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Albano G, Teti A, Scrò A, Bonfanti RC, Fortunato L, Lo Coco G. A systematic review on the role of therapist characteristics in the treatment of eating disorders. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024; 27. [PMID: 38988291 DOI: 10.4081/ripppo.2024.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/04/2024] [Indexed: 07/12/2024]
Abstract
Treating patients with eating disorders can be challenging for therapists, as it requires the establishment of a strong therapeutic relationship. According to the literature, therapist characteristics may influence intervention outcomes. The aim of this systematic review was to identify and synthesize existing literature on therapist interpersonal characteristics that could affect psychotherapy relationship or outcomes in the context of eating disorder treatment from both patients' and therapists' perspectives. We conducted a systematic search using electronic databases and included both qualitative and quantitative studies from 1980 until July 2023. Out of the 1230 studies screened, 38 papers met the inclusion criteria and were included in the systematic review. The results indicate that patients reported therapist's warmth, empathic understanding, a supportive attitude, expertise in eating disorders, and self-disclosure as positive characteristics. Conversely, a lack of empathy, a judgmental attitude, and insufficient expertise were reported as therapist negative characteristics, which could have a detrimental impact on treatment outcome. Few studies have reported therapist's perceptions of their own personal characteristics which could have an impact on treatment. Therapists reported that empathy and supportiveness, optimism, and previous eating disorder experience were positive characteristics. Conversely, clinician anxiety, a judgmental attitude, and a lack of objectivity were reported as negative characteristics that therapists felt could hinder treatment. This systematic review offers initial evidence on the personal characteristics of therapists that may affect the treatment process and outcomes when working with patients with eating disorders.
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Affiliation(s)
- Gaia Albano
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | - Arianna Teti
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | - Arianna Scrò
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | | | - Lucia Fortunato
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
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Robertson N, Davies L. The experiences of a therapeutic relationship between dietitians and patients in UK eating disorder treatment: A qualitative study. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38890773 DOI: 10.1002/erv.3117] [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: 01/08/2024] [Revised: 04/05/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Dietitians have a central role in eating disorder (ED) treatment, however few studies exist investigating therapeutic aspects of dietetic care and factors influencing the dietitian-patient relationship. To address the gap, this study aimed to use a qualitative description approach to explore the experiences of delivering and receiving dietetic care in ED treatment in the UK. METHOD Semi-structured interviews were conducted with 6 specialist ED dietitians and focus groups with 11 recovered ED patients. Interviews were transcribed and inductive thematic analysis was performed to identify key themes describing the data. RESULTS Six key themes were generated: (1) Building trust, (2) Appropriate timing, (3) Adapting, (4) Dietitians as experts, (5) Boundaries, and (6) Difficult relationships. Participants highlighted the importance of building trust and considering nutritional risk and readiness in treatment approach. Patients expressed a desire for dietitians to have experience in EDs, facilitating understanding of their illness. However, dietitians identified the nature of EDs making their role challenging at times. DISCUSSION This study described various factors affecting dietetic care in EDs and provided a valuable insight into patients' perceptions of treatment. The findings support advancements in ED dietitians' knowledge and understanding, helping to enhance quality of care.
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Affiliation(s)
- Nicole Robertson
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, UK
- Department of Nutrition and Dietetics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Luke Davies
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, UK
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3
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Sedgewick F, Leppanen J, Austin A, Tchanturia K. Different pathways, same goals: A large-scale qualitative study of autistic and non-autistic patient-generated definitions of recovery from an eating disorder. EUROPEAN EATING DISORDERS REVIEW 2022; 30:580-591. [PMID: 34820930 DOI: 10.1002/erv.2873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Definitions of recovery from an eating disorder (ED) have generally been formulated around clinical conceptualisations, rather than based on the views of patients. This paper therefore asked those with lived experience of ED for their own definitions of recovery. METHOD Data were collected as part of an online study looking at EDs, autism and relationships. About 173 participants identified as recovered from ED and gave free-response definitions of recovery. Responses were subject to thematic analysis. RESULTS Seven major themes were identified: Weight restoration, lack of ED behaviours, thoughts and behaviours, cognitions, emotional responses, getting on with life, and ongoing challenges. CONCLUSIONS Many definitions of recovery given by those who have lived experience of ED echoed those used by clinicians and researchers. There were also points of divergence around the ongoing challenges of recovery. Our findings highlight the need for continuing support post-weight restoration to facilitate the successful long-term recovery for those with ED.
