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Ralph-Nearman C, Rae J, Levinson CA. Using clinician and patient input to assess utility, accuracy, efficiency, and therapeutic implementation of a new data-driven digital therapeutic for personalized clinical eating disorder treatment: Awaken digital guide. Psychother Res 2024:1-14. [PMID: 38917165 DOI: 10.1080/10503307.2024.2360445] [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: 07/20/2023] [Accepted: 05/18/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE Eating disorders (EDs) take a life every 52 minutes and treatments are ineffective for ∼50% of individuals. Though EDs are heterogeneous illnesses, current evidence-based treatments take a "one-size-fits-all" approach. Network-Informed Personalized Treatment is a new promising treatment for EDs, but clinician-patient-friendly software tools are needed to integrate this guidance system into routine treatment. Adoption is key for impact, necessitating the inclusion of clinicians in the software development. The current pilot assessed a new data-driven clinician-guidance therapeutic. METHOD A two-part pilot was analyzed for quantitative (0-not at all to 10-extremely) and qualitative input on user perception through quantitative and open-ended prompted questions evaluating using personalizing ED treatment with the Awaken Digital Guide therapeutic. RESULTS Results demonstrated that clinicians in a focus group (N = 9) and clinician/patient dyads within implementation (N = 10) endorsed improved efficiency, effectiveness, self-awareness, and accuracy using Awaken Digital Guide compared to current treatment as suggested by quantitative and qualitative results. Both clinicians and patients rated the tool positively (6.8-9.6/5.8-8.6, respectively) with an average rating of good and excellent. CONCLUSION Findings suggest that ED-specialized clinicians desire data-driven guidance on personalizing ED treatment. Users perceive Awaken Digital Guide therapeutic with potential to increase collaboration, motivation, efficiency, and effectiveness of ED personalized treatment.
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Affiliation(s)
- Christina Ralph-Nearman
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Jesse Rae
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
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Warren JS, Bullock M, Top DN, Salazar GC. Self-efficacy, motivation, social support, and alliance as predictors of youth psychotherapy outcomes in usual care. Psychother Res 2024:1-13. [PMID: 38735039 DOI: 10.1080/10503307.2024.2349996] [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: 09/01/2023] [Accepted: 04/24/2024] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVE We examined how youth self-efficacy, motivation for treatment, social support, and therapeutic alliance relate to psychotherapy outcomes of patients receiving services at outpatient community clinics. We hypothesized that (1) these variables would increase throughout the course of therapy, (2) baseline scores would predict initial ratings of distress, (3) baseline scores would predict the rate of change in symptoms throughout treatment, and (4) changes in these variables would be associated with symptom change over the course of treatment. METHOD Participants included 150 adolescents at community outpatient treatment centers. Data was collected prior to beginning treatment, and every three weeks afterward until termination. We used hierarchical linear modeling (HLM) to address our hypotheses. RESULTS We found that (1) youth ratings of self-efficacy, social support, and motivation increased throughout treatment, (2) initial self-efficacy and social support were associated with initial levels of distress, (3) ratings of youth self-efficacy at intake predicted its rate of change over therapy, and (4) changes in all variables during therapy were related to lower distress at termination. DISCUSSION Results suggest that these variables may affect the trajectory and course of treatment in community-based treatment settings. These results may have implications for treatment planning to maximize treatment effectiveness.
