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Wittek T, Zeiler M, Truttmann S, Philipp J, Kopp K, Krauss H, Auer-Welsbach E, Ohmann S, Sackl-Pammer P, Werneck-Rohrer S, Laczkovics C, Mitterer M, Schneider A, Kahlenberg L, Schmidt U, Karwautz A, Wagner G. Exploring neurocognitive features in adolescents and young adults with anorexia nervosa: Evidence from a longitudinal study. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38995317 DOI: 10.1002/erv.3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/26/2024] [Accepted: 06/30/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE We aimed to evaluate longitudinal changes in set-shifting and central coherence in a predominantly adolescent cohort with anorexia nervosa (AN) and to explore whether these factors predict long-term eating disorder outcomes. METHOD Ninety-two female patients with AN (mean age: 16.2, range: 13-21 years) completed neurocognitive tests (Rey Complex Figure Test, Adapted Version of the Wisconsin Card Sorting Test) before and after 12 months of psychotherapeutic treatment (n = 45 Maudsley AN Treatment, MANTRa; n = 47 standard psychotherapy; groups not randomised). Eating disorder severity was assessed at baseline, after 6, 12 and 18 months. RESULTS Central coherence (indicated by an increase in the Rey Figure Style Index) and set-shifting (indicated by a reduction in the percentage of perseverative errors) significantly improved over the course of treatment, with similar outcomes across groups. Lower central coherence was associated with higher eating disorder severity. Individuals with lower baseline set-shifting ability tended to have worse eating disorder outcomes in the long-term. However, this trend did not reach statistical significance in a multilevel linear mixed model. CONCLUSIONS Neurocognitive difficulties in adolescents and young adults with AN can improve after treatment. Interventions specifically addressing flexibility in thinking and behaviour may contribute to treatment success.
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Affiliation(s)
- Tanja Wittek
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michael Zeiler
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Stefanie Truttmann
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Julia Philipp
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Konstantin Kopp
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Helene Krauss
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Ellen Auer-Welsbach
- Department of Neurology and Psychiatry of Childhood and Adolescence, Clinical Centre Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Suanne Ohmann
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Petra Sackl-Pammer
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Sonja Werneck-Rohrer
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Clarissa Laczkovics
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michaela Mitterer
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Andrea Schneider
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Leonie Kahlenberg
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andreas Karwautz
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gudrun Wagner
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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Philipp J, Franta C, Zeiler M, Truttmann S, Wittek T, Schöfbeck G, Mairhofer D, Mitterer M, Laczkovics C, Treasure J, Karwautz AFK, Wagner G. Acceptability and feasibility of SUCCEAT, an intervention for parents of adolescents with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2024; 32:662-675. [PMID: 38407519 DOI: 10.1002/erv.3080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE "Supporting Carers of Children and Adolescents with Eating Disorders in Austria" (SUCCEAT), a skills training for parents, delivered via workshops (WS) or online modules (ONL), has been proven to be effective in terms of parental distress, caregiver skills, and adolescents' outcome. This study examined the adherence to and the acceptability and feasibility of SUCCEAT. METHOD One-hundred parents (86% mothers) of adolescents with anorexia nervosa participated in the 8-week training. Parents were assigned to the WS (n = 50) or ONL (n = 50) format using a quasi-randomised design. Adherence, acceptability, and feasibility were assessed using self-report questionnaires. RESULTS Adherence to the sessions was high (66%-98%) for both groups. The usage of the material was comparable between the groups. However, in the WS group, participants actively approached the coaches (71.8% vs. 48.9% often/very often) or other parents (63% vs. 4.4% often/very often) more often. Perceived helpfulness was high in both groups, overall satisfaction and practicability were higher in the WS group. CONCLUSIONS Good adherence, acceptability, and feasibility were confirmed for both formats of SUCCEAT, with minimal advantages of the WS regarding satisfaction and contact with other parents and coaches. Thus, both formats can be recommended for implementation in clinical routine.
