and Northern Health, Laurentian University, Sudbury, Canada
| | - Erin J Strahan
- Department of Psychology, Wilfrid Laurier University, Brantford, Canada
| | - Amanda Stillar
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
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12
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Gorrell S, Byrne CE, Trojanowski PJ, Fischer S, Le Grange D. A scoping review of non-specific predictors, moderators, and mediators of family-based treatment for adolescent anorexia and bulimia nervosa: a summary of the current research findings. Eat Weight Disord 2022; 27:1971-1990. [PMID: 35092554 PMCID: PMC9872820 DOI: 10.1007/s40519-022-01367-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/13/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE This scoping review presents an up-to-date synthesis of the current evidence base for non-specific predictors, moderators, and mediators of family-based treatment (FBT) for adolescent anorexia and bulimia nervosa. METHODS We identify ways in which end-of-treatment outcomes have been shown to differ based upon baseline clinical features and person-specific factors and explore psychological mechanisms that may explain differences in treatment response. We draw from this evidence base to outline recommendations for clinical practice, as well as directions for future clinical eating disorder research. RESULTS Noted findings from review include that early response in weight gain and parental criticism may be particularly influential in treatment for anorexia nervosa. Further, for adolescents with either anorexia or bulimia nervosa, eating-related obsessionality may be a key intervention target to improve outcomes. CONCLUSION In addition to highlighting a need for attention to specific patient- and caregiver-level factors that impact treatment response, recommendations for research and clinical practice include testing whether certain targeted treatments (e.g., exposure-based approaches) may be suitable within the context of FBT for eating disorders. LEVEL OF EVIDENCE Level I: Evidence obtained from: at least one properly designed randomized controlled trials; experimental studies.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL, USA
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13
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Rienecke RD, Gorrell S, Blalock DV, Smith K, Lock J, Le Grange D. Expressed emotion and long-term outcome among adolescents with anorexia nervosa. Int J Eat Disord 2021; 54:2019-2024. [PMID: 34553396 PMCID: PMC8810289 DOI: 10.1002/eat.23613] [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: 05/20/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of the current study is to examine expressed emotion (EE) and long-term treatment outcome among adolescents participating in a randomized controlled trial (RCT) for treatment of anorexia nervosa (AN). It was hypothesized that patients with high EE parents at baseline would show more severe symptoms at end-of-treatment, 12-month follow-up, and 4-year follow-up than patients from low EE families. METHOD Secondary data analysis was conducted of original RCT data from a two-site eating disorder treatment trial conducted in the United States. Participants were 121 adolescents with AN who completed measures of EE, eating disorder psychopathology, depression, and self-esteem. RESULTS Generalized estimating equations showed that participants who were in the Low EE group achieved a more accelerated drop in depression scores in the context of treatment (first 12 months) than participants in the High EE group. No other significant Group × Time interactions were found. DISCUSSION Findings suggest that high parental EE at baseline does not indicate that adolescent patients with AN will fare poorly 4 years later.
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Affiliation(s)
- Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Chicago, Illinois, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, 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
| | - Kathryn Smith
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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Siegel JA, Ramseyer Winter V, Cook M. "It really presents a struggle for females, especially my little girl": Exploring fathers' experiences discussing body image with their young daughters. Body Image 2021; 36:84-94. [PMID: 33217716 DOI: 10.1016/j.bodyim.2020.11.001] [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: 06/30/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
Body dissatisfaction in children, particularly young girls, is a growing concern around the world. The home environment can have a strong influence on children's well-being, and parents may contribute to their children's positive or negative body image development. Nearly all research on parent influence on body image has focused on mothers, leaving fathers' attitudes and experiences poorly-understood. To address this gap in the literature, we interviewed 30 fathers (Mage = 40.30; SD = 7.48) of girls between the ages of 5 and 10 about the conversations they have with their daughters regarding body image. Through thematic analysis, we identified three primary themes: barriers to effective communication, combatting negative influences, and strategies for discussing body image. Fathers recognized the importance of talking about body image with their daughters, yet many did not feel confident or competent to do so effectively. They engaged in a variety of strategies to combat adverse cultural influences and encourage self-expression, character development, and mental and physical health in their daughters. However, messages about health were sometimes conflated with messages about thinness or food restriction. Implications for families and future research are discussed.
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Affiliation(s)
- Jaclyn A Siegel
- Western University, Department of Psychology, 1151 Richmond Street, London, Ontario, Canada, N6A 3K7.
| | - Virginia Ramseyer Winter
- University of Missouri, School of Social Work, Clark Hall 729, Columbia, MO, 65211, United States.
| | - Mackenzie Cook
- University of Missouri, School of Social Work, Clark Hall 729, Columbia, MO, 65211, United States.
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15
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Mizzi A, Honey A, Scanlan JN, Hancock N. Parent strategies to support young people experiencing mental health problems in Australia: What is most helpful? HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2299-2311. [PMID: 32511853 DOI: 10.1111/hsc.13051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
Parents are a critical resource in supporting young people who live with mental health problems. Qualitative research has identified that parents use a wide range of strategies to provide support. However, parents report being unsure which strategies are likely to be helpful, so often struggle in this role. Presently, little empirical evidence exists to assist parents to decide which strategies are likely to be most helpful. This study aimed to explore the parent-perceived helpfulness of parental strategies to support young people living with mental health problems. Data were collected from February to July of 2018, using a cross-sectional, online, anonymous, self-report survey of participants who identified as parenting a young person (15-24 years) diagnosed with a mental health problem (n = 70). Overall, the strategies perceived as most helpful were practical assistance and personal interactions aimed at promoting positive thoughts and feelings and obtaining appropriate treatment. Least helpful strategies tended to be control-type strategies, aimed at behaviour change. Overall, there was good alignment between strategies' helpfulness and frequency of use, however, there were exceptions. These exceptions are likely reflections of the specific context of particular situations as well as parental uncertainty regarding alternative strategies. Generally, perceptions of strategies' helpfulness were unrelated to parent or child characteristics. However, helpfulness of strategies was associated with parents' satisfaction with their relationship with the young person. Parents' collective experience-based perceptions about the helpfulness of strategies used to support young people experiencing mental health problems can be harnessed to inform mental health practitioners' advice to parents and contribute to better mental health outcomes for young people.
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Affiliation(s)
- Andrea Mizzi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Anne Honey
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Justin N Scanlan
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Nicola Hancock
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Blondin S, Meilleur D, Taddeo D, Frappier JY. Caregiving experience and expressed emotion among parents of adolescents suffering from anorexia nervosa following illness onset. Eat Disord 2019; 27:453-470. [PMID: 30612513 DOI: 10.1080/10640266.2018.1553431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to better understand the relationship between parents' experience of caregiving and expressed emotion during the early stage of their child's eating disorder. Fifty mothers and 38 fathers of adolescents suffering from anorexia nervosa and hospitalized for the first time participated in this study. They completed the Experience of Caregiving Inventory, a measure of the negative and positive aspects of the caregiving experience, and the Family Questionnaire, which measured the different dimensions of expressed emotion, namely emotional over-involvement and critical comments. Results showed that caregiving experience is significantly and positively correlated to expressed emotion. Among the negative aspects of caregiving, sense of loss contributed most to emotional over-involvement, while difficult behaviours contributed most to critical comments. The results suggest that parents' perceptions of their child and child's future are strongly related to their tendency to be over-involved. The perception of disruptive behaviours in their child could be one of the principal triggers or exacerbating factors of parents' critical attitudes.