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Affiliation(s)
- Jared S Warren
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Mariah Bullock
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - D Nicholas Top
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Gus C Salazar
- Department of Psychology, Brigham Young University, Provo, UT, USA
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3
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Robinson L, Flynn M, Cooper M. Individual differences in motivation to change in individuals with eating disorders: A systematic review. Int J Eat Disord 2024; 57:1069-1087. [PMID: 38436481 DOI: 10.1002/eat.24178] [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: 11/29/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Motivation to change has been suggested to significantly impact treatment outcomes in eating disorders (EDs). This review will investigate factors associated with motivation to change in EDs with the aim of supporting clinicians to be aware and sensitive to factors that might obstruct recovery and to inform motivation-based interventions. METHOD Using PRISMA guidelines, this article identified 24 studies through database searches meeting eligibility criteria. Only correlates of motivation were identified, limiting the ability of this review to identify causal relationships. Factors that changed alongside changes in motivation were identified from longitudinal studies. RESULTS This review identified factors such as individual characteristics, co-morbid psychopathology, lack of treatment autonomy and relationships with others to be associated with motivation to change in individuals with EDs. In addition, motivation to change significantly increased alongside self-esteem and identity re-negotiation when measured longitudinally. DISCUSSION Motivational interviewing can typically focus on exploring ambivalence to treatment, identifying goals and values, and increasing self-efficacy. However, this review identifies individual and relational factors to be particularly significant and may obstruct recovery from an ED. As such, evidence-based targets have been identified to inform clinicians and motivation-based interventions. PUBLIC SIGNIFICANCE Knowledge of factors associated with motivation to change in EDs is important to understand those who may have poorer treatment outcomes. Motivation may be improved by supporting individuals' relationship with others and tailoring interventions according to temperament and personality traits. Utilizing an individual's social support as they enter ED treatment may be effective in maximizing motivation to recover.
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Affiliation(s)
- Lauren Robinson
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
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Schorer L, Ross T, Fontao M. [Patient Factors in Offender Treatment: Personality, Therapy Motivation and Outcome]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:170-185. [PMID: 35948024 DOI: 10.1055/a-1872-9220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Using a systematic literature review according to the PRISMA criteria, patient factors of offenders were related to forensic outcomes. Searches were conducted in the PsycInfo and PSYNDEX databases; further relevant studies were taken from the bibliographies of studies that met the selection criteria. Only quantitative empirical studies for the period 1990-2021 were included. Findings from 31 studies on patient factors (personality, therapy motivation, therapy expectation, satisfaction with therapy) are reported. Patient factors could not always be consistently associated with outcomes. The clearest correlations were found between the expression of anti- or dissocial personality traits and/or psychopathy and (negative) therapy outcomes. Traits usually associated with antisocial developments (impulsivity, anger, rage, hostility) in some cases also correlated negatively with therapeutically desirable outcomes. Patient motivation for therapy should generally have a positive impact on the likelihood of successful forensic therapies, but not all relevant studies pointed in this direction. No studies were identified on the relationships between therapy expectancy or satisfaction and outcome. Based on general psychotherapy research, we suggest that offender therapy could benefit from broader approaches to studying therapy effectiveness.
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Affiliation(s)
- Leila Schorer
- Fachbereich Psychologie, Universität Konstanz, Konstanz, Germany
| | - Thomas Ross
- Klinik für Forensische Psychiatrie und Psychotherapie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
- Medizinische Fakultät, Universität Ulm, Ulm, Germany
| | - Maria Fontao
- Fachbereich Psychologie, Universität Konstanz, Konstanz, Germany
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Tempia Valenta S, Rapezzi M, Marcolini F, Speciani M, Giordani G, De Panfilis C, De Ronchi D, Atti AR. Assessing motivation for treatment in eating disorders: psychometric validation of the Italian version of the Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ-ITA). Eat Weight Disord 2024; 29:23. [PMID: 38573529 PMCID: PMC10995063 DOI: 10.1007/s40519-024-01653-9] [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: 07/26/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Treatment resistance is a significant challenge in addressing eating disorders (EDs). The Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ) has been previously validated in ED populations to assess patients' motivation for treatment. This study aimed to validate the ACMTQ in the Italian language (ACMTQ-ITA) and evaluate its psychometric properties. METHODS We recruited a clinical sample of adults aged 18 or older, diagnosed with EDs, proficient in the Italian language, and providing written informed consent. Participants with psychiatric comorbidities such as schizophrenia, bipolar disorder, and substance use disorder were excluded from the study. Validity of the ACMTQ-ITA was assessed using reliability analysis with Cronbach's α and McDonald's ω estimates, and Confirmatory Factor Analysis (CFA). RESULTS Results from the reliability analysis confirmed the internal consistency of the Autonomous Motivation (AM) factor (α = 0.82, ω = 0.82), the Controlled Motivation (CM) factor (α = 0.76, ω = 0.77), and the ACMTQ-ITA overall score (α = 0.79). The CFA confirmed the two-factor solution (i.e., AM and CM) identified in the original validation of the ACMTQ (Comparative Fit Index = 0.92, Akaike Information Criterion = 3427.26, Bayesian Information Criterion = 3486.82; Root Mean Square Error of Approximation = 0.08, Standardized Root Mean Square Residual = 0.09). CONCLUSION The ACMTQ-ITA emerged as a valid and reliable tool for measuring motivation for treatment in individuals with EDs. Its implementation may facilitate the comprehension of treatment motivation, offering valuable clinical insights and implications for health management practices. LEVEL OF EVIDENCE Level V, descriptive studies.
