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Martinelli MK, Schreyer CC, Vanzhula IA, Guarda AS. Impulsivity and reward and punishment sensitivity among patients admitted to a specialized inpatient eating disorder treatment program. Front Psychiatry 2024; 15:1325252. [PMID: 38832324 PMCID: PMC11145411 DOI: 10.3389/fpsyt.2024.1325252] [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: 10/20/2023] [Accepted: 04/23/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Eating disorders (EDs) are conceptualized as disorders of under- and over-control, with impulsivity reflecting under-control. Extant research indicates that impulsivity and related factors such as reward sensitivity and punishment sensitivity may serve as trait-level transdiagnostic risk and/or maintenance factors in EDs. Findings on impulsivity and reward and punishment sensitivity by diagnosis are mixed and research on the relationship between these factors and ED symptoms, hospital course, and treatment outcomes is limited. Methods Participants (N = 228) were patients admitted to a specialized inpatient behavioral treatment program for EDs who agreed to participate in a longitudinal study and completed self-report measures of impulsivity, reward sensitivity, and punishment sensitivity at admission. Weight and ED symptomatology were measured at admission and discharge. Hospital course variables included length of stay and premature treatment dropout. Results Impulsivity was lower in individuals with anorexia nervosa (AN) restricting type compared to those with AN binge/purge type or bulimia nervosa; no other group differences were observed. Higher impulsivity was associated with greater bulimic symptoms on the Eating Disorder Inventory 2 (EDI-2) at admission. Impulsivity was not related to ED symptoms, weight outcomes, length of hospital stay, or treatment dropout at program discharge. Conclusion Impulsivity may help distinguish restrictive versus binge/purge EDs, but does not necessarily relate to discharge outcomes in an intensive inpatient ED program. Findings from this study provide novel contributions to the literature on personality traits in EDs and have important clinical implications. Results suggest that patients with higher levels of impulsivity or reward and punishment sensitivity can be expected to respond to inpatient treatment. Suggestions for future research are discussed.
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Affiliation(s)
- Mary K. Martinelli
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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2
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García-Fernández G, Krotter A, García-Pérez Á, Aonso-Diego G, Secades-Villa R. Pilot randomized trial of cognitive-behavioral treatment plus contingency management for quitting smoking and weight gain prevention among smokers with overweight or obesity. Drug Alcohol Depend 2022; 236:109477. [PMID: 35525238 DOI: 10.1016/j.drugalcdep.2022.109477] [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: 01/24/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Post-cessation weight gain is a risk factor for relapse among quitters. The primary study aim was to evaluate, among smokers with overweight or obesity, the feasibility and acceptability of a cognitive-behavioral treatment (CBT) plus contingency management (CM) for quitting smoking and weight control. The secondary aim was to examine preliminary tobacco abstinence and weight change outcomes. METHODS In an 8-week pilot randomized clinical trial, 41 participants (Mage = 52.73, SD = 10.91, 56.1% females) with overweight or obesity (MBMI = 31.86, SD = 4.7) received a CBT for both quitting smoking and weight gain prevention (n = 24) or the same treatment plus CM (n = 17), consisting of providing incentives contingent upon smoking abstinence biochemically verified. RESULTS Recruitment success rate was 80.39% (41/51), completion rate was 90.24% (37/41), and mean number of sessions attended (out of 15 possible) was 13.20 (SD = 3.1). Mean satisfaction rating for the treatment (1-10 likert-type scale with 10 being most satisfactory) was 9.73 (SD =.61). Preliminary efficacy data indicated that the CM group achieved higher abstinence rates compared with the CBT condition (100% vs. 58.33%, p = .007). Abstinent participants increased 1.25 kg (SD = 1.79) their baseline body weight at the end of treatment (p = .001). CONCLUSIONS Providing weight gain prevention strategies and CM within a smoking cessation treatment seems feasible and acceptable. Preliminary data indicated that including CM facilitates tobacco abstinence rates, nevertheless no advantage for CM was found for weight control.