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Affiliation(s)
- Julia Philipp
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Claudia Franta
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Stefanie Truttmann
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Tanja Wittek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gabriele Schöfbeck
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Dunja Mairhofer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michaela Mitterer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Clarissa Laczkovics
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andreas F K Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gudrun Wagner
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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Zeiler M, Philipp J, Truttmann S, Wittek T, Kopp K, Schöfbeck G, Mairhofer D, Auer-Welsbach E, Staab E, Karwautz A, Wagner G. Fathers in the spotlight: parental burden and the effectiveness of a parental skills training for anorexia nervosa in mother-father dyads. Eat Weight Disord 2023; 28:65. [PMID: 37526742 PMCID: PMC10393897 DOI: 10.1007/s40519-023-01597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE Research on the engagement of fathers in the treatment of childhood psychiatric disorders is scarce. This study aims to investigate differences between mothers and fathers of adolescents with anorexia nervosa regarding parental burden and effectiveness of a parental skills training. METHODS Ninety-one mother-father dyads caring for a child with anorexia nervosa participated in an 8-week parental skills training and completed a set of questionnaires assessing parental psychopathology, eating disorder related burden, caregiver skills and expressed emotion at baseline and post-intervention. RESULTS Fathers showed lower levels of general psychological distress, depression, anxiety and eating disorder related burden as well as lower emotional overinvolvement compared to mothers. The skills training was effective in reducing parental psychopathology, eating disorder-related burden and emotional overinvolvement as well as in increasing caregiver skills with no differences between mothers and fathers. However, session adherence and the willingness to practice skills between the sessions were slightly lower in fathers. CONCLUSIONS These findings show that fathers are a great resource for the child's eating disorder treatment as they may counterbalance maternal emotional overinvolvement and over-protection. Furthermore, this is the first study demonstrating that fathers can profit from a parental skills training for anorexia nervosa in a similar way as mothers. LEVEL III Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Michael Zeiler
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Philipp
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefanie Truttmann
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Tanja Wittek
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Konstantin Kopp
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gabriele Schöfbeck
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Dunja Mairhofer
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ellen Auer-Welsbach
- Department for Neurology and Psychiatry of Children and Adolescents, Klagenfurt am Wörthersee, Austria
| | - Eva Staab
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Andreas Karwautz
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gudrun Wagner
- Eating Disorder Unit, Department for Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Zeiler M, Schneider A, Philipp J, Truttmann S, Wittek T, Kahlenberg L, Auer-Welsbach E, Schöfbeck G, Mairhofer D, Merl E, Karwautz A, Wagner G. Psychological distress and caregiving experience during the first two years of the COVID-19 pandemic among parents of an offspring with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 36922368 DOI: 10.1002/erv.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/18/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To compare different aspects of caregiving distress and experience in parents of patients with anorexia nervosa (AN) before and during the COVID-19 pandemic. METHODS Three cohorts of parents of AN patients (cohort 1-pre-pandemic: N = 78, cohort 2-first pandemic year: N = 51, cohort 3-second pandemic year: N = 119) were recruited from child and adolescent psychiatry wards and cross-sectionally assessed as part of the clinical routine. Quantitative measures of psychological distress, psychopathology, eating disorder (ED)-related burden, expressed emotion and caregiver skills were obtained at the beginning of the child's inpatient or outpatient treatment. RESULTS Cohort 2 showed lower levels of anxiety and a tendency of lower emotional overinvolvement and higher caregiving skills compared to the pre-pandemic cohort. In contrast, the levels of general psychological distress, depression, ED-related burden and criticism observed in cohort 3 significantly exceeded pre-pandemic levels. The prevalence of clinically relevant depression was higher in cohort 3 (41.5%) compared to cohorts 1 (24.4%) and 2 (21.6%). DISCUSSION The pandemic effects on parents seem to be time-specific. Lower distress in the early phase of the pandemic may be associated with improvements in parent-child-relationships reported in previous studies. However, the pandemic may has negative consequences in the long-term emphasising the need of ongoing parental support.
