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Miskovic-Wheatley J, Schlage J, Pehlivan MJ, Simone R, Koreshe E, Hunt C, Maguire S. Skills-based online self-help program for carers of people with an eating disorder (SupportED): A case series evaluation. Int J Eat Disord 2024; 57:423-436. [PMID: 38149436 DOI: 10.1002/eat.24112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To investigate the acceptability, feasibility, and preliminary effectiveness of "SupportED," a novel, online, self-paced skills-based program for carers/support people of those with lived and/or living experience of an eating disorder (ED). METHOD Carers of a loved one with an ED were invited to undertake a five-module skills-based (one core module, four optional modules) online program at their own pace. Modules cover general information about EDs, communication, practical skills, treatment engagement, and recovery. Participants completed demographics and were assessed using EDSIS, CASK, and DASS-21 for caregiver burden, skills, and distress, respectively, at program completion and 3-month follow-up. Feedback on the program and modules was also collected. RESULTS Most carers (65%; 82/126) completed the core module of the program, which is on par with other online learning programs. Nearly half of program completers responded to the 3-month follow-up (n = 39). On average, carers rated the program as relevant and useful and found the information validating and easy to understand, albeit a few carers found the program time-consuming and technically challenging. Intent-to-treat (ITT) linear mixed models demonstrated the preliminary effectiveness of the program for improving carer burden and skills, although the change in carer distress was non-significant. CONCLUSIONS Results of this case series evaluation suggest SupportED is an acceptable and feasible program for carers and may improve burden and support skill development. Although the online, self-paced format was highly rated, small improvements to improve acceptability were suggested. Reasons for a lack of impact on carer distress are discussed. PUBLIC SIGNIFICANCE This article describes a case series evaluation of "SupportED," an online skills-based support program for families, carers, and supporters of people with lived experience of an eating disorder. This is the first online carer support program that is designed to be inclusive of all carer types (e.g., partners, siblings) for all eating disorder presentations. Findings suggest the program's suitability and helpfulness for reducing carers' load and bolstering skills and knowledge.
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Affiliation(s)
- Jane Miskovic-Wheatley
- InsideOut Institute of Eating Disorders, Faculty of Medicine and Health, The University of Sydney, and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jasmin Schlage
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Melissa J Pehlivan
- InsideOut Institute of Eating Disorders, Faculty of Medicine and Health, The University of Sydney, and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rachel Simone
- InsideOut Institute of Eating Disorders, Faculty of Medicine and Health, The University of Sydney, and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Eyza Koreshe
- InsideOut Institute of Eating Disorders, Faculty of Medicine and Health, The University of Sydney, and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Caroline Hunt
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Maguire
- InsideOut Institute of Eating Disorders, Faculty of Medicine and Health, The University of Sydney, and Sydney Local Health District, Sydney, New South Wales, Australia
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Guillén V, Arnal A, Pérez S, Garcia-Alandete J, Fernandez-Felipe I, Grau A, Botella C, Marco JH. Family connections in the treatment of relatives of people with eating disorders and personality disorders: study protocol of a randomized control trial. BMC Psychol 2023; 11:88. [PMID: 36998024 PMCID: PMC10064734 DOI: 10.1186/s40359-023-01138-x] [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: 02/09/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are serious disorders that significantly affect not only the lives of patients, but also those of their family members who often experience high levels of burden, suffering and helplessness. If, in addition to ED, the patient has a personality disorder (PD), the psychological distress experienced by family members can be devastating. However, few treatments have been developed for family members of people with ED and PD. Family Connections (FC) is a programme that has been shown to be effective for family members of people with borderline personality disorder. The overall aims of this work are: (a) to adapt FC for application to family members of patients with BPD-PD (FC: ED-PD); (b) to analyse, in a randomised controlled clinical trial, the efficacy of this programme in a Spanish population, compared to a control condition consisting of treatment as usual optimised treatment (TAU-O); (c) to analyse the feasibility of the intervention protocol; (d) to analyse whether the changes that may occur in relatives are related to improvements in the family climate and/or improvements observed in patients; and (e) to analyse the perceptions and opinions of relatives and patients about the two intervention protocols. METHODS The study uses a two-arm randomised controlled clinical trial with two experimental conditions: adaptation of FC programme (FC: ED-PD) or Treatment as usual optimised (TAU-O). Participants will be family members of patients who meet DSM-5 criteria for ED and PD or dysfunctional personality traits. Participants will be assessed before and after treatment and at one-year follow-up. The intention-to-treat principle will be used when analysing the data. DISCUSSION The results obtained are expected to confirm the effectiveness of the programme and its good acceptance by family members. Trial registration ClinicalTrials.gov Identifier: NCT05404035. Accepted: May 2022.