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Affiliation(s)
- Silvia Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy.
| | - Matilde Rapezzi
- Department of Management, University of Bologna, Bologna, Italy
| | - Federica Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Maurizio Speciani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Gabriele Giordani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Chiara De Panfilis
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
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Keegan E, Wade TD. The role of readiness and confidence to change in the treatment of atypical anorexia nervosa and bulimia nervosa. Int J Eat Disord 2024; 57:1020-1025. [PMID: 36840352 DOI: 10.1002/eat.23918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Atypical anorexia nervosa (AN) is a serious eating disorder that is more common in the population than AN. Despite this, people with atypical AN are less likely to be referred or admitted for eating disorder treatment and there is evidence that they are less likely to complete or benefit from existing interventions. This study examined whether baseline readiness and/or confidence moderated outcomes from 10-session cognitive behavioral therapy among people with atypical AN and bulimia nervosa (BN), and whether the impact of these variables differed between diagnoses. METHODS Participants (n = 67; 33 with atypical AN) were a subset from an outpatient treatment study. Linear mixed model analyses were conducted to examine whether baseline readiness and/or confidence moderated outcomes. RESULTS People with BN who had higher levels of readiness or confidence at baseline had steeper decreases in eating disorder psychopathology over time. There was no evidence that readiness or confidence moderated outcomes for people with atypical AN. DISCUSSION This study suggests that the moderators that have been identified for other eating disorders may not apply for people with atypical AN and highlights a need for future work to routinely investigate whether theoretically or empirically driven variables moderate outcomes in this little-understood population. PUBLIC SIGNIFICANCE STATEMENT People with bulimia nervosa with higher readiness and confidence experienced greater decreases in eating disorder symptoms than people with lower readiness and confidence when treated with cognitive behavioral therapy. These findings did not apply to people with atypical anorexia nervosa. Results demonstrate that future work is urgently required to identify helpful treatments for people with atypical anorexia nervosa as well as the variables that have a positive impact on outcomes in treatment for these individuals.
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Affiliation(s)
- Ella Keegan
- Flinders Institute for Mental Health and Wellbeing, School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Flinders Institute for Mental Health and Wellbeing, School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Ruzicka EB, Shomaker LB, Pyle L, Bakalar JL, Shank LM, Crosby RD, Wilfley DE, Young JF, Sbrocco T, Brady SM, Gulley LD, Yanovski JA, Tanofsky-Kraff M. Effects of Therapeutic Alliance in Interpersonal Psychotherapy Among Adolescent Girls With Loss-of-Control Eating. Am J Psychother 2024; 77:7-14. [PMID: 38196343 DOI: 10.1176/appi.psychotherapy.20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Interpersonal psychotherapy (IPT) has been proposed for prevention of excess weight gain among adolescents with loss-of-control (LOC) eating. Mixed findings from a trial testing this conjecture warrant elucidation of potential outcome predictors. The therapeutic alliance (adolescent-facilitator emotional bond and task collaboration) may be important for IPT but has received little attention in weight-related interventions. This study evaluated associations of adolescent-reported therapeutic alliance during IPT with weight- and eating-related outcomes. METHODS Secondary analyses of a randomized controlled trial were conducted to compare group IPT to health education (HE) for preventing excess weight gain among 113 girls (ages 12-17) with body mass index (BMI) at the 75th to 97th percentile and LOC eating. BMI and LOC eating were measured at baseline, 12 weeks (postintervention), and 1 year. Multilevel modeling was used to test associations between change in therapeutic alliance (from session 1 to session 12) and changes in weight- and eating-related outcomes (from postintervention to 1 year). Analyses were controlled for therapeutic alliance after session 1 and for baseline and postintervention outcome values; group assignment (IPT vs. HE) was a moderator. RESULTS Increases in emotional bond were associated with decreased weight and with greater decreases in number of LOC eating episodes at 1 year in the IPT group (p<0.05) and with weight gain in the HE group (p<0.05). Greater task collaboration was related to greater weight gain at 1-year follow-up, regardless of group assignment (p<0.05). CONCLUSIONS The association of therapeutic alliance during IPT with weight and LOC eating outcomes among adolescent girls merits further investigation.