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Affiliation(s)
- Michael Zeiler
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Andrea Schneider
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Julia Philipp
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Stefanie Truttmann
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Tanja Wittek
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Leonie Kahlenberg
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Ellen Auer-Welsbach
- Department for Neurology and Psychiatry of Children and Adolescents, Klagenfurt am Wörthersee, Austria
| | - Gabriele Schöfbeck
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Dunja Mairhofer
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Merl
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Andreas Karwautz
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
| | - Gudrun Wagner
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Vienna, Austria
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Zeiler M, Truttmann S, Philipp J, Kahlenberg L, Wittek T, Franta C, Schneider A, Imgart H, Zanko A, Karwautz A, Wagner G. An investigation of the factor structure of a German version of the Eating Disorder Symptom Impact Scale (EDSIS) among parents of adolescents and young adults with anorexia nervosa. Eat Behav 2023; 48:101695. [PMID: 36495623 DOI: 10.1016/j.eatbeh.2022.101695] [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: 08/17/2022] [Revised: 11/02/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
The aim of this study was to explore the factor structure, scale characteristics and convergent validity of a German version of the Eating Disorder Symptom Impact Scale (EDSIS). A total of 335 parents of adolescents and young adults with anorexia nervosa in inpatient or outpatient treatment completed the 24-item German translation of the EDSIS and other measures of caregiving burden and psychological distress. We tested a 4 vs. 6-factor model of the EDSIS using confirmatory factor analyses. The 6-factor model treating items as ordinal variables showed the best fit to the data (CFI = 0.949, RMSEA = 0.064). Strong invariance of this model was shown between the sample of mothers and fathers. Internal consistencies of the EDSIS scales were in the acceptable-to-good range. Bottom effects were observed for the 'Binge-Purge-Impacts' subscale only. Mothers had significantly higher EDSIS scores compared to fathers. The EDSIS total score and most of the subscores showed substantial positive correlations with caregivers' psychological distress, level of depression, anxiety and expressed emotion as well as negative associations with the level of perceived caregiving skills. The German version of the EDSIS is a useful tool to assess caregiving burden in mothers and fathers of patients with anorexia nervosa.
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Affiliation(s)
- Michael Zeiler
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Stefanie Truttmann
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Julia Philipp
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Leonie Kahlenberg
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Tanja Wittek
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Claudia Franta
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Andrea Schneider
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Hartmut Imgart
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, Bad Wildungen, Germany.
| | - Annika Zanko
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, Bad Wildungen, Germany.
| | - Andreas Karwautz
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Gudrun Wagner
- Department for Child and Adolescent Psychiatry, Eating Disorders Unit, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Karlstad J, Moe CF, Wattum M, Adelsten Stokland R, Brinchmann BS. "Putting your own oxygen mask on first": a qualitative study of siblings of adults with anorexia or bulimia. J Eat Disord 2021; 9:83. [PMID: 34238375 PMCID: PMC8264474 DOI: 10.1186/s40337-021-00440-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/28/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In families where one of the siblings has an eating disorder (ED), research indicates that the siblings without eating disorders (EDs) experience insufficient care and negative changes in family life. The illness then takes up a great deal of space within the family. Support from the siblings without EDs is considered to be important for the recovery of the sibling with ED. A key issue is how to involve siblings without EDs in treatment and establish what kind of support they themselves need. A majority of the research on EDs and family has focused on children and adolescents with EDs. The aim of this study is to expand knowledge about the experiences and coping strategies of sisters and brothers of adult women with anorexia nervosa or bulimia nervosa. METHODS This qualitative study used a constructivist grounded theory approach. Individual semi-structured interviews were conducted with 10 sisters and brothers (aged 20-31 years). They were recruited from eating disorders and general psychiatrics units and from user organisations for patients with eating disorders within Norway. An iterative process of data collection, coding and analysis was employed in order to generate a theory about these participants' experiences and strategies. RESULTS The core category is "put your own oxygen mask on first". It indicates that the siblings realize that they need to take care of themselves first, in order to be able to stay involved with their sister with the ED. The three subcategories; "taking a new role", "distancing" and "adapted care" describe how the siblings handle their situation as the relatives of adult sisters with an ED. The siblings without ED became more responsible and independent and assumed a caregiving role. They downplayed their own needs to reduce their parents' burden. This new role became difficult to fulfil and the siblings experienced that over time they needed more distance. Eventually, they developed a more manageable way of caring for their sister. CONCLUSIONS The findings suggest that the ED challenged the boundaries within the family. The siblings without ED assumed a caregiver role, gradually leading to exhaustion and the need to distance from the sister with the ED, to take care of themselves.