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Affiliation(s)
- Soline Blondin
- Department of Psychology, Adolescence and Eating Disorders Research Laboratory, Montreal University , Montreal , Quebec , Canada
| | - Dominique Meilleur
- Department of Psychology, Adolescence and Eating Disorders Research Laboratory, Montreal University , Montreal , Quebec , Canada
| | - Danielle Taddeo
- Division of Adolescent Medicine, Sainte-Justine Hospital Center , Montreal , Quebec , Canada
| | - Jean-Yves Frappier
- Division of Adolescent Medicine, Sainte-Justine Hospital Center , Montreal , Quebec , Canada
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Dimitropoulos G, Landers AL, Freeman V, Novick J, Cullen O, Le Grange D. Family-based treatment for transition age youth: the role of expressed emotion and general family functioning. Eat Disord 2019; 27:419-435. [PMID: 30358513 DOI: 10.1080/10640266.2018.1529472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to investigate changes in family functioning and parental expressed emotion (EE) in parents and transition age youth (18 to 25 years old) with Anorexia Nervosa participating in Family-Based Treatment for Transition Age Youth (FBT-TAY). Further, we examined whether perceived family functioning and EE were associated with changes in eating disorder behaviour and weight in participants at end-of-treatment and three months post-treatment. Generalized estimating equations revealed that changes in family functioning significantly improved from baseline to end-of-treatment (p = .0001), and baseline to three months post-treatment (p = .0001) in parents; and from baseline to end-of-treatment (p = .011), and baseline to three months post-treatment (p = .0001) in transition age youth. The level of parental EE did not differ significantly from baseline to end-of-treatment (p = .379), or baseline to three months post-treatment (p = .185). A series of Ordinary Least Square regression models demonstrated that changes in perceived family functioning and EE were not significantly associated with changes in eating disorder behaviour and weight restoration of transition age youth at end-of-treatment and three months post-treatment. Overall, perceptions of family functioning improved during the course of FBT-TAY, but EE did not.
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Affiliation(s)
- Gina Dimitropoulos
- Toronto General Hospital Eating Disorder Program, University Health Network , Toronto , Ontario , Canada
| | - Ashley L Landers
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University , Falls Church , Virginia , USA
| | - Victoria Freeman
- Toronto General Hospital, University Health Network , Toronto Ontario , Canada
| | - Jason Novick
- Department of Sociology, Mount Royal University , Calgary Alberta , Canada
| | - Olivia Cullen
- Faculty of Social Work, University of Calgary , Calgary Alberta , Canada
| | - Daniel Le Grange
- Department of Psychiatry, University of California , San Francisco CA , USA
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18
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Martin-Wagar CA, Holmes S, Bhatnagar KAC. Predictors of Weight Restoration in a Day-Treatment Program that Supports Family-Based Treatment for Adolescents with Anorexia Nervosa. Eat Disord 2019; 27:400-417. [PMID: 30358497 DOI: 10.1080/10640266.2018.1528085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Family-Based Treatment (FBT) is considered a first-line treatment for adolescents with eating disorders. The traditional outpatient model of FBT may not, however, be appropriate for adolescents requiring more intensive treatment due to severe medical complications or insufficient progress in traditional outpatient FBT. In response, efforts have been made to incorporate FBT into higher levels of care, such as day-treatment programs (DTPs), for families who need additional support. Little is known about the factors that predict weight restoration for DTPs intended to support FBT. The current study examined the ability of specific adolescent and caregiver variables to predict weight restoration at discharge for adolescents with anorexia nervosa (AN) enrolled in a skills-based DTP that supports FBT. Participants were 87 adolescents diagnosed with AN and their caregivers (N = 74). Body Mass Index (BMI) at baseline, percentage of Expected Body Weight (%EBW) gain within the first 4 weeks, and caregiver empowerment level at baseline were found to significantly predict weight restoration. Higher BMI at baseline and higher %EBW gained in the first 4 weeks of treatment were predictive of weight restoration, whereas lower caregiver empowerment at baseline was predictive of weight restoration. Additionally, the rate of weight gain is reported for this DTP grounded in FBT philosophy.
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Affiliation(s)
| | - Samantha Holmes
- a Department of Psychology , University of Akron , Ohio , USA
| | - Kelly A C Bhatnagar
- b Department of Psychological Sciences , The Center for Evidence Based Treatment-Ohio & Case Western Reserve University , Ohio , USA
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Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. AUTHORS' CONCLUSIONS There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.
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Affiliation(s)
- Caroline A Fisher
- Royal Melbourne Hospital, Melbourne HealthAllied Health ‐ PsychologyParkvilleVictoriaAustralia3050
| | - Sonja Skocic
- HealthscopeThe Melbourne ClinicRichmondVictoriaAustralia
| | | | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
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20
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Wufong E, Rhodes P, Conti J. "We don't really know what else we can do": Parent experiences when adolescent distress persists after the Maudsley and family-based therapies for anorexia nervosa. J Eat Disord 2019; 7:5. [PMID: 30805186 PMCID: PMC6373134 DOI: 10.1186/s40337-019-0235-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/21/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Maudsley Family Therapy (MFT), and its manualised version, Family-Based Therapy (FBT), are the only well-established treatment interventions for adolescent anorexia nervosa (AN), with treatment efficacy primarily measured by improvements in eating behaviours and weight restoration. A crucial component of this therapy is an intensive home-based refeeding intervention that requires a substantial commitment from parents for up to one year. While this treatment works to restore weight in a proportion of adolescents, very little is known about its impacts on family distress, relationships and identity, including in the 40% of families where the adolescent experiences ongoing eating disorder (ED) symptomatology and/or psychological distress during and post-treatment. Specifically, few studies have investigated the impacts of MFT/FBT treatment on family functioning or on how parents negotiate their identities, or who they understand themselves to be, in the context of this treatment intervention. This is a significant omission, given the substantive role assigned to parents to take responsibility for their child's eating restoration in the first treatment phase. This study seeks to address this gap through a qualitative exploration of parents' experiences of MFT/FBT, in cases where treatment was discontinued and/or their child continued to experience psychological distress post-treatment. METHODS 13 parents participated in in-depth semi-structured interviews that scaffolded between their experiences and ways they negotiated and sustained their identities as parents within the context of MFT/FBT for their child. Interview data was analysed through a framework of critical discursive analysis to generate themes centred on these parents' experiences and identity negotiation. RESULTS Key findings are that MFT/FBT: (1) provided a map for therapy that initially relieved parents' anxieties for their child and facilitated improvements in family functioning; (2) inadequately addressed parental guilt and blame with a form of externalisation of the illness; (3) perpetuated parental guilt by raising anxiety about AN and allocating responsibility for refeeding their child in phase 1 of the treatment; and (4) when ceased, left these parents struggling with an uncertain future, and fears for the wellbeing of their children. CONCLUSIONS The structure of MFT/FBT provided initial relief with some improvements in family communication patterns, however, when the adolescent experienced protracted ED symptoms and/or ongoing psychological distress post-treatment, these parents were left with uncertainty as to how to navigate their shifting roles and their child's ongoing struggles. This research highlights the need for treatments for adolescent AN that more comprehensively address both the adolescent and parents' psychological distress and also (re)build their senses of identity that have been challenged by AN and its effects.