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Affiliation(s)
- Elizabeth B Ruzicka
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Laura Pyle
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Jennifer L Bakalar
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Lisa M Shank
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Ross D Crosby
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Denise E Wilfley
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Jami F Young
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Tracy Sbrocco
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Sheila M Brady
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Lauren D Gulley
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Jack A Yanovski
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
| | - Marian Tanofsky-Kraff
- Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young)
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Thal SB, Baker P, Marinis J, Wieberneit M, Sharbanee JM, Bruno R, Skeffington PM, Bright SJ. Therapeutic frameworks in integration sessions in substance-assisted psychotherapy: A systematised review. Clin Psychol Psychother 2023. [PMID: 38148518 DOI: 10.1002/cpp.2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/07/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed.
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Affiliation(s)
- Sascha B Thal
- Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Paris Baker
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Jonathon Marinis
- Orygen Youth Health, University of Melbourne, Parkville, Victoria, Australia
| | - Michelle Wieberneit
- Law School, University of Western Australia, Crawley, Western Australia, Australia
| | - Jason M Sharbanee
- Enable Institute, Discipline of Psychology, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Raimundo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Petra M Skeffington
- School of Psychology, College of Health & Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Psychedelic Research in Science and Medicine (PRISM), Balwyn North, Victoria, Australia
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9
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Miskovic-Wheatley J, Bryant E, Ong SH, Vatter S, Le A, Touyz S, Maguire S. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disord 2023; 11:85. [PMID: 37254202 DOI: 10.1186/s40337-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality. METHODS This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review. RESULTS Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates. CONCLUSION Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.
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Affiliation(s)
- Jane Miskovic-Wheatley
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Emma Bryant
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Shu Hwa Ong
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sabina Vatter
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Stephen Touyz
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
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10
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Amarnath A, Ozmen S, Struijs SY, de Wit L, Cuijpers P. Effectiveness of a guided internet-based intervention for procrastination among university students - A randomized controlled trial study protocol. Internet Interv 2023; 32:100612. [PMID: 36922962 PMCID: PMC10009202 DOI: 10.1016/j.invent.2023.100612] [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: 09/28/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Procrastination is a widespread problem that is highly prevalent among the young adult population and is associated with several negative consequences. However, current evidence on the effectiveness of e-health interventions for procrastination either lack a comparison to an inactive control, do not include a student population or are of poor quality. This protocol describes the design of a trial that will overcome these limitations and examine the effectiveness of a guided internet-based intervention (GetStarted) to reduce problematic procrastinating behaviors in college students compared to a waitlist control. This study will be a two-armed randomized controlled trial with a calculated sample size of N = 176. Participants will be students from seven universities in the Netherlands. The intervention group will receive a four-week e-coach-guided intervention for procrastination. The waitlist control group will get access to treatment four weeks after randomization. Assessments will take place at baseline, post-test (4 weeks post-baseline) and follow-up (6 months post-baseline). Data will be analyzed with an intent-to-treat principle. The primary outcome is change in procrastination behaviors measured on the Irrational Procrastination scale (IPS). Secondary outcomes are depression, anxiety, stress, and quality of life. Additionally, sociodemographic characteristics of the participants, satisfaction with treatment, program usability, satisfaction with e-coach and treatment adherence will be examined as potential moderators. The results from this study can build evidence for the effectiveness of a guided internet-based intervention for treating procrastination in college students. Should it be effective, GetStarted could provide a flexible, low-intense and cost-effective treatment for procrastination and prevent common mental health problems in college students. Trial registration This trial is registered at ClinicalTrials.gov Protocol Registration and Results System (Trial number: NCT05478096).