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Affiliation(s)
- Gloria García-Fernández
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain.
| | - Andrea Krotter
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Ángel García-Pérez
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Gema Aonso-Diego
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Roberto Secades-Villa
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
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3
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Sourlier P, Bozzi S, Kabuth B, Lamourette M, Ligier F. Experiences of parents and patients hospitalised in a child psychiatric unit for anorexia nervosa after reorganisation of care imposed by the COVID-19 Pandemic in France: a qualitative study-The QUALICOVID study. J Eat Disord 2022; 10:57. [PMID: 35468851 PMCID: PMC9035507 DOI: 10.1186/s40337-022-00579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a serious, albeit common mental illness that generally occurs during adolescence. Although outpatient care is recommended, hospitalisation is sometimes required. There is a dedicated hospitalisation unit caring for children and adolescents presenting with anorexia nervosa in Nancy, France. However, on 16 March 2020, a national lockdown was declared by the French government as the COVID-19 pandemic escalated in France. This resulted in the adjustment of hospital admissions accompanied by premature discharge and an intensive outpatient care programme. In the light of such changes, consideration should be given to the potential impact of changes in the care pattern for anorexic patients and their parents. The purpose of our study was to explore the experiences of anorexia nervosa patients hospitalised in the unit, and their parents, following changes in the care strategy. METHODS The study was conducted between weeks four and eight after lockdown was announced. The study cohort included all the patients treated for anorexia nervosa and hospitalised in the treatment unit before 16 March 2020 and their parents. A qualitative method was used and every subject was offered a semi-structured interview. Data were analysed by means of inductive thematic analysis. RESULTS Seven superordinate themes were identified: positive aspects, concerns, preparation, loss of landmarks and hospital security, gradual return to a "normal" life, relational aspects and the likelihood of disease progression. Moreover, all the parents and patients were satisfied with the intensive outpatient care offered on discharge. CONCLUSION Despite initial ambivalence, all patients and their parents viewed this unexpected hospital discharge positively in these exceptional conditions. This suggests that restructuring the care programme could prove beneficial with increasing use of outpatient management, thereby reducing the length of the hospital stay and adjusting the return to school. TRIAL REGISTRATION ID-RCB 2020-A01101-38-This project was approved by the Comité de Protection des Personnes (CPP) Sud Méditerranée IV [South Mediterranean IV Ethics Committee (EC)] on 5 May 2020.
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Affiliation(s)
- Pauline Sourlier
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France. .,EA 4432 PRISME, Université de Lorraine, 54000, Nancy, France.
| | - Sophie Bozzi
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4432 PRISME, Université de Lorraine, 54000, Nancy, France
| | - Bernard Kabuth
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4432 PRISME, Université de Lorraine, 54000, Nancy, France
| | - Marilou Lamourette
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4360 APEMAC, Université de Lorraine, 54000, Nancy, France
| | - Fabienne Ligier
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4360 APEMAC, Université de Lorraine, 54000, Nancy, France
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4
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Identifying and Managing Eating Disorders in Persons Presenting for Addiction Treatment. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Towards a Comprehensive Understanding of Body Image: Integrating Positive Body Image, Embodiment and Self-Compassion. Psychol Belg 2021; 61:248-261. [PMID: 34394951 PMCID: PMC8323527 DOI: 10.5334/pb.1057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
Body image (BI) disturbance is a relevant factor in the etiology and treatment of eating disorders (ED). Although progress has been made in recent decades in understanding BI and its relationship with ED, the efficacy of BI disturbance prevention and intervention programs is still limited. In order to reach deeper understanding of BI disturbance and clarify the interactions between some protective and risk factors related to this construct, we carried out a literature review on some specific BI-related factors that so far have been analyzed independently. We specifically examined positive and negative BI; embodiment and its role in the development of positive and negative BI; and self-compassion as a protective factor that promotes positive embodiment (vs. disembodiment) and protection against body shame. We conclude that integrating the available evidence on these factors into BI models may be used to enhance our understanding of BI and improve the efficacy of prevention and intervention programs to help fight negative BI (by reducing body shame and disembodiment) and promote positive BI (by increasing self-compassion and positive embodiment).