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Affiliation(s)
- Jannike Karlstad
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Cathrine F Moe
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Nordland Hospital Trust, Bodø, Norway
| | - Mari Wattum
- KUN Centre for Equality and Diversity, Nordfold, Norway
| | | | - Berit S Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.,Nordland Hospital Trust, Bodø, Norway
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Philipp J, Franta C, Zeiler M, Truttmann S, Wittek T, Imgart H, Zanko A, Auer-Welsbach E, Mairhofer D, Mitterer M, Laczkovics C, Schöfbeck G, Jilka E, Egermann WB, Treasure J, Karwautz AFK, Wagner G. Does a Skills Intervention for Parents Have a Positive Impact on Adolescents' Anorexia Nervosa Outcome? Answers from a Quasi-Randomised Feasibility Trial of SUCCEAT. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094656. [PMID: 33925694 PMCID: PMC8124826 DOI: 10.3390/ijerph18094656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/17/2021] [Accepted: 04/23/2021] [Indexed: 12/14/2022]
Abstract
Skills trainings for caregivers of patients with anorexia nervosa (AN) have been proven to be effective in improving caregiver skills and reducing caregivers’ psychopathology. The effects on patients, especially adolescents, are largely unknown. The aim of this study was to evaluate the effectiveness of a caregivers’ skills training program (Supporting Carers of Children and Adolescents with Eating Disorders in Austria, SUCCEAT, workshop or online version) on adolescents with AN delivered as workshops (WS) or online (ONL). Outcomes are Body-Mass-Index (BMI) percentile, eating psychopathology (Eating Disorder Examination, EDE), attitudinal and behavioural dimensions of eating disorders (Eating Disorder Inventory-2), motivation to change (AN Stages of Change Questionnaire), emotional and behavioural problems (Youth Self-Report) and quality of life (KINDL). All outcome variables significantly improved across both SUCCEAT groups (WS and ONL) and were sustained at 12-month follow-up. The online and workshop delivery of SUCCEAT were equally effective. Most effect sizes were in the medium-to-high range. Full or partial remission was observed in 72% (WS) and 87% (ONL) of patients. Caregiver skills trainings, either delivered as workshops or online modules, are highly recommended to complement treatment as usual.
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Affiliation(s)
- Julia Philipp
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Claudia Franta
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Stefanie Truttmann
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Tanja Wittek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Hartmut Imgart
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, 34537 Bad Wildungen, Germany; (H.I.); (A.Z.)
| | - Annika Zanko
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, 34537 Bad Wildungen, Germany; (H.I.); (A.Z.)
| | - Ellen Auer-Welsbach
- Department for Neurology and child and adolescents Psychiatry, 9020 Klagenfurt am Wörthersee, Austria;
| | - Dunja Mairhofer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Michaela Mitterer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Clarissa Laczkovics
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Gabriele Schöfbeck
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Elisabeth Jilka
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Wolfgang B. Egermann
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK;
| | - Andreas F. K. Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
| | - Gudrun Wagner
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (C.F.); (M.Z.); (S.T.); (T.W.); (D.M.); (M.M.); (C.L.); (G.S.); (E.J.); (W.B.E.); (A.F.K.K.)
- Correspondence: ; Tel.: +43-140-400-3-0170
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Wittek T, Truttmann S, Zeiler M, Philipp J, Auer-Welsbach E, Koubek D, Ohmann S, Werneck-Rohrer S, Sackl-Pammer P, Schöfbeck G, Mairhofer D, Kahlenberg L, Schmidt U, Karwautz AFK, Wagner G. The Maudsley model of anorexia nervosa treatment for adolescents and young adults (MANTRa): a study protocol for a multi-center cohort study. J Eat Disord 2021; 9:33. [PMID: 33685522 PMCID: PMC7941930 DOI: 10.1186/s40337-021-00387-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment of anorexia nervosa (AN) is often challenging due to medical complications as well as high relapse and mortality rates. Studies about effective treatment options for people with AN are particularly scarce in the adolescent population. This paper is a study protocol for a multi-center cohort study assessing the feasibility, acceptability and efficacy of a new, manualized treatment program, the "Maudsley Model of Anorexia Nervosa Treatment for Adolescents and Young Adults" (MANTRa) compared to psychotherapeutic treatment as usual (TAU). METHODS/DESIGN One hundred patients between 13 and 21 years who meet the inclusion criteria will receive 24 to 34 individual weekly MANTRa therapy sessions or weekly TAU sessions. Primary outcome variables will be BMI and eating disorder psychopathology 12 months after baseline. Further changes in central coherence, cognitive flexibility, emotion recognition, comorbid psychopathology (e.g. depression, obsessive-compulsive and anxiety disorders, non-suicidal self-injury), personality factors and therapeutic alliance will be assessed. DISCUSSION This multi-center study will examine the utility of the treatment program MANTRa for adolescents with AN and, therefore enhances the current knowledge about potential treatments for this patient group. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03535714 . Registered: 24/05/2018 (retrospectively registered, still recruiting).