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Affiliation(s)
- Arpana Amarnath
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Sevin Ozmen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Sascha Y Struijs
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.,Institute of Clinical Psychology, Leiden University, Leiden, the Netherlands
| | - Leonore de Wit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.,WHO Collaborating Centre for Research and Dissemination of Psychological Interventions
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11
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Rankin R, Conti J, Touyz S, Arcelus J, Meyer C, Hay P. Dancing with change: a qualitative exploration of in-session motivation to change in the treatment of anorexia nervosa. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2022.2151338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Rebekah Rankin
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Janet Conti
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
| | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, Australia
- InsideOut Institute, Level 2, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Jon Arcelus
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Caroline Meyer
- WMG and Warwick Medical School, University of Warwick, Coventry, UK
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Campbelltown Hospital, South West Sydney Local Health District (SWSLHD), Sydney, Australia
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12
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Schaper R, Nowotny C, Michalek S, Schmidt U, Brockmeyer T. Language style matching and treatment outcome in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023; 31:110-120. [PMID: 35962959 DOI: 10.1002/erv.2943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Psychotherapy is the treatment of choice for anorexia nervosa (AN) but mechanisms of action are still largely unknown. Growing research suggests that synchrony between patient and therapist contributes to treatment success. Adding to this literature, this study examined the association between language style matching (LSM) among patient and therapist as an indicator of interpersonal (verbal) synchrony and treatment outcome in AN. METHOD Audio recordings of mid-treatment therapy sessions (n = 25) in a multi-centre randomized controlled trial on the Maudsley Model of Anorexia Nervosa Treatment for Adults were transcribed and used to calculate LSM for each patient-therapist dyad. These scores were used to predict treatment outcome at 12-month follow-up. RESULTS LSM did not predict body mass index (primary outcome) at follow-up. However, higher LSM (M = 0.87, SD = 0.04) was associated with lower eating disorder psychopathology (accounting for 11% of the variance) and higher recovery rates (accounting for 28% of variance) at follow-up. CONCLUSIONS These preliminary findings suggest that verbal synchrony between patients with AN and their therapists contributes to favourable treatment outcomes. High levels of LSM may reflect therapeutic empathy, cooperation, or mutual positive perception. Further research should explore the mechanisms of linguistic synchrony with larger samples to allow for stronger conclusions.