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Affiliation(s)
- Ella Wufong
- Western Sydney University, Locked Bag 1797, Penrith, 2751 Australia
| | - Paul Rhodes
- Western Sydney University, Locked Bag 1797, Penrith, 2751 Australia
| | - Janet Conti
- Western Sydney University, Locked Bag 1797, Penrith, 2751 Australia
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Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. AUTHORS' CONCLUSIONS There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.
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Affiliation(s)
- Caroline A Fisher
- Royal Melbourne Hospital, Melbourne HealthAllied Health ‐ PsychologyParkvilleAustralia3050
| | - Sonja Skocic
- HealthscopeThe Melbourne ClinicRichmondAustralia
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Duclos J, Dorard G, Cook-Darzens S, Curt F, Faucher S, Berthoz S, Falissard B, Godart N. Predictive factors for outcome in adolescents with anorexia nervosa: To what extent does parental Expressed Emotion play a role? PLoS One 2018; 13:e0196820. [PMID: 30063706 PMCID: PMC6067718 DOI: 10.1371/journal.pone.0196820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/20/2018] [Indexed: 11/18/2022] Open
Abstract
In studies on family therapy in Anorexia Nervosa, family relationships, as assessed by Expressed Emotion, have been associated with outcome. Our aim was to explore the contribution of Expressed Emotion as a predictor of 18-month outcome, above and beyond the usual predictive factors. Sixty adolescent girls suffering from Anorexia Nervosa and their parents were assessed at baseline and 18 months later. Levels of Expressed Emotion were evaluated in both parents with the Five-Minute Speech Sample. After controlling for treatment group and initial clinical status, high maternal Emotional Over-Involvement at baseline was significantly associated with better clinical state. More precisely, high maternal Emotional Over-Involvement was associated with higher nutritional status, lower eating disorder severity and fewer re-hospitalizations 18 months later. No associations were found with paternal levels of Expressed Emotion. Therefore, our study confirmed the importance of taking into account both maternal and paternal Expressed Emotion. Our results also underlined that high maternal Emotional Over-Involvement plays a positive role in the outcome of Anorexia Nervosa and needs to be explored further.
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Affiliation(s)
- Jeanne Duclos
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
- * E-mail:
| | - Géraldine Dorard
- Laboratoire de Psychopathologie et Processus de santé (LPPS), University Paris Descartes, Boulogne, France
| | - Solange Cook-Darzens
- Service de psychopathologie de l’enfant et de l’adolescent, Hôpital Robert Debré, Paris, France
| | - Florence Curt
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Sophie Faucher
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Sylvie Berthoz
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
| | - Bruno Falissard
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
| | - Nathalie Godart
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
- Fondation de Santé des Etudiants de France, Paris, France
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Richards IL, Subar A, Touyz S, Rhodes P. Augmentative Approaches in Family-Based Treatment for Adolescents with Restrictive Eating Disorders: A Systematic Review. EUROPEAN EATING DISORDERS REVIEW 2017; 26:92-111. [PMID: 29282801 DOI: 10.1002/erv.2577] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To systematically review the literature reporting outcomes of augmentative family-based treatment (FBT) interventions for adolescents with restrictive eating disorders (EDs). METHOD Articles were identified through a systematic search of five electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Database). RESULTS Thirty articles were included, reporting on FBT augmentations featuring adjunctive treatment components, modified treatment structure and/or content with adherence to FBT principles, and adaptations allowing FBT delivery in different settings. All reported significant improvements in weight and/or ED symptoms at end-of-treatment, although few compared augmentative and standard FBT interventions and good quality follow-up data was generally lacking. CONCLUSIONS There is early evidence for the effectiveness of augmentative FBT-based approaches in facilitating weight and/or ED symptom improvements for adolescents with restrictive EDs. There remains a lack of robust evidence demonstrating superior effects of such approaches over standard FBT, and further controlled studies are required to expand on the current evidence. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Imogen Lim Richards
- Clinical Psychology Unit, School of Psychology, The University of Sydney, NSW, Australia
| | - Anni Subar
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, The University of Sydney, NSW, Australia
| | - Paul Rhodes
- Clinical Psychology Unit, School of Psychology, The University of Sydney, NSW, Australia
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24
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Schwarte R, Timmesfeld N, Dempfle A, Krei M, Egberts K, Jaite C, Fleischhaker C, Wewetzer C, Herpertz-Dahlmann B, Seitz J, Bühren K. Expressed Emotions and Depressive Symptoms in Caregivers of Adolescents with First-Onset Anorexia Nervosa-A Long-Term Investigation over 2.5 Years. EUROPEAN EATING DISORDERS REVIEW 2017; 25:44-51. [PMID: 27943533 DOI: 10.1002/erv.2490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/03/2016] [Accepted: 08/01/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE High levels of expressed emotions (EE) and depressive symptoms (DS) are often found in caregivers of patients with anorexia nervosa (AN). Both parameters are considered to influence AN symptoms of the patient. METHODS One hundred seventy adolescent women with AN and their caregivers were assessed at admission, discharge, at 1-year and 2.5-year follow up to evaluate AN symptoms of the patient and EE and DS of caregivers. RESULTS The EE and DS were elevated at admission and decreased during treatment, criticism (as part of EE) exhibited again at the 2.5-year follow up. Caregivers of more severely ill patients reported significantly greater levels of EE and DS. Mothers were more affected than fathers. EE and DS were interrelated. CONCLUSION Caregivers of adolescent AN patients suffer from elevated levels of EE and DS. Further studies are needed to examine whether therapeutic interventions to reduce caregivers' EE and DS might have a positive influence on treatment outcome. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Reinhild Schwarte
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Nina Timmesfeld
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - Astrid Dempfle
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany.,Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Melanie Krei
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Karin Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité University Berlin, Berlin, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Clinics Freiburg, Freiburg, Germany
| | - Christoph Wewetzer
- Department of Child and Adolescent Psychiatry and Psychotherapy, Köln-Holweide, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Katharina Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
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25
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Darrow SM, Accurso EC, Nauman ER, Goldschmidt AB, Le Grange D. Exploring Types of Family Environments in Youth with Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 25:389-396. [PMID: 28675592 DOI: 10.1002/erv.2531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/08/2017] [Accepted: 05/27/2017] [Indexed: 11/10/2022]