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Affiliation(s)
- Verónica Guillén
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain.
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain.
| | - Antonio Arnal
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
| | - Sandra Pérez
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
| | - Joaquín Garcia-Alandete
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
| | - Isabel Fernandez-Felipe
- Universitat Jaume I de Castelló, Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón de la Plana, Castellón, Spain
| | - Antoni Grau
- Ita-Salud Mental, Especialistas en Salud Mental, C/Tavern, 61, 08006, Barcelona, Spain
| | - Cristina Botella
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
- Universitat Jaume I de Castelló, Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón de la Plana, Castellón, Spain
| | - José Heliodoro Marco
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
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Rienecke RD, Gorrell S, Johnson M, Duffy A, Mehler PS, Le Grange D. Expressed emotion and treatment outcome in higher levels of care for eating disorders. Int J Eat Disord 2023; 56:628-636. [PMID: 36584076 PMCID: PMC9992295 DOI: 10.1002/eat.23890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Expressed emotion (EE) among caregivers toward the affected offspring is a negative prognostic indicator for adolescent patients with eating disorders (EDs) in outpatient treatment. Less research has examined its impact on adolescents in higher levels of care (HLOC). The current study examined differences in caregiver EE according to the subtype of anorexia nervosa (AN) (restricting [AN-R] versus binge/purge [AN-BP]), and level of care (LOC). We also examined the main effects of baseline caregiver EE (emotional overinvolvement [EOI] or criticism), AN subtype, and their interaction on eating pathology and depression at discharge. METHOD Adolescent patients (N = 203) receiving treatment at HLOCs completed measures of ED pathology (Eating Disorder Examination-Questionnaire) and depression (Patient Health Questionnaire-9) at baseline and discharge, and one caregiver of each patient completed a measure of EE (Family Questionnaire) at baseline. RESULTS No differences in caregiver EE were found between patients with AN-R versus AN-BP, or relative to LOC. Caregiver EE did not predict outcome for ED symptoms or depression at discharge. DISCUSSION The impact of high caregiver EE may be less substantial at HLOCs than outpatient care given that caregivers are less involved in treatment at HLOCs. Future research is needed to determine if high caregiver EOI leads to poor treatment outcome for adolescents as it does for adults, or whether it is an appropriate expression of care for patients who are ill enough to require HLOC treatment. PUBLIC SIGNIFICANCE STATEMENT High caregiver EE was not found to predict treatment outcome for adolescents with eating disorders in higher levels of care (HLOCs), possibly due to the limited involvement of caregivers in HLOCs. However, patients step down to outpatient treatment, where high caregiver EE can have a significant negative impact on outcome. HLOCs should incorporate efforts to reduce high caregiver EE in anticipation of step-down to outpatient treatment.