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Affiliation(s)
- Rachel Schaper
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Christina Nowotny
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Silke Michalek
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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13
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Mac Donald B, Bulik CM, Petersen LV, Clausen L. Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa. Eat Weight Disord 2022; 27:3157-3172. [PMID: 35864298 PMCID: PMC9805523 DOI: 10.1007/s40519-022-01446-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We explored associations between clinical factors, including eating disorder psychopathology and more general psychopathology, and involuntary treatment in patients with anorexia nervosa. Our intention was to inform identification of patients at risk of involuntary treatment. METHODS This was a retrospective cohort study combining clinical data from a specialized eating disorder hospital unit in Denmark with nationwide Danish register-based data. A sequential methodology yielding two samples (212 and 278 patients, respectively) was adopted. Descriptive statistics and regression analyses were used to explore associations between involuntary treatment and clinical factors including previous involuntary treatment, patient cooperation, and symptom-level psychopathology (Eating Disorder Inventory-2 (EDI-2) and Symptom Checklist-90-Revised (SCL-90-R)). RESULTS Somatization (SCL-90-R) (OR = 2.60, 95% CI 1.16-5.81) and phobic anxiety (SCL-90-R) (OR = 0.43, 95% CI 0.19-0.97) were positively and negatively, respectively, associated with the likelihood of involuntary treatment. Furthermore, somatization (HR = 1.77, 95% CI 1.05-2.99), previous involuntary treatment (HR = 5.0, 95% CI 2.68-9.32), and neutral (HR = 2.92, 95% CI 1.20-7.13) or poor (HR = 3.97, 95% CI 1.49-10.59) patient cooperation were associated with decreased time to involuntary treatment. Eating disorder psychopathology measured by the EDI-2 was not significantly associated with involuntary treatment. CONCLUSIONS Clinical questionnaires of psychopathology appear to capture specific domains relevant to involuntary treatment. Poor patient cooperation and previous involuntary treatment being associated with shorter time to involuntary treatment raise important clinical issues requiring attention. Novel approaches to acute anorexia nervosa care along with unbiased evaluation upon readmission could mitigate the cycle of repeat admissions with involuntary treatment. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Benjamin Mac Donald
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liselotte V Petersen
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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14
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Gukasyan N, Schreyer CC, Griffiths RR, Guarda AS. Psychedelic-Assisted Therapy for People with Eating Disorders. Curr Psychiatry Rep 2022; 24:767-775. [PMID: 36374357 DOI: 10.1007/s11920-022-01394-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW A growing body of research suggests psychedelic-assisted therapy (PAT) may be safe and effective for a variety of mental health conditions. Among these, eating disorders have been a recent target of interest. This review provides an up-to-date summary of the potential mechanisms and use of PAT in people diagnosed with eating disorders, with a focus on anorexia nervosa. RECENT FINDINGS Classic psychedelics may have transdiagnostic efficacy through several mechanisms relevant to eating disorder pathology. Interest in, and efforts to increase access to PAT are both high. Early clinical trials are focused on establishing the safety and utility of this treatment in eating disorders, and efficacy remains unclear. High-quality published data to support the use of PAT for people with eating disorders remains lacking. Recent studies however suggest PAT has the potential to augment the efficacy of current interventions for these difficult-to-treat conditions.
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Affiliation(s)
- Natalie Gukasyan
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA
| | - Roland R Griffiths
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA
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15
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Oliverio S, Steiger H, St-Hilaire A, Paquin-Hodge C, Leloup AG, Israel M, Thaler L. Barriers and facilitators to providing autonomy supportive counselling to individuals seeking treatment for an eating disorder. Eat Weight Disord 2022; 27:2919-2929. [PMID: 35366169 DOI: 10.1007/s40519-022-01395-6] [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: 12/14/2021] [Accepted: 03/16/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Self-determination theory suggests that autonomous motivation for change (i.e., motivation that is internal and self-endorsed) can be enhanced in therapeutic contexts by clinicians acting in an autonomy supportive manner. While previous research has established a link between autonomy support (AS) and autonomous motivation in enhancing outcomes in eating disorder (ED) treatment, few studies have examined factors that support or hinder therapists' ability to be autonomy supportive in the context of an ED therapeutic encounter. The goal of the present study was to conduct a qualitative analysis of personal and contextual factors that facilitated or hindered therapists' ability to provide autonomy supportive interventions. METHODS Semi-structured interviews were conducted with 10 therapists conducting outpatient psychotherapy at a specialized eating disorders treatment program. Data were analyzed using thematic analysis. RESULTS The most frequently noted facilitators were organizational support of AS interventions and patients' engagement and motivation for treatment. The most frequently noted barriers were patients' personality variables such as patients that exhibit passive and help-rejecting behaviours, as well as therapists feeling overwhelmed due to a high workload. CONCLUSION Our results provide insight into the factors that facilitate and impede the utilization of an autonomy supportive approach in specialized ED treatment and can be used to inform future quantitative research on such factors. LEVEL OF EVIDENCE Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Stephanie Oliverio
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada. .,Research Centre, Douglas University Institute, Montreal, Canada.
| | - Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada.,Department of Psychology, McGill University, Montreal, Canada
| | - Annie St-Hilaire
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
| | - Chloé Paquin-Hodge
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
| | - Anne-Gaëlle Leloup
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Clinique Baca, Montreal, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
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16
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Fetahi E, Søgaard AS, Sjögren M. Estimating the Effect of Motivational Interventions in Patients with Eating Disorders: A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12040577. [PMID: 35455693 PMCID: PMC9028385 DOI: 10.3390/jpm12040577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 12/10/2022] Open
Abstract
Motivation to change behavior is seen as an important factor in achieving a better treatment effect in patients with eating disorders (ED). The aim of this systematic review was to assess whether motivational interviewing (MI) and motivational enhancement therapy (MET) might (1) increase motivation to change behavior and (2) improve eating disorder psychopathology (EDP) and body mass index (BMI) in patients with ED. To investigate this, a literature search was conducted on 9 March 2021 on four scientific databases: Cochrane, Embase (Ovid), MEDLINE (PubMed), and PsycInfo (EBSCO). A total of 2647 publications were identified and following a rigorous stepwise procedure to assess titles and abstracts and, thereafter, full texts of relevant publications, 13 studies were included in the data extraction and analyses. A few individual studies (n = 5) found a significant increase in motivation, two a decrease in ED symptoms (n = 2), while none found an effect on BMI. However, the meta-analysis of each outcome found effect sizes near zero, thereby confirming the results of previous narrative reviews that have described a lack of effect of MET/MI on motivation in ED. Since the individual studies differ substantially in design, and the outcomes were inconsistently assessed with regards to instruments and duration, the effect of MET/MI on motivation for behavioral change, ED psychopathology, and BMI is still unclear.
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Affiliation(s)
- Egzona Fetahi
- Eating Disorder Research Unit, Psychiatric Centre Ballerup, 2750 Ballerup, Denmark; (E.F.); (A.S.S.)
| | - Anders Stjerne Søgaard
- Eating Disorder Research Unit, Psychiatric Centre Ballerup, 2750 Ballerup, Denmark; (E.F.); (A.S.S.)
| | - Magnus Sjögren
- Eating Disorder Research Unit, Psychiatric Centre Ballerup, 2750 Ballerup, Denmark; (E.F.); (A.S.S.)
- Institute for Clinical Science, Umeå University, 901 85 Umeå, Sweden
- Correspondence:
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17
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Runge E, Jensen EK, Mathiasen K, Larsen PV, Hertz SPT, Holmberg TT, Tarp K, Linnet J, Lichtenstein MB. Early development of treatment motivation predicts adherence and symptom reduction in an internet-based guided self-help program for binge eating disorder. Front Psychiatry 2022; 13:969338. [PMID: 36276339 PMCID: PMC9583526 DOI: 10.3389/fpsyt.2022.969338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/14/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Lack of motivation is widely acknowledged as a significant factor in treatment discontinuity and poor treatment outcomes in eating disorders. Treatment adherence is lower in internet-based treatment. The current study aimed to assess the relationship between treatment motivation and treatment outcomes in an internet-based therapist-guided intervention for Binge Eating Disorder (BED). METHOD Adults (N = 153) with mild to moderate symptoms of BED participated in a 10-session internet-based treatment program. Baseline and between-session scores of "Readiness to change" and "Belief in change" were used to predict treatment completion and eating disorder symptom reduction (EDE-Q Global, BED-Q, and weekly number of binge eating episodes) at post-treatment. RESULTS Baseline treatment motivation could not predict treatment completion or symptom reduction. Early measures of treatment motivation (regression slope from sessions 1-5) significantly predicted both treatment completion and post-treatment symptom reduction. "Belief in change" was the strongest predictor for completing treatment (OR = 2.18, 95%-CI: 1.06, 4.46) and reducing symptoms (EDE-Q Global: B = -0.53, p = 0.001; number of weekly binge eating episodes: B = 0.81, p < 0.01). DISCUSSION The results indicated that patients entering online treatment for BED feel highly motivated. However, baseline treatment motivation could not significantly predict treatment completion, which contradicts previous research. The significant predictive ability of early measures of treatment motivation supports the clinical relevance of monitoring the development of early changes to tailor and optimize individual patient care. Further research is needed to examine treatment motivation in regard to internet-based treatment for BED with more validated measures.