Abstract
While many studies have explored the relationship between different eating disorder diagnoses and the familial social environment, current evidence does not support associations between distinct family interaction patterns (e.g. high enmeshment) and particular diagnoses (e.g. anorexia nervosa). The current study seeks to move beyond the current literature to explore whether empirically derived subtypes of family environment are associated with clinical features within a transdiagnostic sample of youth seeking treatment for eating disorders (n = 123). Latent class modelling of the Family Environment Scale identified three classes (i.e. different Family Environment Scale profiles): (1) Control-Oriented; (2) System Maintenance-Oriented; and (3) Conflict-Oriented. Data are presented to characterize the classes (e.g. age, gender, rates of different eating disorders, severity of eating disorder pathology and rates of comorbid disorders). These preliminary results suggest that family interaction types may help personalize treatment for eating disorders and encourage future research to guide such efforts. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Sabrina M Darrow
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Erin C Accurso
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Emily R Nauman
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Andrea B Goldschmidt
- Weight Control and Diabetes Research Center, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Daniel Le Grange
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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Pezard L, Doba K, Lesne A, Nandrino JL. Quantifying the dynamics of emotional expressions in family therapy of patients with anorexia nervosa. Psychiatry Res 2017; 253:49-57. [PMID: 28346889 DOI: 10.1016/j.psychres.2017.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 01/14/2017] [Accepted: 03/22/2017] [Indexed: 11/30/2022]
Abstract
Emotional interactions have been considered dynamical processes involved in the affective life of humans and their disturbances may induce mental disorders. Most studies of emotional interactions have focused on dyadic behaviors or self-reports of emotional states but neglected the dynamical processes involved in family therapy. The main objective of this study is to quantify the dynamics of emotional expressions and their changes using the family therapy of patients with anorexia nervosa as an example. Nonlinear methods characterize the variability of the dynamics at the level of the whole therapeutic system and reciprocal influence between the participants during family therapy. Results show that the variability of the dynamics is higher at the end of the therapy than at the beginning. The reciprocal influences between therapist and each member of the family and between mother and patient decrease with the course of family therapy. Our results support the development of new interpersonal strategies of emotion regulation during family therapy. The quantification of emotional dynamics can help understanding the emotional processes underlying psychopathology and evaluating quantitatively the changes achieved by the therapeutic intervention.
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Affiliation(s)
- Laurent Pezard
- Aix Marseille Université CNRS, NIA UMR 7260, 13331 Marseille, France
| | - Karyn Doba
- Université de Lille CNRS, SCALab UMR 9193, 59653 Villeneuve d'Ascq, France; Clinique Médico-Psychologique Fondation Santé des Étudiants de France, 59653 Villeneuve d'Ascq, France
| | - Annick Lesne
- CNRS, LPTMC UMR 7600, UPMC-Paris 6 Sorbonne Universités, 75252 Paris, France; IGMM, UMR 5535, CNRS, Université de Montpellier, 34293 Montpellier, France
| | - Jean-Louis Nandrino
- Université de Lille CNRS, SCALab UMR 9193, 59653 Villeneuve d'Ascq, France; Clinique Médico-Psychologique Fondation Santé des Étudiants de France, 59653 Villeneuve d'Ascq, France.
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27
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Rienecke RD. Family-based treatment of eating disorders in adolescents: current insights. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2017; 8:69-79. [PMID: 28615982 PMCID: PMC5459462 DOI: 10.2147/ahmt.s115775] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Eating disorders are serious illnesses associated with significant morbidity and mortality. Family-based treatment (FBT) has emerged as an effective intervention for adolescents with anorexia nervosa, and preliminary evidence suggests that it may be efficacious in the treatment of adolescents with bulimia nervosa. Multifamily therapy for anorexia nervosa provides a more intensive experience for families needing additional support. This review outlines the three phases of treatment, key tenets of family-based treatment, and empirical support for FBT. In addition, FBT in higher levels of care is described, as well as challenges in the implementation of FBT and recent adaptations to FBT, including offering additional support to eating-disorder caregivers. Future research is needed to identify families for whom FBT does not work, determine adaptations to FBT that may increase its efficacy, develop ways to improve treatment adherence among clinicians, and find ways to support caregivers better during treatment.
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Affiliation(s)
- Renee D Rienecke
- Department of Pediatrics.,Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC.,Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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Wallis A, Rhodes P, Dawson L, Miskovic-Wheatley J, Madden S, Touyz S. Relational containment: exploring the effect of family-based treatment for anorexia on familial relationships. J Eat Disord 2017; 5:27. [PMID: 28770090 PMCID: PMC5532769 DOI: 10.1186/s40337-017-0156-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/04/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The aim of this research was to investigate the process of familial relationship change for adolescents with anorexia nervosa and their parents, who participated in Family-Based Treatment (FBT). METHOD A Constructionist grounded theory design was employed with purposive sampling. Sixteen young people between 12 and 18 years with a good outcome in FBT and twenty-eight of their parents participated. Young people and their parents took part in separate interviews at the end of treatment. Each interview was transcribed and analysed to identify a unifying phenomenon across the data to elicit a theory that explained the data and then integrated into existing theory. RESULTS Prior to treatment families' experienced significant conflict, disconnection and isolation. The FBT structure, therapist direction, and the specialist medical setting created a process of relational containment. This enabled parents to trust the process of FBT and develop confidence in their executive role in the family. In turn this allowed the adolescent with anorexia nervosa to trust their parents, feel more secure and gradually engage in the treatment process themselves. Improvements in closeness, communication and adolescent sense of self were reported after FBT. CONCLUSIONS These findings illuminate a possible mechanism of change in FBT. It underscores the importance of parental management of eating disorder symptoms at the commencement of treatment to enable increased parental confidence. Meaningful changes occurred for the adolescents' that aided normal developmental and relational processes, an important aspect of recovery. TRIAL REGISTRATION Australian Clinical Trials Register number: ACTRN012607000009415.