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Affiliation(s)
- Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Madelyn Johnson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Philip S. Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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Matthews A, Bruening AB, Aarnio-Peterson CM, Kramer R. Predictors of caregiver burden before starting family-based treatment for adolescent anorexia nervosa and associations with weight gain during treatment. Eat Weight Disord 2023; 28:21. [PMID: 36809428 PMCID: PMC9944026 DOI: 10.1007/s40519-023-01553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE Caregivers play a pivotal role in the success of family-based treatment (FBT) for anorexia nervosa (AN). Caregiver burden is frequently demonstrated in eating disorders (EDs) and may impact FBT outcomes. This study examined factors associated with caregiver burden before starting FBT and whether pre-treatment caregiver burden was associated with weight gain during FBT. METHODS Participants included 114 adolescents with AN or atypical AN (mean age = 15.6 years, SD = 1.4) and a primary caregiver (87.6% mothers) who received FBT in the United States. Before starting treatment, participants completed self-report measures of caregiver burden (via the Eating Disorder Symptom Impact Scale), caregiver anxiety, caregiver depression, and ED symptoms. Clinical characteristics and percentage of target goal weight (%TGW) at FBT session 1 and 3 and 6 months after starting treatment were obtained via retrospective chart review. Hierarchical regressions examined predictors of caregiver burden before FBT initiation. Associations between pre-treatment caregiver burden and %TGW gain at 3 and 6 months after starting FBT were assessed with hierarchical regressions. RESULTS Caregiver anxiety (p < 0.001), family history of EDs (p = 0.028), adolescent mental health treatment history (p = 0.024), and ED symptoms (p = 0.042) predicted caregiver burden before starting FBT. Pre-treatment caregiver burden was not associated with %TGW gain at 3 or 6 months. Males demonstrated less %TGW gain than females at 3 months (p = 0.010) and 6 months (p = 0.012). CONCLUSION Proactively evaluating caregiver burden before starting FBT is suggested. Providing recommendations and/or referrals for identified caregiver vulnerabilities could indirectly impact FBT progress. Males in FBT could require longer courses of treatment and extra vigilance to this demographic is suggested. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Abigail Matthews
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Amanda B Bruening
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Claire M Aarnio-Peterson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rachel Kramer
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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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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Batchelor R, Cribben H, Macdonald P, Treasure J, Cini E, Nicholls D, Kan C. The experiential perspectives of siblings and partners caring for a loved one with an eating disorder in the UK. BJPsych Open 2022; 8:e76. [PMID: 35322783 PMCID: PMC9059625 DOI: 10.1192/bjo.2022.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Caring for a loved one with an eating disorder typically comes with a multitude of challenges, yet siblings and partners are often overlooked. It is important to understand if current clinical guidance for supporting carers are effective and being utilised for these groups, to help meet their needs. AIMS To identify the experiential perspectives of siblings and partners of a loved one with an eating disorder compared with guidance for improving the adequacy of support provided to carers published by Beat and Academy for Eating Disorders. METHOD Three online focus groups were held for ten siblings and five partners from across the UK (12 females and three males). Carers had experience of caring for a loved one with anorexia nervosa (13 carers) or bulimia nervosa (two carers), across a range of therapeutic settings. Focus group transcriptions were analysed with thematic analysis. RESULTS Four key themes were identified: (a) role-specific needs, (b) challenges encountered by siblings and partners, (c) generic needs and helpful strategies or approaches, and (d) accounts of service provision and family support. CONCLUSIONS Overall, the majority of experiences reported by siblings and partners did not meet the published guidance. Consequently, clinical practice recommendations were identified for services, alongside the charity sector, to take a proactive approach in detecting difficulties, providing skills training and emotional/practical support, adapting/tailoring peer support groups and supporting online facilitation. Our findings part-informed the design of our national online survey on loved ones' experiences of care in eating disorders.