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Affiliation(s)
- Felicity Sedgewick
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Education, University of Bristol, Bristol, UK
| | - Jenni Leppanen
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Amelia Austin
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, London, UK
- Department of Psychology, Illia State University, Tbilisi, Georgia
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Examination of perfectionism and self-concept constructs across stages of eating disorder recovery in men: An exploratory study. Eat Behav 2022; 46:101658. [PMID: 35981487 PMCID: PMC9812292 DOI: 10.1016/j.eatbeh.2022.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study examined perfectionism and self-concept constructs across eating disorder recovery stages in men, using a conceptualization of recovery that encompasses physical, behavioral, and cognitive recovery. METHOD Participants were 35 men with an eating disorder history (Mage = 26.60 years, SD = 10.81), categorized as in full recovery, in partial recovery, or with a current eating disorder diagnosis/pathology, and 27 men with no eating disorder history (controls; Mage = 26.44 years, SD = 10.08). Data for determining recovery status were collected from surveys, interviews, and measured weight and height; perfectionism and self-concept were assessed via surveys. RESULTS Among the perfectionism constructs, the greatest magnitude of effect sizes involving the fully recovered group was for socially prescribed perfectionism where this group had lower levels of perfectionism than the eating disorder diagnosis/pathology group (Hedge's g = -1.72) or the partially recovered group (Hedge's g = -1.56). For the self-concept constructs, effect sizes involving the fully recovered group and the other recovery status groups were all large (absolute values: 0.76-1.58) and reflected a large magnitude of difference with fully recovered men having higher self-esteem and self-efficacy and lower social comparison than men with a current eating disorder diagnosis or pathology or those partially recovered. CONCLUSION Full recovery in men was associated with healthy self-concept constructs and with low socially prescribed perfectionism. Future research with larger samples should seek to replicate these findings and, using a longitudinal design, examine these constructs as potential predictors or maintenance factors of comprehensive eating disorder recovery in men.
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Berking M, Eichler E, Naumann E, Svaldi J. The efficacy of a transdiagnostic emotion regulation skills training in the treatment of binge-eating disorder-Results from a randomized controlled trial. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:998-1018. [PMID: 35567309 DOI: 10.1111/bjc.12371] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Deficits in emotion regulation (ER) have been shown to be associated with binge-eating disorder (BED). To further clarify the causal nature of this association, we tested whether systematically enhancing ER skills would reduce symptoms of BED. METHODS We randomly allocated N = 101 individuals meeting the criteria for BED to a transdiagnostic ER skills training or to a waitlist control condition (WLC). Primary outcome was the reduction in binges during the treatment-vs.-waiting period as assessed with the Eating Disorder Examination (EDE) interview. RESULTS Mixed-model ANOVAs indicated that the average pre-to-post decrease in binges assessed with the EDE was significantly greater in the ER skills training condition than in the WLC (d = 0.66). These effects were stable over the 6-month follow-up period (d = 0.72). Remission rates at post/follow-up were 34.4/45.0% in the skills training and 7.5/20.0% in the WLC. Additionally, we found a greater reduction in general eating disorder psychopathology, of food consumption in a bogus taste test and of depression in the ER skills training condition. Moreover, the greater reduction in binge-eating episodes in the training condition was (partially) mediated by a greater increase in ER skills. CONCLUSIONS The findings provide further support for the assumed importance of deficits in ER as a maintaining factor and, hence, as a target in the treatment of BED. As ER skills trainings have been shown to also reduce other kinds of psychopathology, they might be considered a promising transdiagnostic add-on component to disorder-specific interventions.