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Affiliation(s)
- Andrew Wallis
- Eating Disorder Service, Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia.,School of Psychology, The University of Sydney, Sydney, Australia
| | - Paul Rhodes
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Lisa Dawson
- Eating Disorder Service, Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Jane Miskovic-Wheatley
- Eating Disorder Service, Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Sloane Madden
- Eating Disorder Service, Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia.,School of Psychology, The University of Sydney, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, The University of Sydney, Sydney, Australia
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How does family functioning effect the outcome of family based treatment for adolescents with severe anorexia nervosa? J Eat Disord 2017; 5:55. [PMID: 29255605 PMCID: PMC5729267 DOI: 10.1186/s40337-017-0184-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this research was to investigate the relationship between family functioning, adolescent-parent attachment and remission, as well as changes in these variables over time for adolescents with severe anorexia nervosa treated with family based treatment (FBT). Understanding how families respond to treatment is important because the family will be the ongoing context for psychosocial development in the longer term. The relationship between family functioning and outcome is also an important variable because it is potentially modifiable during treatment and this may improve outcome. METHODS Fifty-seven female adolescents treated with FBT in a randomised controlled trial were assessed at baseline, FBT session 20 and 12-months post FBT session 20. Data on family functioning and adolescent-parent attachment was collected from patients and their parents at each time point. A series of regression analyses were used to determine the relationship between family functioning and comorbidity at baseline, and the relationship with remission status over time. Repeat measure mixed-effects models were used to assess changes in family functioning and attachment quality over time. RESULTS Greater adolescent perceived family functioning impairment was positively related to psychiatric comorbidity at the start of treatment. Conversely, better family functioning predicted higher self-esteem and stronger attachment quality. Adolescent's reporting better general family functioning, communication and problem solving were more likely to be remitted at session 20, but not at 12-month follow-up. There was no overall improvement in family functioning for any respondent either during treatment or at follow-up, and no significant relationship between change and remission at either session 20 or follow-up. CONCLUSIONS The adolescent's perspective on family functioning at the start of treatment impacts on a positive outcome. Addressing family issues earlier in FBT may be important for some patients. Further research is needed in this area to determine how these findings could be integrated into the current FBT model. TRIAL REGISTRATION Australian Clinical Trials Register number: ACTRN012607000009415 (www.anzctr.org.au).
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Moskovich AA, Timko CA, Honeycutt LK, Zucker NL, Merwin RM. Change in expressed emotion and treatment outcome in adolescent anorexia nervosa. Eat Disord 2017; 25:80-91. [PMID: 27869569 PMCID: PMC6361377 DOI: 10.1080/10640266.2016.1255111] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Expressed emotion (EE) has been associated with poor outcomes in anorexia nervosa (AN); however, whether changes in EE predict superior treatment outcomes is unknown. The current study examined whether decreases in EE during an open trial of a novel family-based treatment for AN predicted symptoms at end of treatment. Forty-seven adolescents (12-18 years of age) with AN or sub-threshold AN and their parents (mothers: n = 47, fathers: n = 39) participated in 6 months of family treatment. Measures of AN symptomatology (Eating Disorder Examination completed by adolescent and end of treatment recovery status) and parental EE (Family Questionnaire completed by parents which measures two facets of EE: critical communication [CC] and emotional over-involvement [EOI]) were collected at baseline and end of treatment. Parental EOI, but not CC, significantly decreased during the course of treatment. Change in mothers', but not fathers', EE accounted for additional variance in AN symptomatology at end of treatment above baseline EE and baseline AN symptom levels. Findings suggest a greater emphasis on parent support during treatment may improve outcomes.
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Affiliation(s)
- Ashley A Moskovich
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA
| | - C Alix Timko
- b Department of Psychology, Towson University , Baltimore , Maryland , USA.,c Department of Behavioral and Social Sciences , University of the Sciences , Philadelphia , Pennsylvania , USA.,d Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| | - Lisa K Honeycutt
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA
| | - Nancy L Zucker
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA.,e Department of Psychology & Neuroscience , Duke University , Durham , North Carolina , USA
| | - Rhonda M Merwin
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA
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31
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Rienecke RD, Sim L, Lock J, Le Grange D. Patterns of expressed emotion in adolescent eating disorders. J Child Psychol Psychiatry 2016; 57:1407-1413. [PMID: 27377705 PMCID: PMC5115973 DOI: 10.1111/jcpp.12594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND This goal of this study was to understand the patterns of expressed emotions (EEs) in adolescent eating disorders. As such, this study compared EE among families of adolescents with anorexia nervosa (AN), bulimia nervosa (BN), and a psychiatric control group, major depressive disorder (MDD). This study also examined the influence of family status (intact vs. nonintact) and the presence of siblings on EE. METHODS Two-hundred and fifteen adolescents (ages 12-19) and their families were recruited for this study including 121 adolescents with AN, 54 adolescents with BN, and 40 adolescents with MDD. Adolescents with at least one parent completed the Standardized Clinical Family Interview. Adolescents completed structured diagnostic interviews to assess eligibility for the study, as well as a standardized questionnaire to assess depression. RESULTS Analyses revealed that fathers showed higher levels of critical comments to adolescents with BN or MDD than those with AN, whereas mothers made more critical comments toward patients with BN. Mothers made the least number of positive remarks toward patients with MDD. In terms of the influence of family status, fathers from intact families showed more expressions of warmth and were less critical than fathers from nonintact families, whereas mothers from intact families were less critical but also made fewer positive remarks than mothers from nonintact families. The presence of siblings appeared to reduce mothers' expression of warmth and emotional overinvolvement. CONCLUSIONS Unique patterns of EE were found to characterize AN, BN, and MDD. Family status and the presence of siblings exert an influence on EE that should be taken into consideration in future research.
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Affiliation(s)
- Renee D. Rienecke
- Department of Pediatrics at Medical University of South Carolina, Charleston, SC,Department of Psychiatry at the University of Michigan, Ann Arbor, MI
| | - Leslie Sim
- Department of Psychiatry and Psychology at the Mayo Clinic, Rochester, MN
| | - James Lock
- Department of Psychiatry & Behavioral Sciences at Stanford University, Stanford, CA
| | - Daniel Le Grange
- Department of Psychiatry at the University of California, San Francisco, San Francisco, CA, USA
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Rienecke RD, Richmond R, Lebow J. Therapeutic alliance, expressed emotion, and treatment outcome for anorexia nervosa in a family-based partial hospitalization program. Eat Behav 2016; 22:124-128. [PMID: 27289048 DOI: 10.1016/j.eatbeh.2016.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/01/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
Abstract
Adolescent therapeutic alliance has been found to be associated with improvements in eating disorder cognitions and with early weight gain. The current study assessed patient and parent therapeutic alliance, correlates of parent alliance, and relationship between alliance and treatment outcome. Fifty-six patients with anorexia nervosa completed measures of therapeutic alliance and eating disorder symptoms. Patients' parents completed measures of therapeutic alliance, expressed emotion, and psychopathology. Patients' alliance predicted cognitive and behavioral symptomatology at end of treatment (β=-0.39, p=0.001), though it was not related to changes in weight (β=0.12, p=0.377). Maternal hostility was associated with lower maternal alliance (r=-0.34, p=0.05). Findings suggest that maternal hostility should be addressed in treatment, and that patient alliance may be important in achieving psychological recovery from disordered eating.