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Affiliation(s)
- Rachel Batchelor
- Department of Psychology, Royal Holloway, University of London, UK
| | - Hannah Cribben
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Pamela Macdonald
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Erica Cini
- East London Eating Disorder Service for Children and Young People, East London NHS Foundation Trust, UK; and Nutrition Science Group, Division of Medicine, University College London, UK
| | | | - Carol Kan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Sousa H, Ribeiro O, Paúl C, Costa E, Frontini R, Miranda V, Oliveira J, Ribeiro F, Figueiredo D. "Together We Stand": A Pilot Study Exploring the Feasibility, Acceptability, and Preliminary Effects of a Family-Based Psychoeducational Intervention for Patients on Hemodialysis and Their Family Caregivers. Healthcare (Basel) 2021; 9:healthcare9111585. [PMID: 34828630 PMCID: PMC8624118 DOI: 10.3390/healthcare9111585] [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: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/03/2022] Open
Abstract
This pilot study aimed to assess the feasibility, acceptability, and preliminary effects of a family-based psychoeducational intervention for patients undergoing hemodialysis (HD) and their family members. This was a single-group (six dyads), six-week, pre–post pilot study, delivered in a multifamily group format. Feasibility was based on screening, eligibility, content, retention, completion, and intervention adherence rates. Acceptability was assessed at post-intervention through a focus group interview. Self-reported anxiety and depression and patients’ inter-dialytic weight gain (IDWG) were also measured. The screening (93.5%), retention (85.7%), and completion (100%) rates were satisfactory, whereas eligibility (22.8%), consent (18.4%), and intervention adherence (range: 16.7–50%) rates were the most critical. Findings showed that participants appreciated the intervention and perceived several educational and emotional benefits. The results from the Wilcoxon Signed-Rank Test showed that a significant decrease in anxiety symptoms (p = 0.025, r = 0.646) was found, which was followed by medium to large within-group effect sizes for changes in depression symptoms (p = 0.261, r = 0.325) and patients’ IDWG (p = 0.248, r = 0.472), respectively. Overall, the results indicated that this family-based psychoeducational intervention is likely to be feasible, acceptable, and effective for patients undergoing HD and their family caregivers; nonetheless, further considerations are needed on how to make the intervention more practical and easily implemented in routine dialysis care before proceeding to large-scale trials.
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Affiliation(s)
- Helena Sousa
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal; (H.S.); (O.R.); (J.O.)
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal; (H.S.); (O.R.); (J.O.)
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS.UA), Institute of Biomedical Sciences Abel Salazar, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal;
| | - Elísio Costa
- Research Unit on Applied Molecular Biosciences (UCIBIO—REQUIMTE), Faculty of Pharmacy, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal;
| | - Roberta Frontini
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, 2410-541 Leiria, Portugal;
| | | | - Jaime Oliveira
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal; (H.S.); (O.R.); (J.O.)
| | - Fernando Ribeiro
- Campus Universitário de Santiago, Institute for Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Daniela Figueiredo
- Center for Health Technology and Services Research (CINTESIS.UA), Campus Universitário de Santiago, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
- Correspondence:
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8
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Seyedfatemi N, Ghezeljeh TN, Bolhari J, Rezaei M. Effects of family-based dignity intervention and expressive writing on anticipatory grief of family caregivers of patients with cancer: a study protocol for a four-arm randomized controlled trial and a qualitative process evaluation. Trials 2021; 22:751. [PMID: 34711262 PMCID: PMC8552199 DOI: 10.1186/s13063-021-05718-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers of dying cancer patients are affected by grief experiences and bereavement complications. Several approaches such as psycho-emotional care and an increase in spirituality have been suggested to diminish these complications. However, the knowledge about the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients is limited. This is a study protocol describing a hospital-based mixed-methods study on the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients. METHODS This mixed-methods study will be done in an embedded explanatory design with two quantitative and qualitative phases. In the first phase (quantitative), a randomized clinical trial will be done, in which 200 family caregivers of dying cancer patients will be randomly assigned to one of the four groups: family-based single dignity intervention (group 1), expressive writing intervention (group 2), combined family-based single dignity intervention and expressive writing (group 3), and control (group 4). At baseline, 1 week and 2 weeks after the interventions, anticipatory grief will be assessed by a 13-item anticipatory grief scale. After the quantitative phase, the qualitative phase will be conducted through the conventional content analysis approach of Granheim and Lundman, in which an individual semi-structured interview will be taken from participants in the first phase to collect data on their experiences on interventions. Finally, data from the quantitative and qualitative phases will be analyzed and discussed. DISCUSSION Family caregivers of dying cancer patients usually experience depression, anxiety, and psychological distress due to isolation and inadequate social support. Psychological interventions such as dignity and expressive writing interventions may help caregivers to obtain a better understanding of themselves and to increase their abilities to cope with caregiving difficulties. Therefore, there is a need for a comprehensive study confirming the effects of mentioned interventions on family caregivers of dying cancer patients. TRIAL REGISTRATION Iranian Registry of Clinical Trials ( www.irct.ir ) identifier: IRCT20210111050010N1. Date of trial registration: Feb 6, 2021. This is the first version of this protocol.