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Affiliation(s)
| | - Eva Eichler
- University of Erlangen-Nuremberg, Erlangen, Germany
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Biney H, Giles E, Hutt M, Matthews R, Lacey JH. Self-esteem as a catalyst for change in adolescent inpatients with anorexia nervosa: a pilot randomised controlled trial. Eat Weight Disord 2022; 27:189-198. [PMID: 33713335 PMCID: PMC8860801 DOI: 10.1007/s40519-021-01161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/20/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE To determine the potential effectiveness of a six-session manualised self-esteem group using CBT approaches when given as an adjuvant to adolescent inpatients with Anorexia Nervosa (AN). METHODS Using a randomised controlled design, 50 girls aged 12-17 years with AN were assigned to either self-esteem group with treatment as usual (TAU) (n = 25) or TAU alone (n = 25). 50/78 (64%) consented to be randomised. Both groups completed self-report measures of self-esteem and eating disorder psychopathology at three time points to measure the potential effectiveness of the treatment. Qualitative feedback was collected to assess acceptability. RESULTS 29 participants completed the study: 15 self-esteem group with TAU, 14 TAU alone. Self-esteem group participants had greater improvement in all outcomes than TAU participants at all time points, the difference in self-report self-esteem at T2 is 1.12 (95% CI - 1.44-3.69; effect size = 0.21). Similar small effect sizes were found for the eating disorder psychopathology measure following completion of the intervention but not at four-week follow-up. Favourable qualitative feedback was gained. CONCLUSION These findings demonstrate that the self-esteem group supplements an intensive treatment package which also addresses elements of low self-esteem. The self-esteem group was beneficial for addressing self-esteem and acted as a catalyst for change in eating disorder psychopathology. Positive qualitative feedback indicated the intervention was acceptable to users. Self-esteem group is a potential new adjuvant treatment for AN. EMB RATING Level 1.
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Affiliation(s)
| | | | - Matt Hutt
- Schoen Clinic Newbridge, Birmingham, UK
| | | | - J Hubert Lacey
- Schoen Clinic Newbridge, Birmingham, UK. .,St George's, University of London, London, UK.
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Safi F, Aniserowicz AM, Colquhoun H, Stier J, Nowrouzi-Kia B. Impact of eating disorders on paid or unpaid work participation and performance: a systematic review and meta-analysis protocol. J Eat Disord 2022; 10:7. [PMID: 35033207 PMCID: PMC8760832 DOI: 10.1186/s40337-021-00525-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Eating disorders (ED) can reduce quality of life by limiting participation and performance in social and occupational roles, including paid or unpaid work. The association between ED pathologies and work participation and performance must be well understood to strengthen vocational rehabilitation programmes and prevent occupational disruptions in the ED population. The aims of this study are: (1) to examine the degree of association between ED pathologies and work participation and performance in 15-year-olds and older; (2) to highlight the specific ED symptoms that are most correlated with changes in work performance and participation; (3) to compile the most common metrics and assessments used to measure work participation and performance with ED. METHODS Medline, Embase, CINAHL, Web of Science, PsycINFO, and Cochrane Library will be searched for observational and experimental studies that meet the following criteria: (1) a clinical sample of typical or atypical ED; (2) paid or unpaid employment or training; (3) an association between ED pathologies and work participation or performance. Unpublished data will also be examined. Title and abstract, and full-text screening will be conducted in duplicate. Risk of bias and quality of evidence assessments will be completed. A random-effect meta-analysis will be performed. DISCUSSION This synthesis can clarify knowledge and gaps around the impact of ED on work functioning, thereby allowing better evaluation, improvements and development of current workplace assessments, interventions, and policies. TRIAL REGISTRATION The registration number for this systematic review on PROSPERO is CRD42021255055.