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Affiliation(s)
- Renee D Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Rebekah Richmond
- Medical University of South Carolina, 135 Rutledge Ave., MSC 561, Charleston, SC 29425, USA.
| | - Jocelyn Lebow
- Department of Psychiatry & Behavioral Sciences, University of Miami, 1120 NW 14th St., Miami, FL 33136, USA; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
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Schmidt R, Tetzlaff A, Hilbert A. Perceived Expressed Emotion in Adolescents with Binge-Eating Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:1369-77. [PMID: 25860811 DOI: 10.1007/s10802-015-0015-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A sizeable body of research has documented Expressed Emotion (EE) to predict clinical outcomes in various psychiatric disorders, including eating disorders. Patients' perceptions of relative's EE, however, were found to play an important role in the processing of EE. This study aimed to examine the level of perceived EE in adolescent binge-eating disorder (BED) and its impact on eating disorder psychopathology. Adolescents (12-20 years) seeking treatment for BED (n = 40) were compared to adolescents without current or lifetime eating disorder (CG; n = 40). Both groups were stratified according to age, sex, body mass index (BMI, kg/m(2)), and socio-economic status. The Five Minute Speech Sample (FMSS) and the Brief Dyadic Scale of EE were administered to assess patients' perceived maternal EE. Additionally, adolescents and mothers completed questionnaires on eating disorder and general psychopathology. On the FMSS, 37.5 % of patients with BED perceived their mothers as high EE (vs. 12.5 % in the CG). On the Brief Dyadic Scale of EE, patients with BED reported significantly higher levels of perceived maternal criticism, emotional overinvolvement, and lower levels of perceived warmth than controls. After controlling for the diagnosis of BED, perceived criticism and warmth, as assessed by questionnaire, significantly explained adolescents' global eating disorder psychopathology. Negative perceptions of maternal behavior and emotional atmosphere towards the child are characteristic of adolescent BED. As documented for other eating disorders, family factors are likely to have substantial implications for the maintenance and treatment of adolescent BED.
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Affiliation(s)
- Ricarda Schmidt
- Integrated Research and Treatment Center AdiposityDiseases, Department of Medical Psychology and Medical Sociology, Leipzig University Medical Center, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany,
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Schmidt R, Tetzlaff A, Hilbert A. Validity of the Brief Dyadic Scale of Expressed Emotion in Adolescents. Compr Psychiatry 2016; 66:23-30. [PMID: 26995232 DOI: 10.1016/j.comppsych.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Perceived expressed emotion is a valuable predictor of clinical outcome in psychiatric and community samples, but its assessment is limited to few instruments. A recent development to briefly assess expressed emotion from the patient's perspective is the 14-item Brief Dyadic Scale of Expressed Emotion (BDSEE). Although psychometric properties of the BDSEE have been provided for adult eating disorders, validity for adolescents is still lacking. In this study, BDSEE's factorial, convergent, and divergent validity was tested in an adolescent sample with binge-eating disorder and a matched community sample. METHODS For validation, well-established self- and mother-report questionnaires and adolescent's Five Minute Speech Sample were used. RESULTS Confirmatory factor analysis on the German BDSEE replicated the proposed three-factor structure in adolescents. BDSEE's convergent validity with the Five Minute Speech Sample and construct-related questionnaires was shown. Divergent validity was documented with BDSEE subscales being unrelated to socio-demographic and clinical characteristics. Further, BDSEE subscales were unrelated to measures of maternal distress. CONCLUSIONS While the results underline that the BDSEE is a valid self-report measure for assessing perceived expressed emotion in adolescents with and without binge-eating disorder, the evaluation of its predictive validity is still in need.
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Affiliation(s)
- Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology, Leipzig University Medical Center, Leipzig, Germany.
| | - Anne Tetzlaff
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology, Leipzig University Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology, Leipzig University Medical Center, Leipzig, Germany
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Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2015; 48:946-71. [PMID: 26171853 DOI: 10.1002/eat.22411] [Citation(s) in RCA: 325] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Understanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out. METHOD A literature search was conducted to identify research investigating predictors of outcome in individuals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor. RESULTS The most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge/purge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge/purge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type. DISCUSSION To ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.
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Affiliation(s)
- Eva Vall
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Rienecke RD, Accurso EC, Lock J, Le Grange D. Expressed Emotion, Family Functioning, and Treatment Outcome for Adolescents with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2015. [PMID: 26201083 DOI: 10.1002/erv.2389] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The current study examined the relation between parental expressed emotion (EE) and treatment outcome among adolescents participating in a treatment study for adolescent anorexia nervosa, as well as its impact on family functioning. One hundred and twenty-one families were assigned to family-based treatment or adolescent-focused therapy. Paternal criticism predicted lesser improvement in eating disorder psychopathology at end of treatment. There was also a significant interaction between maternal hostility and treatment, indicating that adolescents whose mothers displayed hostility had greater increases in percent of expected body weight in adolescent-focused therapy than family-based treatment. In addition, maternal hostility predicted less improvement in general family functioning and family communication at the end of treatment. Findings suggest that maternal and paternal EE may differentially impact treatment outcome and should be directly attended to in clinical settings. Future research is needed to further explore ways in which parental EE can be effectively modified in treatment.
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Affiliation(s)
- Renee D Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Erin C Accurso
- Department of Psychiatry, University of California, San Francisco, USA
| | - James Lock
- Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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Abstract
Best-practice guidelines for the treatment of child and adolescent eating disorders recommend the inclusion of parents. Family-based treatment (FBT) posits that families are not only important in supporting their children but are critical change agents in the recovery process. As originally developed for anorexia nervosa, parents take a central role in managing and disrupting eating disorder symptoms. The most evidence-based treatment model for adolescent anorexia nervosa, FBT has also recently been found to be useful in the treatment of adolescent bulimia nervosa. This article provides a summary of the theoretic model, evidence base, and application of FBT.
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Affiliation(s)
- Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
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Rienecke RD, Lebow J, Lock J, Le Grange D. Family Profiles of Expressed Emotion in Adolescent Patients With Anorexia Nervosa and Their Parents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 46:428-436. [PMID: 25945418 DOI: 10.1080/15374416.2015.1030755] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current study examined expressed emotion (EE) among families of adolescents with anorexia nervosa (AN) participating in a treatment study. EE ratings were made from 110 adolescents toward their parents and from parents toward their children using videotaped family interviews. Participants were 92% female and 75% Caucasian with a mean age of 14.41 years. Four family profiles were created (low patient EE/low parent EE, high patient EE/high parent EE, low patient EE/high parent EE, high patient EE/low parent EE). Family EE profile was not related to full remission at end of treatment. Groups were then combined according to EE level of parent. The low parent group (defined as low on criticism, hostility, and emotional overinvolvement) had significantly lower scores on a measure of eating disorder psychopathology than the high parent group at the end of treatment. Patients with AN in low EE families do better in treatment than those patients belonging to high EE families. These findings are true regardless of the EE status of the patient.
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Affiliation(s)
| | - Jocelyn Lebow
- b Department of Psychiatry & Behavioral Sciences , University of Miami.,c Department of Psychiatry and Psychology , Mayo Clinic
| | - James Lock
- d Department of Psychiatry & Behavioral Sciences , Stanford University
| | - Daniel Le Grange
- e Department of Psychiatry , University of California , San Francisco
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Hoste RR, Lebow J, Le Grange D. A bidirectional examination of expressed emotion among families of adolescents with bulimia nervosa. Int J Eat Disord 2015; 48:249-52. [PMID: 24888496 PMCID: PMC4783131 DOI: 10.1002/eat.22306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/13/2014] [Accepted: 05/16/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this paper was to examine expressed emotion (EE) measured from adolescents with bulimia nervosa (BN) toward their parents, in addition to measuring EE from parents toward patients. METHOD Fifty-four adolescents and their parents who were receiving treatment for BN participated in a videotaped family interview, from which ratings of EE were made. RESULTS Parent and patient scores were highly correlated. Four family profiles were created (Low Patient EE/Low Parent EE; High Patient EE/High Parent EE; Low Patient EE/High Parent EE; High Patient EE/Low Parent EE) to determine whether the match between parent and patient EE was related to treatment outcome. The Low Patient EE/Low Parent EE group demonstrated the greatest reduction in purging from baseline to end-of-treatment; the High Patient EE/Low Parent EE group showed the smallest reduction in purging. DISCUSSION EE has historically been rated from relatives toward patients, but patients' own EE may also be related to treatment outcome.