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6
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Simpson CC, Towne TL, Karam AM, Donahue JM, Hadjeasgari CF, Rockwell R, Kaye WH. Predictors of Stepping Up to Higher Level of Care Among Eating Disorder Patients in a Partial Hospitalization Program. Front Psychol 2021; 12:667868. [PMID: 34366985 PMCID: PMC8336564 DOI: 10.3389/fpsyg.2021.667868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
Partial hospitalization programming (PHP) is a treatment option available for individuals with eating disorders (ED) who have made insufficient progress in outpatient settings or are behaviorally or medically unstable. Research demonstrates that this level of care yields efficacy for the majority of patients. However, not all patients achieve recovery in PHP and later admit to a higher level of care (HLOC) including residential treatment or inpatient hospitalization. Although PHP is an increasingly common treatment choice for ED, research concerning outcome predictors in outpatient, stepped levels of care remains limited. Thus, the current study sought to identify the predictors of patients first admitted to PHP that later enter residential or inpatient treatment. Participants were 788 patients (after exclusions) enrolled in adolescent or adult partial hospitalization programs in a specialized ED clinic. When compared to patients who maintained treatment in PHP, a significantly greater proportion of patients who discharged to a HLOC had previously received ED residential treatment. Moreover, patients who discharged to a HLOC were diagnosed with a comorbid anxiety disorder and reported greater anxious and depressive symptomatology. A logistic regression model predicting discharge from PHP to a HLOC was significant, and lower body mass index (BMI) was a significant predictor of necessitating a HLOC. Supplemental programming in partial hospitalization settings might benefit individuals with previous ED residential treatment experience, higher levels of anxiety and depression, and lower BMIs. Specialized intervention for these cases is both practically and economically advantageous, as it might reduce the risk of rehospitalization and at-risk patients needing to step up to a HLOC.
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Affiliation(s)
| | | | | | | | | | | | - Walter H. Kaye
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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7
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Holmes S, Malson H, Semlyen J. Regulating “untrustworthy patients”: Constructions of “trust” and “distrust” in accounts of inpatient treatment for anorexia. FEMINISM & PSYCHOLOGY 2021. [DOI: 10.1177/0959353520967516] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Trust has been seen as a lynchpin of therapeutic relationships. Yet due to perceptions that anorexia is one of the most difficult illnesses to treat and that patients are “treatment resistant”, achieving trust between patient and treatment provider may be challenging. This article draws on qualitative data from 14 semi-structured interviews with women who have experience of inpatient treatment for anorexia in order to analyse how trust and distrust figured in treatment contexts. In so doing, the article draws upon feminist approaches which are critical of conceptions of the “devious” “anorexic” and of the clinical discourses within which these constructions are produced. Our analysis suggests a lack of trust shown toward patients in inpatient contexts – particularly a disqualification of “voice” – which has a number of consequences for participants’ subjectivities, including the erosion of self-esteem; demotivation; dropping out/termination of treatment; and triggering experiences of trauma. As such, our analysis raises serious questions about what participants described as routine treatment practices in inpatient treatment for anorexia, and about the serious consequences of constructing “anorexics” as manipulative and untrustworthy.
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Affiliation(s)
- Su Holmes
- University of East Anglia, UK
- University of East Anglia, UK
| | - Helen Malson
- University of the West of England, UK
- University of East Anglia, UK
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8
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Guarda AS, Cooper M, Pletch A, Laddaran L, Redgrave GW, Schreyer CC. Acceptability and tolerability of a meal-based, rapid refeeding, behavioral weight restoration protocol for anorexia nervosa. Int J Eat Disord 2020; 53:2032-2037. [PMID: 33026118 DOI: 10.1002/eat.23386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Safe, tolerable, effective approaches to weight restoration are needed for adults with anorexia nervosa (AN). We examined weight outcomes and patient satisfaction with an integrated, inpatient-partial hospitalization, meal-based behavioral program that rapidly weight restores a majority of patients. METHOD Consecutively discharged inpatients (N = 149) treated on weight gain protocol completed an anonymous questionnaire assessing treatment satisfaction at inpatient discharge. Responders (107/149) rated their satisfaction with program components, feeling included in treatment, and likelihood of returning, or recommending the program to others. Clinical and demographic data were abstracted by chart review on all cases. RESULTS Over 70% of adult patients met BMI≥19 kg/m2 by program discharge. Mean inpatient rate of gain was 1.85 kg/week (SD = 0.89). A majority (83.2%) would recommend the program to others and 71.4% endorsed a willingness to return if needed. The behavioral treatment focus was rated highly by 82.9% of respondents and was the strongest predictor of likelihood of referring others. DISCUSSION Results indicate a behaviorally focused, integrated, meal-based specialty program for eating disorders that includes rapid weight gain is acceptable to most participants. Data have implications for quality care, outcome reporting, and cost-effectiveness of inpatient behavioral weight restoration programs for individuals with AN.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allisyn Pletch