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Affiliation(s)
- Tanja Wittek
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Stefanie Truttmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Michael Zeiler
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Julia Philipp
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Ellen Auer-Welsbach
- Department of Neurology and Psychiatry of Childhood and Adolescence, Clinical Center Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria
| | - Doris Koubek
- Medical Practice for Child and Adolescent Psychiatry, 4020, Linz, Austria
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Sonja Werneck-Rohrer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Petra Sackl-Pammer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Gabriele Schöfbeck
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Dunja Mairhofer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Leonie Kahlenberg
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, WC2R 21S, UK
| | - Andreas F K Karwautz
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
| | - Gudrun Wagner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090, Vienna, Austria.
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Zeiler M, Philipp J, Truttmann S, Wittek T, Franta C, Imgart H, Zanko A, Auer‐Welsbach E, Kahlenberg L, Wagner G, Karwautz A. A German version of the Caregiver Skills scale for caregivers of patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2021; 29:257-268. [PMID: 33332684 PMCID: PMC7986839 DOI: 10.1002/erv.2817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate acceptance, reliability, convergent validity, factor structure and sensitivity to change of a German translation of the Caregiver Skills (CASK) scale measuring skills related to caring for patients with eating disorders. METHODS Two hundred and thirty-three parents (76% female) of adolescent patients (mean age 15.1) with anorexia nervosa (AN) completed the 27 items of the CASK. We calculated item/scale characteristics, internal consistencies and bivariate correlations with other measures of caregiving burden. We evaluated goodness-of-fit of the 6-factor model using confirmatory factors analysis and explored the sensitivity to change following two skills-based trainings. RESULTS The fit of the 6-factor model was acceptable (Root Mean Square Error of Approximation: 0.077, Standard Root Mean Square Residual: 0.080). Cronbach's alpha was excellent for the total (.94) and acceptable for all subscales (0.73-0.85). The total CASK score was 68.04 (max. 100) showing relatively high self-rated caregiver skills. Non-completion rates of most items were low (<3%) indicating high acceptance. Convergent validity was found with measures of psychological distress, depression, anxiety and expressed emotion. The total score significantly increased following an 8-week workshop/online skills training (d = 0.70) and a 2-day multi-family intervention (d = 0.47). DISCUSSION The German CASK version is a useful instrument to assess caregiver skills in parents of patients with AN and to evaluate outcomes of skills-based trainings.
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Affiliation(s)
- Michael Zeiler
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Julia Philipp
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Stefanie Truttmann
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Tanja Wittek
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Claudia Franta
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Hartmut Imgart
- Parkland ClinicClinic for Psychosomatic Medicine and PsychotherapyBad WildungenGermany
| | - Annika Zanko
- Parkland ClinicClinic for Psychosomatic Medicine and PsychotherapyBad WildungenGermany
| | - Ellen Auer‐Welsbach
- Department for Neurology and Psychiatry of Children and AdolescentsKlagenfurt am WörtherseeAustria
| | - Leonie Kahlenberg
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Gudrun Wagner
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
| | - Andreas Karwautz
- Department for Child and Adolescent PsychiatryEating Disorders UnitMedical University of ViennaViennaAustria
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Herpertz-Dahlmann B, Bonin E, Dahmen B. Can you find the right support for children, adolescents and young adults with anorexia nervosa: Access to age-appropriate care systems in various healthcare systems. EUROPEAN EATING DISORDERS REVIEW 2021; 29:316-328. [PMID: 33626222 DOI: 10.1002/erv.2825] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) often has its onset in childhood or adolescence. However, there is insufficient knowledge regarding access to and utilisation of age-specific clinical diagnostics and treatment. METHODS A literature review covering the last 10 years was conducted to provide a narrative review of the current state of research on the detection and treatment of young patients with AN in primary and secondary care. RESULTS Most articles were of Western European or US origin. Timely diagnosis of the eating disorder (ED) and treatment options more often depend on the structure and quality of the national health care system than on scientific evidence. Regular paediatric health check-ups and age-appropriate eating disorder services appear to facilitate early diagnosis. Age-specific treatment that also involves the carers is often associated with a higher continuity of care and a better outcome. Although many adolescents require an extension of treatment into young adulthood, individual and health care system-related obstacles in many countries prevent a smooth transition. CONCLUSION To improve outcomes in childhood and adolescent AN, age-specific and timely diagnostic and therapeutic procedures are urgently needed.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Eva Bonin