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Affiliation(s)
- Renee Rienecke Hoste
- Assistant Professor, Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Jocelyn Lebow
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL
| | - Daniel Le Grange
- Professor, Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL
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Forsberg S, Fitzpatrick KK, Darcy A, Aspen V, Accurso EC, Bryson SW, Agras S, Arnow KD, Grange DL, Lock J. Development and evaluation of a treatment fidelity instrument for family-based treatment of adolescent anorexia nervosa. Int J Eat Disord 2015; 48:91-9. [PMID: 25142619 PMCID: PMC4349507 DOI: 10.1002/eat.22337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study provides data on the psychometric properties of a newly developed measure of treatment fidelity in Family-Based Treatment (FBT) for adolescent anorexia nervosa (AN). The Family Therapy Fidelity and Adherence Check (FBT-FACT) was created to evaluate therapist adherence and competency on the core interventions in FBT. METHOD Participants were 45 adolescents and their families sampled from three randomized clinical trials evaluating treatment for AN. Trained fidelity raters evaluated 19 therapists across 90 early session recordings using the FBT-FACT. They also rated an additional 15 session 1 recordings of an alternate form of family therapy-Systemic Family Therapy for the purpose of evaluating discriminant validity of the FBT-FACT. The process of development and the psychometric properties of the FBT-FACT are presented. RESULTS Overall fidelity ratings for each session demonstrated moderate to strong inter-rater agreement. Internal consistency of the measure was strong for sessions 1 and 2 and poor for session 3. Principal components analysis suggests sessions 1 and 2 are distinct interventions. DISCUSSION The FBT-FACT demonstrates good reliability and validity as a measure of treatment fidelity in the early phase of FBT.
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Affiliation(s)
- Sarah Forsberg
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Kathleen Kara Fitzpatrick
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Alison Darcy
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Vandana Aspen
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637
| | - Susan W. Bryson
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Stewart Agras
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Katherine D. Arnow
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637
| | - James Lock
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
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Anastasiadou D, Medina-Pradas C, Sepulveda AR, Treasure J. A systematic review of family caregiving in eating disorders. Eat Behav 2014; 15:464-77. [PMID: 25064301 DOI: 10.1016/j.eatbeh.2014.06.001] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/09/2014] [Indexed: 12/12/2022]
Abstract
The objective of the study was to review systematically the available new evidence on family caregiving in eating disorders (ED), updating the study of Zabala, Macdonald, and Treasure (2009). Electronic databases were searched from October 2008 until May 2013. Selected studies included carers of people with ED and employed one or more measures of caregiving experience, accommodation and enabling behaviours, expressed emotion, and/or psychological distress. Twenty-nine studies were identified. Most of the studies examined these features in mothers of patients with anorexia. Only a few studies included a control group. The majority of studies found high levels of negative aspects of caregiving, accommodation and enabling behaviours, expressed emotion and psychological distress in carers of people with ED, although positive aspects and emotions were also reported. These features varied depending on some sociodemographic and clinical characteristics of carers and patients; moreover, interesting preliminary cultural and gender differences emerged. Progress has been made in research on family caregiving in ED and there is evidence that these factors can be associated with the outcome of ED. Theoretical, research and clinical implications of the findings are discussed.
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Affiliation(s)
- Dimitra Anastasiadou
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain.
| | - Cristina Medina-Pradas
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain.
| | - Ana R Sepulveda
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain.
| | - Janet Treasure
- FRCP, FRCPsych, Section of Eating Disorders, King's College of London, Institute of Psychiatry, London, UK.
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Duclos J, Dorard G, Berthoz S, Curt F, Faucher S, Falissard B, Godart N. Expressed emotion in anorexia nervosa: what is inside the "black box"? Compr Psychiatry 2014; 55:71-9. [PMID: 24199888 DOI: 10.1016/j.comppsych.2013.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 09/28/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Expressed Emotion has been called a "black box", since little is known about contributing factors. The aim of this study was to examine which parental and which patient/illness-related characteristics contribute to maternal and paternal Expressed Emotion levels. METHOD Sixty adolescent girls with Anorexia Nervosa (AN) and their parents completed instruments that evaluate characteristics of the adolescent's illness and patient/parental psychological characteristics (depression; anxiety; obsession-compulsion; social anxiety and alexithymia). The following illness-related characteristics were recorded: age at AN onset, duration of illness, AN subtype (restrictive AN-R vs. purging type AN-B), current Body Mass Index (BMI) (in kg/m(2)), minimum lifetime BMI and number of previous hospitalizations, the Global Outcome Assessment Scale total score. Levels of Expressed Emotion were assessed for the two parents using the Five-Minute Speech Sample. RESULTS Less than 30% of the parents in our sample expressed high levels of Critical EE and Emotional Over-Involvement. Our main findings indicate that maternal Criticism (Critical EE levels, Critical Comments, Dissatisfaction) and the sub-dimensions of maternal Emotional Over-Involvement (EOI EE) (Statement of loving Attitudes and Excessive Details about the past) were related both to the severity of the daughters' clinical state and to maternal psychological functioning. Only paternal levels of anxiety explained paternal Dissatisfaction, EOI EE and Statement of loving Attitudes. DISCUSSION Parental psychological functioning and the severity of the daughters' clinical state have an impact on the family relationships. These elements should be targeted by individual treatment for parents where necessary, and by psycho-educational sessions about Anorexia Nervosa for parents generally.
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Affiliation(s)
- Jeanne Duclos
- Psychiatry Unit, Institut Mutualiste Montsouris, 75014 Paris, France; INSERM U669, 75014 Paris, France.
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Goddard E, Hibbs R, Raenker S, Salerno L, Arcelus J, Boughton N, Connan F, Goss K, Laszlo B, Morgan J, Moore K, Robertson D, S S, Schreiber-Kounine C, Sharma S, Whitehead L, Schmidt U, Treasure J. A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK. BMC Psychiatry 2013; 13:287. [PMID: 24200194 PMCID: PMC3871017 DOI: 10.1186/1471-244x-13-287] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/15/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Individual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored. METHOD Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177). RESULTS One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control. CONCLUSIONS Overall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour may influence the response to inpatient care, as may improved social functioning and confidence to change.