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lori Laddaran
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Granero R, Treasure J, Claes L, Favaro A, Jiménez-Murcia S, Karwautz A, Le Grange D, Tchanturia K, Fernández-Aranda F. Null hypothesis significance tests, a misleading approach to scientific knowledge: Some implications for eating disorders research. EUROPEAN EATING DISORDERS REVIEW 2020; 28:483-491. [PMID: 32797731 DOI: 10.1002/erv.2782] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Roser Granero
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Angela Favaro
- Department of Neuroscience, University of Padua and Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain.,Eating Disorders Unit, Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Daniel Le Grange
- Eating Disorders Program, Department of Psychiatry, University of California, San Francisco, California, USA
| | - Kate Tchanturia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain.,Eating Disorders Unit, Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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10
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Sudres JL, Bordet A, Brandibas G. Art-thérapie et troubles des conduites alimentaires. Évaluation en follow-up. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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11
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Abstract
Behavioral methods are inherent in many evidence-based treatments of eating disorders and have also been used separately. This review demonstrates that behavioral methods are necessary in the effective treatment of eating disorders-in particular, the improvement of nutrition and exposure-based methods. It is also possible that these methods are sufficient to treat anorexia nervosa, although other elements are needed on the treatment of bulimia nervosa. The impacts and mechanisms of behavioral and nutritional change merit serious attention in clinical work and research. Clinicians are often reluctant, however, to use these methods, and that needs to be the focus of supervision.
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Affiliation(s)
- Glenn Waller
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, UK.
| | - Bronwyn Raykos
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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12
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Ziser K, Giel KE, Resmark G, Nikendei C, Friederich HC, Herpertz S, Rose M, de Zwaan M, von Wietersheim J, Zeeck A, Dinkel A, Burgmer M, Löwe B, Sprute C, Zipfel S, Junne F. Contingency Contracts for Weight Gain of Patients with Anorexia Nervosa in Inpatient Therapy: Practice Styles of Specialized Centers. J Clin Med 2018; 7:jcm7080215. [PMID: 30110917 PMCID: PMC6111747 DOI: 10.3390/jcm7080215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022] Open
Abstract
The treatment of patients with anorexia nervosa (AN) is often challenging, due to a high degree of ambivalence towards recovery and weight gain these patients often express. One part of the multimodal treatment is the utilization of treatment contracts (i.e., contingency contracts) that aim to motivate patients to gain weight by applying positive and negative consequences for the (non-)achievement of weight goals. The main aim of this study is to assess and analyze current standards of contingency contracts’ utilization in German eating disorder centers. n = 76 mental health professionals of twelve specialized university centers in Germany that are currently or were formerly treating patients with AN in an inpatient setting participated. Most experts use contingency contracts in their clinic with weekly weight goals ranging between 500 and 700 g. Overall effectiveness and significance of contingency contracts for the inpatient treatment of patients with AN was rated high. Typical characteristics of a contingency contract in specialized German university hospital centers, such as the most frequent consequences, are described. The survey results assist the planning of further studies aiming to improve the multimodal treatment of patients with AN. For clinical practice, using external motivators such as contingency contracts as well as targeting internal motivation (e.g., by using motivational interviewing) is proposed.
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Affiliation(s)
- Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
| | - Christoph Nikendei
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Baden-Wuerttemberg, Germany.
| | - Hans-Christoph Friederich
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Nordrhein-Westfalen, Germany.
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr. 1-3, 44791 Bochum, Nordrhein-Westfalen, Germany.
| | - Matthias Rose
- Division of Psychosomatic Medicine, Charité University Hospital Berlin, Hindenburgdamm 30, 12200 Berlin, Berlin, Germany.
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Niedersachsen, Germany.
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Baden-Wuerttemberg, Germany.
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Hauptstr. 8, 79104 Freiburg, Baden-Wuerttemberg, Germany.
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Langerstr. 3, 81675 Munich, Bayern, Germany.
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Domagkstr. 22, 48149 Muenster, Nordrhein-Westfalen, Germany.
| | - Bernd Löwe
- Institute and Outpatient Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg-Eppendorf, Hamburg, Germany.
| | - Carina Sprute
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Virchowstr. 174, 45147 Essen, Nordrhein-Westfalen, Germany.
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
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