- Care Policy and Evaluation Centre, London School of Economics, London, UK
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
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11
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Philipp J, Truttmann S, Zeiler M, Franta C, Wittek T, Schöfbeck G, Mitterer M, Mairhofer D, Zanko A, Imgart H, Auer-Welsbach E, Treasure J, Wagner G, Karwautz AFK. Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa-Caregivers' and Adolescents' Perspective. J Clin Med 2020; 9:jcm9072021. [PMID: 32605074 PMCID: PMC7409203 DOI: 10.3390/jcm9072021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
High expressed emotion (EE) is common in caregivers of patients with anorexia nervosa (AN) and associated with poorer outcome for patients. In this study, we examined the prevalence of high EE in caregivers of adolescents with AN and analyzed predictors for EE using multivariate linear regression models. We further analyzed whether EE is reduced by the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) intervention using general linear mixed models and whether a reduction of EE predicts patients’ outcomes. Caregivers were randomly allocated to the SUCCEAT workshop (N = 50) or online intervention (N = 50) and compared to a comparison group (N = 49). EE and patients’ outcomes were assessed at the baseline, post-intervention, and at the 12-month follow-up. Up to 47% of caregivers showed high EE. Lower caregiver skills, higher AN symptom impact, higher levels of depression and motivation to change in caregivers were significant predictors for high EE. EE significantly decreased in the SUCCEAT groups and the comparison group according to the caregivers’, but not the patients’ perspective. The level of reduction could partially predict subjective improvement and improvement in clinically assessed AN symptoms and body mass index of patients. Implementing interventions for caregivers addressing EE in the treatment of adolescents with AN is strongly recommended.
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Affiliation(s)
- Julia Philipp
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Stefanie Truttmann
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Claudia Franta
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Tanja Wittek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Gabriele Schöfbeck
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Michaela Mitterer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Dunja Mairhofer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Annika Zanko
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, 34537 Bad Wildungen, Germany; (A.Z.); (H.I.)
| | - Hartmut Imgart
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, 34537 Bad Wildungen, Germany; (A.Z.); (H.I.)
| | - Ellen Auer-Welsbach
- Department for Neurology and Child and Adolescent Psychiatry, 9020 Klagenfurt am Wörthersee, Austria;
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK;
| | - Gudrun Wagner
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Andreas F. K. Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
- Correspondence: ; Tel.: +43-1-40400-30140
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Truttmann S, Philipp J, Zeiler M, Franta C, Wittek T, Merl E, Schöfbeck G, Koubek D, Laczkovics C, Imgart H, Zanko A, Auer-Welsbach E, Treasure J, Karwautz AFK, Wagner G. Long-Term Efficacy of the Workshop Vs. Online SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders) Intervention for Parents: A Quasi-Randomised Feasibility Trial. J Clin Med 2020; 9:E1912. [PMID: 32570930 PMCID: PMC7355675 DOI: 10.3390/jcm9061912] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/06/2020] [Accepted: 06/15/2020] [Indexed: 11/17/2022] Open
Abstract
Interventions for main carers of adult patients with anorexia nervosa (AN) can reduce the caregiving burden and increase caregiver skills. However, the effectiveness and feasibility for carers of adolescent patients, the optimal form of the intervention and long-term outcomes are largely unknown. We evaluated the efficacy and feasibility of the "Supporting Carers of Children and Adolescents with Eating Disorders in Austria" (SUCCEAT) workshop vs. online intervention. Main caregivers (parents) of adolescent patients with AN were randomly allocated to a workshop (n = 50) or online version (n = 50). Participants were compared to a non-randomised comparison group (n = 49) receiving multi-family or systemic family therapy. Primary (General Health Questionnaire) and secondary outcomes were obtained at baseline, three-month and 12-month follow-up. Adherence was high for workshop and online participants (6.2 and 6.7 sessions completed out of 8). Intention-to-treat analyses revealed significant pre-post reductions in the primary outcome for the workshop (d = 0.87 (95%conficence interval (CI): 0.48; 1.26)) and online (d = 0.65 (95%CI: 0.31; 0.98)) intervention that were sustained at the 12-month follow-up. There was no significant group difference (p = 0.473). Parental psychopathology and burden decreased and caregiver skills increased in all groups; the improvement of caregiver skills was significantly higher in SUCCEAT participants than in the comparison group. Online interventions for parents of adolescents with AN were equally effective as workshops. The improvements remained stable over time.