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Affiliation(s)
- Naima Seyedfatemi
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.,Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Rezaei
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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9
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Anderson LM, Smith KE, Nuñez MC, Farrell NR. Family accommodation in eating disorders: a preliminary examination of correlates with familial burden and cognitive-behavioral treatment outcome. Eat Disord 2021; 29:327-343. [PMID: 31414973 PMCID: PMC7021579 DOI: 10.1080/10640266.2019.1652473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Previous research suggests caregivers of individuals with eating disorders (EDs) may attempt to reduce family strain by engaging in accommodation and enabling behaviors to avoid conflict or alleviate stress of the affected individual. Moreover, families often reorganize life around the ED, reinforcing ED behaviors and exacerbating family dysfunction and caregiver distress. However, limited research has examined how accommodation relates to caregivers' distress, family functioning, and treatment outcomes. The current study provides an initial evaluation of these associations among treatment-seeking individuals with EDs and their family members. Forty family members of individuals receiving cognitive behavioral therapy for EDs in a residential treatment setting completed the Accommodation and Enabling Scale for Eating Disorders (AESED) and measures of anxiety (Patient-Reported Outcomes Measurement Information System anxiety scale) and family functioning (Family Assessment Device; FAD) at the time of their family member's treatment admission. Eighteen patients completed the Eating Disorder Examination-Questionnaire (EDE-Q) at admission and discharge. AESED scores were positively associated with family member anxiety, FAD roles, FAD behavioral control, and higher patient EDE-Q global scores at discharge. Findings provide preliminary evidence that greater family accommodation not only relates to poorer family functioning, but uniquely relates to worse ED treatment outcome.
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Affiliation(s)
- Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Kathryn E Smith
- Sanford Center for Bio-behavioral Research, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
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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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11
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Couturier J, Pellegrini D, Miller C, Bhatnagar N, Boachie A, Bourret K, Brouwers M, Coelho JS, Dimitropoulos G, Findlay S, Ford C, Geller J, Grewal S, Gusella J, Isserlin L, Jericho M, Johnson N, Katzman DK, Kimber M, Lafrance A, Leclerc A, Loewen R, Loewen T, McVey G, Norris M, Pilon D, Preskow W, Spettigue W, Steinegger C, Waite E, Webb C. The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond. J Eat Disord 2021; 9:46. [PMID: 33863388 PMCID: PMC8050997 DOI: 10.1186/s40337-021-00394-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. METHODS Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. RESULTS Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. CONCLUSIONS Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.
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Affiliation(s)
- Jennifer Couturier
- McMaster University, Hamilton, ON, Canada.
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.