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Affiliation(s)
- Fatima Safi
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Anna M Aniserowicz
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jill Stier
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
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Plumley S, Kristensen A, Jenkins PE. Continuation of an eating disorders day programme during the COVID-19 pandemic. J Eat Disord 2021; 9:34. [PMID: 33750463 PMCID: PMC7942518 DOI: 10.1186/s40337-021-00390-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/27/2021] [Indexed: 12/22/2022] Open
Abstract
The current paper describes an adaptation of a daypatient programme for adults with anorexia nervosa in the UK in response to the COVID-19 pandemic and consequent government guidelines. The paper details how the programme, which is normally delivered face-to-face, became a 'virtual' clinic, providing support to a group of patients via the Internet and conducting its core activities almost exclusively via videoconferencing. Anxiety around the pandemic influenced patients' feelings about recovery, and there were concerns about the programme moving online, which necessitated careful management. It has been possible to continue an intensive level of care given wider organisational backing and the support of the patients involved. Some of the patients' reflections on the experience are included in the article. As well as the adaptations, the article also discusses some of the challenges and opportunities encountered, in the hope of guiding similar services.
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Affiliation(s)
- Sarah Plumley
- Eating Disorders Unit (Block 22), St Mark's Hospital, 112 St Mark's Road, Maidenhead, SL6 6DU, UK.
| | - Anna Kristensen
- Eating Disorders Unit (Block 22), St Mark's Hospital, 112 St Mark's Road, Maidenhead, SL6 6DU, UK
| | - Paul E Jenkins
- School of Psychology & Clinical Language Sciences, University of Reading, Harry Pitt Building, Earley Gate, Reading, RG6 6ES, UK
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Bullivant B, Rhydderch S, Griffiths S, Mitchison D, Mond JM. Eating disorders "mental health literacy": a scoping review. J Ment Health 2020; 29:336-349. [PMID: 32041463 DOI: 10.1080/09638237.2020.1713996] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: While it is apparent that much has been learned about "mental health literacy" (MHL) relating to certain mental health problems, such as depression, in recent years, what has been learned about MHL relating to eating disorders (ED-MHL) is unclear.Aims: A scoping review was conducted to inform the current state of knowledge in this field.Methods: A systematic search of relevant literature published between 1997 and 2017 was followed by a narrative synthesis of the findings.Results: The number of eligible studies increased from 32 in 1997-2001 to 98 in 2012-2017 (total = 264). Most studies originated from North America or Europe, recruited individuals with EDs receiving treatment or college students and included both female and male or only female participants. The majority of studies examined MHL relating to anorexia nervosa or bulimia nervosa and examined attitudes which facilitate recognition and appropriate help-seeking and knowledge and beliefs about professional help available.Conclusion: Interest in ED-MHL is increasing and there is now a considerable body of research addressing some aspects of ED-MHL in a range of study populations. Notable gaps in the literature exist, including a paucity of information about ED-MHL relating to EDs other than anorexia nervosa and bulimia nervosa, ED behaviour in males and the use of self-help interventions. We hope the findings will provide an incentive to further research in these and other aspects of ED-MHL.