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Affiliation(s)
- Stefanie Truttmann
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Julia Philipp
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Claudia Franta
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Tanja Wittek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Elisabeth Merl
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Gabriele Schöfbeck
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Doris Koubek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Clarissa Laczkovics
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Hartmut Imgart
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, 34537 Bad Wildungen, Germany; (H.I.); (A.Z.)
| | - Annika Zanko
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, 34537 Bad Wildungen, Germany; (H.I.); (A.Z.)
| | - Ellen Auer-Welsbach
- Department for Neurology and child and adolescents Psychiatry, 9020 Klagenfurt am Wörthersee, Austria;
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK;
| | - Andreas F. K. Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
| | - Gudrun Wagner
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (S.T.); (J.P.); (M.Z.); (C.F.); (T.W.); (E.M.); (G.S.); (D.K.); (C.L.); (A.F.K.K.)
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Imgart H, Plassmann R. [Effective factors in multifamily therapy in patients with eating disorders : Critical appraisal and implications for practice]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 34:48-60. [PMID: 31997267 DOI: 10.1007/s40211-020-00330-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
Multifamily therapy (MFT), the treatment of several families simultaneously, is an established method of psychotherapy used in a wide range of diagnoses. However, there is limited knowledge about the exact factors of action of this treatment method. The development of MFT as a separate form of therapy is presented, as are its previous applications in the treatment of patients with eating disorders. Known factors of change are critically evaluated, new factors of change are discussed and the practical application in MFT in the context of inpatient treatment of adolescents with eating disorders is demonstrated.Processes in the large group that have not yet been considered, such as emotional contagion, exaltation of emotion and subgroup formation and work with the meta-family, are described for the first time in the context of MFT and possibly represent mediators in the therapeutic process.The model of affect and process resonance in Plassmann's individual therapy can be applied well to the processes in the MFT and possibly represents its own effect factor through the production of episodes of secure attachment. Further research on the factors of change in the MFT is of practical relevance.
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Affiliation(s)
- Hartmut Imgart
- Kompetenzzentrum für Essstörungen und Adipositas, Parkland-Klinik, Im Kreuzfeld 6, 34537, Bad Wildungen, Deutschland.
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Franta C, Philipp J, Waldherr K, Truttmann S, Merl E, Schöfbeck G, Koubek D, Laczkovics C, Imgart H, Zanko A, Zeiler M, Treasure J, Karwautz A, Wagner G. Supporting Carers of Children and Adolescents with Eating Disorders in Austria (SUCCEAT): Study protocol for a randomised controlled trial. EUROPEAN EATING DISORDERS REVIEW 2018; 26:447-461. [PMID: 29732651 PMCID: PMC6175075 DOI: 10.1002/erv.2600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/20/2018] [Accepted: 03/30/2018] [Indexed: 12/12/2022]
Abstract
Supporting Carers of Children and Adolescents with Eating Disorders in Austria (SUCCEAT) is an intervention for carers of children and adolescents with anorexia nervosa and atypical anorexia nervosa. This paper describes the study protocol for a randomised controlled trial including the process and economic evaluation. Carers are randomly allocated to one of the 2 SUCCEAT intervention formats, either 8 weekly 2‐hr workshop sessions (n = 48) or web‐based modules (n = 48), and compared with a nonrandomised control group (n = 48). SUCCEAT includes the cognitive‐interpersonal model, cognitive behavioural elements, and motivational interviewing. The goal is to provide support for carers to improve their own well‐being and to support their children. Outcome measures include carers' distress, anxiety, depression, expressed emotions, needs, motivation to change, experiences of caregiving, and skills. Further outcome measures are the patients' eating disorder symptoms, emotional problems, behavioural problems, quality of life, motivation to change, and perceived expressed emotions. These are measured before and after the intervention, and 1‐year follow‐up.
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Affiliation(s)
- Claudia Franta
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Julia Philipp
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Karin Waldherr
- Ferdinand Porsche Distance Learning University for Applied Sciences, Vienna, Austria
| | - Stefanie Truttmann
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Merl
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gabriele Schöfbeck
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Doris Koubek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Clarissa Laczkovics
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Hartmut Imgart
- Parkland-Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, Bad Wildungen-Reinhardshausen, Germany
| | - Annika Zanko
- Parkland-Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, Bad Wildungen-Reinhardshausen, Germany
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gudrun Wagner
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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