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Affiliation(s)
- Eik Runge
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark
| | - Esben Kjems Jensen
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kim Mathiasen
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pia Veldt Larsen
- Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Søren Peter Thygesen Hertz
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark
| | - Trine Theresa Holmberg
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark
| | - Kristine Tarp
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jakob Linnet
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Clinic on Gambling- and Binge Eating Disorder, Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Mia Beck Lichtenstein
- Mental Health Services in the Region of Southern Denmark, Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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18
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A randomized controlled trial of two 10-session cognitive behaviour therapies for eating disorders: An exploratory investigation of which approach works best for whom. Behav Res Ther 2021; 146:103962. [PMID: 34534858 DOI: 10.1016/j.brat.2021.103962] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
Cognitive behaviour therapy for eating disorders (CBT-ED) outperforms other treatments for non-underweight eating disorders in adults, but we have limited ability to match CBT-ED to individual profiles. We examined if we could identify who benefits most from two forms of 10-session CBT-ED; one emphasizing early behaviour change with substantial content on improving body image (CBT-T), and the other including motivational work and no content on body image using chapters from self-help books (CBTm). Participants were 98 consecutive referrals to the Flinders University Services for Eating Disorders. Fourteen clinical psychology postgraduates delivered the treatment under expert supervision. Outcome measures were completed on five occasions: baseline, 4-, 10-, 14- and 22-weeks post-randomisation. Our primary outcome was global eating psychopathology. Moderators included motivation (readiness and confidence to change) and body avoidance and body checking. Intent-to-treat analyses showed no difference between the groups with a significant main effect of time associated with large effect size improvements, commensurate with longer forms of CBT-ED. Participants with lower readiness to change in CBTm had significantly greater decreases in disordered eating over follow-up compared to those with low motivation in CBT-T. People with lower readiness to change might benefit from the incorporation of motivational work in CBT-ED.
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Manwaring J, Blalock DV, Le Grange D, Duffy A, McClanahan SF, Johnson C, Mehler PS, Plotkin M, Rienecke RD. Motivation to recover for adolescent and adult eating disorder patients in residential treatment. EUROPEAN EATING DISORDERS REVIEW 2021; 29:622-633. [PMID: 33851492 DOI: 10.1002/erv.2828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/22/2021] [Accepted: 02/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess how baseline motivation to recover impacts eating disorder (ED) and comorbid symptoms at end-of-treatment (EOT) for adolescents and adults in inpatient/residential treatment. METHOD Two hundred and three adolescent (M = 15.90) and 395 adult (M = 25.45) patients with a Diagnostic Statistical Manual, 5th edition ED diagnosis completed the Decisional Balance Scale (DBS) at baseline, and psychosocial measures (ED symptoms, anxiety, depression, obsessive-compulsive disorder symptoms), and %body mass index (kg/m2 ; BMI) or median %BMI (for adolescents) at baseline and EOT. RESULTS The DBS Avoidance Coping and Burdens subscales at baseline were significantly lower for adolescents than adults (p < 0.001), whereas the DBS Benefits subscale at baseline did not significantly differ between subsamples (p = 0.06). Motivation to recover via DBS subscales was a more reliable predictor of EOT outcomes for both ED and comorbid psychopathology in adults (significant predictor in 19 of 54 total analyses, and 4 significant associations post-Bonferroni correction) than adolescents (significant predictor in 5 of 54 total analyses, and 1 significant association post-Bonferroni correction). CONCLUSIONS Baseline motivation to recover may be an important predictor of outcome for adult patients in inpatient/residential treatment but does not appear associated with outcomes for adolescent patients.
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Affiliation(s)
- Jamie Manwaring
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Susan F McClanahan
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA.,Department of Psychiatry, Rush University Medical Center, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Craig Johnson
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA.,ACUTE, Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Millie Plotkin
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
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