| | | | - Catherine Miller
- Canadian Mental Health Association - Waterloo Wellington, Waterloo, ON, Canada
| | | | | | - Kerry Bourret
- St. Joseph's Care Group - Thunder Bay, Thunder Bay, ON, Canada
| | | | | | | | - Sheri Findlay
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Catherine Ford
- Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada
| | - Josie Geller
- The University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Natasha Johnson
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | | | | | | | - Anick Leclerc
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | | | | | - Gail McVey
- University of Toronto, Toronto, ON, Canada
| | | | | | - Wendy Preskow
- National Initiative for Eating Disorders, Toronto, ON, Canada
| | | | | | | | - Cheryl Webb
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
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12
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Fleming C, Le Brocque R, Healy K. How are families included in the treatment of adults affected by eating disorders? A scoping review. Int J Eat Disord 2021; 54:244-279. [PMID: 33345319 DOI: 10.1002/eat.23441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The involvement of families in the treatment of adults with eating disorders is recommended as a core component of comprehensive care, yet little is known about the optimal way to implement or routinely facilitate this. This article evaluates the recent evidence on the inclusion of families in treatment programs for adults with eating disorders. METHOD A systematic literature search was conducted to identify evidence of family inclusive treatment approaches for adults with eating disorders. A scoping review framework was applied to assess and synthesize findings. RESULTS Sixty-eight studies were identified. Substantial conceptual research contributing to the theoretical basis of current practice with families of adults with eating disorders and clinical applications in current use were identified. Most research used uncontrolled studies with few experimental designs, reflecting the standing of the extant literature. Common elements of existing approaches have been distinguished and shared core components of interventions identified. DISCUSSION Results confirmed that family members of adults were willing to be involved with eating disorder treatment services and appeared to respond to interventions of varying intensity and duration. The impact on individual patients, and effect on treatment outcomes, are yet to be established. The localized settings of existing studies, the homogenous nature of interventions used, and the limited diversity in research subjects, make it difficult to generalize from the results to the wide range of adult eating disorder presentations seen in practice. Suggestions for future research and further clinical developments are discussed.
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Affiliation(s)
- Carmel Fleming
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Health Metro North Hospital and Health Service, Queensland Eating Disorder Service, Brisbane, Australia
| | - Robyne Le Brocque
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Karen Healy
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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13
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Yaffa S, Adi EL, Itai P, Marit JM, Doron G, Daniel S. Treatment of eating disorders in adolescents during the COVID-19 pandemic: a case series. J Eat Disord 2021; 9:17. [PMID: 33568207 PMCID: PMC7874990 DOI: 10.1186/s40337-021-00374-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are among the most difficult psychiatric disorders to treat in normal conditions. They are likely even more difficult to manage in at-risk conditions such as the COVID-19 pandemic. Currently there is limited evidence about the particular needs and recommended treatment of adolescents with EDs during the COVID-19 outbreak, in particular regarding the use of telemedicine and the involvement of the family in long distance-treatment. AIMS We sought to discuss the advantages and problems associated with the use of multi-professional long-distance telemedicine treatment in the management of adolescents with EDs and their families during the COVID-19 outbreak. METHODS We gathered data about the treatment of adolescents with EDs in our pediatric ED-treatment center in Israel during the COVID-19 outbreak in the first 10 months of 2020, and compared it to the respective period in the past five years (2015-2019). Second, we described the management of four young females with anorexia nervosa (AN), treated in the ambulatory, daycare and inpatient facilities of our center during the COVID-19 pandemic. FINDINGS Slightly less patients were treated in our center during the COVID-19 pandemic than in the respective period in the past five years. These patients received at that time considerably more treatment sessions from all treatment providers (psychiatrists, clinical nutritionists and psychotherapists). This was related, in part, to the extensive use of telemedicine during that period (more than as third of all sessions were carried out with telemedicine in comparison to no use of long-distance treatment in the previous years). The condition of the four adolescents with AN was compromised at the start of the COVID-19 quarantine. The use of multi-disciplinary long-distance telemedicine treatment resulted in an improvement in the condition in three of the four adolescents, living in well-organized families, with the motivation and ability to adjust to the new conditions, but not in one adolescent whose family experienced more problems. These families might require the use of face-to-face interventions even during pandemic conditions. CONCLUSION The choice of the mode of treatment for adolescents with EDs during pandemic times (telemedicine vs. face-to-face) should consider the functioning of the family.
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Affiliation(s)
- Serur Yaffa
- Pediatric Psychosomatic Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel
| | - Enoch-Levy Adi
- Pediatric Psychosomatic Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel
| | - Pessach Itai
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Joffe-Milstein Marit
- Pediatric Psychosomatic Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel
| | - Gothelf Doron
- Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Stein Daniel
- Pediatric Psychosomatic Department, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Child and Adolescent Psychiatric Division, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Tel Hashomer, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel.
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14
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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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15
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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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