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Affiliation(s)
- Elizabeth Goddard
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Rebecca Hibbs
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Simone Raenker
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Laura Salerno
- Department of Psychology, University of Palermo, Palermo, Italy
| | - Jon Arcelus
- Eating Disorders Service, Brandon Unit, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Nicky Boughton
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Frances Connan
- Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, London, UK
| | - Ken Goss
- Eating Disorders Service, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
| | - Bert Laszlo
- Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK
| | - John Morgan
- Yorkshire Centre for Eating Disorders, Leeds and St George’s University of London, Leeds, UK
| | - Kim Moore
- Kinver Centre, Eating Disorders, South Staffordshire and Shropshire NHS Foundation Trust, Staffordshire, UK
| | - David Robertson
- National Centre for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Saeidi S
- Yorkshire Centre for Eating Disorders, Leeds and St George’s University of London, Leeds, UK
| | | | - Sonu Sharma
- Eating Disorders Service, The Priory Hospital Cheadle Royal, Manchester, UK
| | - Linette Whitehead
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
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Merwin RM, Zucker NL, Timko CA. A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa. COGNITIVE AND BEHAVIORAL PRACTICE 2013; 20:485-500. [PMID: 27307691 PMCID: PMC4905735 DOI: 10.1016/j.cbpra.2012.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of adolescent anorexia nervosa (AN) has improved significantly with the increased emphasis on family-based intervention. Yet despite advances, a substantial number of adolescents do not respond optimally to existing treatment models and thus there is a need for treatment alternatives that address barriers to recovery. We developed and piloted an acceptance-based separated family treatment (ASFT) with 6 adolescents with AN or subthreshold AN (eating disorder not otherwise specified, with the primary symptoms of restriction and severe weight loss). Treatment acceptability was adequate. Overall, parents rated the treatment as credible and expected improvement in their child's condition. Five of the 6 adolescents treated with ASFT restored weight to their ideal body mass index as indicated by age, height, and sex and determined by individual growth charts. Many demonstrated improved psychological health and adaptive functioning. There was evidence of broad effects, with parents reporting decreased anxiety and caregiver burden. ASFT holds promise as a treatment option for AN. The efficacy of this therapeutic approach should be tested in larger trials and compared to current family-based interventions to determine unique effects.
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Darcy AM, Bryson SW, Agras WS, Fitzpatrick KK, Le Grange D, Lock J. Do in-vivo behaviors predict early response in family-based treatment for anorexia nervosa? Behav Res Ther 2013; 51:762-6. [PMID: 24091274 DOI: 10.1016/j.brat.2013.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/22/2013] [Accepted: 09/06/2013] [Indexed: 11/28/2022]
Abstract
The aim of the study is to explore whether identified parental and patient behaviors observed in the first few sessions of family-based treatment (FBT) predict early response (weight gain of 1.8 kg by session four) to treatment. Therapy film recordings from 21 adolescent participants recruited into the FBT arm of a multi-site randomized clinical trial were coded for the presence of behaviors (length of observed behavior divided by length of session recording) in the first, second and fourth sessions. Behaviors that differed between early responders and non-early responders on univariate analysis were entered into discriminant class analyses. Participants with fewer negative verbal behaviors in the first session and were away from table during the meal session less had the greatest rates of early response. Parents who made fewer critical statements and who did not repeatedly present food during the meal session had children who had the greatest rates of early response. In-vivo behaviors in early sessions of FBT may predict early response to FBT. Adaptations to address participant resistance and to decrease the numbers of critical comments made by parents while encouraging their children to eat might improve early response to FBT.
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Affiliation(s)
- Alison M Darcy
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States.
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Doba K, Nandrino JL, Dodin V, Antoine P. Is There a Family Profile of Addictive Behaviors? Family Functioning in Anorexia Nervosa and Drug Dependence Disorder. J Clin Psychol 2013; 70:107-17. [DOI: 10.1002/jclp.21977] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Karyn Doba
- Research Unit on Cognitive and Affective Sciences; Department of Psychology, University of North of France
- Medical and Psychological Clinic; Foundation Health Students from France
| | - Jean-Louis Nandrino
- Research Unit on Cognitive and Affective Sciences; Department of Psychology, University of North of France
- Medical and Psychological Clinic; Foundation Health Students from France
| | | | - Pascal Antoine
- Research Unit on Cognitive and Affective Sciences; Department of Psychology, University of North of France
- Medical Hospital of Saint-Vincent (GHICL)
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48
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Binford Hopf RB, Grange DL, Moessner M, Bauer S. Internet-Based Chat Support Groups for Parents in Family-Based Treatment for Adolescent Eating Disorders: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2012; 21:215-23. [DOI: 10.1002/erv.2196] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/13/2012] [Accepted: 07/28/2012] [Indexed: 12/11/2022]
Affiliation(s)
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience; The University of Chicago; Chicago; IL; USA
| | - Markus Moessner
- Center for Psychotherapy Research; University Hospital Heidelberg; Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research; University Hospital Heidelberg; Germany
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49
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Strober M, Johnson C. The need for complex ideas in anorexia nervosa: why biology, environment, and psyche all matter, why therapists make mistakes, and why clinical benchmarks are needed for managing weight correction. Int J Eat Disord 2012; 45:155-78. [PMID: 22287383 DOI: 10.1002/eat.22005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2012] [Indexed: 11/12/2022]
Abstract
Anorexia nervosa remains an enigma and its clinical challenge is intimidating. But the potential for new insights has been advancing, largely as a result of elegant research in the neurosciences that has modeled behavioral processes resembling key features of the illness. Unfortunately, many in the eating disorder field seem to know little of this work or the implication it holds for treatment philosophy. Instead, the knowledge void has been taken up recently by a host of misguided notions about etiology, blatantly dismissive attitudes toward psychological concepts, and ill-conceived beliefs about therapy priorities. This article is a clinical perspective on these issues.
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Affiliation(s)
- Michael Strober
- Department of Psychiatry and Biobehavioral Sciences and Semel Institute for Neuroscience, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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50
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Hoste RR, Labuschagne Z, Lock J, Le Grange D. Cultural variability in Expressed Emotion among families of adolescents with anorexia nervosa. Int J Eat Disord 2012; 45:142-5. [PMID: 22170027 PMCID: PMC3066275 DOI: 10.1002/eat.20888] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the cultural variability in Expressed Emotion (EE) among families of white and ethnic minority adolescents with anorexia nervosa (AN). METHOD One-hundred and eighty-nine AN patients and their parents completed the Eating Disorder Examination and the Structured Clinical Family Interview, from which EE ratings were made. RESULTS No differences were found in the number of white and minority families classified as high EE. White families were higher on warmth (W) and tended to be higher on positive remarks (PR) than minority families. High EE was associated with a longer duration of illness, but was not related to eating disorder pathology. DISCUSSION Few differences were found between white and ethnic minority families on the EE dimensions of CC, hostility (H), or EOI. Differences between families on W and PR, however, may have important treatment implications.
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Affiliation(s)
- Renee Rienecke Hoste
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois 60637, USA.
| | - Zandre Labuschagne
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - James Lock
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California
| | - Daniel Le Grange
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
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