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Affiliation(s)
- Bianca Bullivant
- Faculty of Medicine, Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| | - Suzie Rhydderch
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Deborah Mitchison
- Department of Psychology, Macquarie University, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Jonathan M Mond
- Department of Psychology, Macquarie University, Sydney, Australia.,Centre for Rural Health, University of Tasmania, Launceston, Australia
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Johns G, Taylor B, John A, Tan J. Current eating disorder healthcare services - the perspectives and experiences of individuals with eating disorders, their families and health professionals: systematic review and thematic synthesis. BJPsych Open 2019; 5:e59. [PMID: 31530301 PMCID: PMC6646967 DOI: 10.1192/bjo.2019.48] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Eating disorders have the highest mortality rate of mental disorders and a high incidence of morbidity, but if diagnosed and treated promptly individuals can benefit from full recovery. However, there are numerous problems at the healthcare interface (i.e. primary and secondary care) for eating disorders. It is important to examine these to facilitate appropriate, seamless treatment and improve access to specialist care. AIMS To examine the current literature on the experiences and perspectives of those across healthcare interfaces for eating disorders, to include individuals with eating disorders, people close to or caring for those with eating disorders such as family and friends, and health professionals. METHOD To identify relevant papers, a systematic search of electronic databases was conducted. Other methods, including hand-searching, scanning reference lists and internet resources were also used. Papers that met inclusion criteria were analysed using a systematic methodology and synthesised using an interpretative thematic approach. RESULTS Sixty-three papers met the inclusion criteria. The methodological quality was relatively good. The included papers were of both qualitative (n = 44) and quantitative studies (n = 24) and were from ten different countries. By synthesising the literature of these papers, three dominant themes were identified, with additional subthemes. These included: 'the help-seeking process at primary care'; 'expectations of care and appropriate referrals' and 'opposition and collaboration in the treatment of and recovery from eating disorders'. CONCLUSIONS This review identifies both facilitators and barriers in eating disorder healthcare, from the perspectives of those experiencing the interface first hand. The review provides recommendations for future research and practice. DECLARATION OF INTEREST None.
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Affiliation(s)
- Gemma Johns
- Research Assistant, School of Medicine, Swansea University, UK
| | - Bridget Taylor
- Retired Psychiatric Nurse and currently a Lay Representative, Department of Medicine, Swansea University, UK
| | - Ann John
- Professor in Public Health and Psychiatry, Population Psychiatry, Suicide and Informatics, Swansea University Medical School, UK
| | - Jacinta Tan
- Clinical Associate Professor of Psychiatry, School of Medicine, Swansea University, UK
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Pettersen G, Rosenvinge JH, Skomakerstuen T, Sordal S, Mathisen TF, Sundgot-Borgen J. Patient expectations of a new treatment for eating disorders combining guided physical exercise and dietary therapy: an interview study of women participating in a randomised controlled trial at the Norwegian School of Sport Sciences. BMJ Open 2019; 9:e025344. [PMID: 31005919 PMCID: PMC6500244 DOI: 10.1136/bmjopen-2018-025344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study the expectations women with bulimia nervosa (BN) or binge eating disorder (BED) had to a new treatment programme based on guided physical exercise and dietary therapy. DESIGN AND PARTICIPANTS Semistructured interviews were conducted with six women with BN and four women with BED following a group-based therapy programme. Transcribed interviews were analysed using a text-condensing analytic approach. RESULTS The analysis resulted in three main categories, that is, expectations about (1) increased knowledge, (2) symptom changes and (3) therapeutic expertise. The women expected that learning more about nutrition and physical exercise would give them more energy, less fear of food, physical and mental symptoms and a negative body focus. They also expected therapists to be professional and competent, and able to take care of them. CONCLUSION The overall high and positive treatment expectation can, to some extent, reflect enthusiasm about a new and innovative approach to treatment. However, the results also reflect generic and highly adequate outcome expectations, which for the purpose of effectiveness should be incorporated into all treatment efforts at least for patients with eating disorders. TRIAL REGISTRATION NUMBER NCT02079935; Results.
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Affiliation(s)
- Gunn Pettersen
- Department of Health and Care Science, UiT - The Artic University of Norway, Norway, Europe
| | - Jan H Rosenvinge
- Department of Psychology, UiT - The Artic University of Norway, Norway, Europe
| | - Tone Skomakerstuen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Norway, Europe
| | - Solveig Sordal
- Department of Sports Medicine, Norwegian School of Sport Sciences, Norway, Europe
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12
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Kästner D, Löwe B, Gumz A. The role of self-esteem in the treatment of patients with anorexia nervosa - A systematic review and meta-analysis. Int J Eat Disord 2019; 52:101-116. [PMID: 30488479 DOI: 10.1002/eat.22975] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to provide a comprehensive overview of the role of self-esteem in the treatment of patients with anorexia nervosa (AN). Specifically, our objectives were to investigate the differences in self-esteem between individuals with AN and healthy controls, or individuals with other eating disorders, and to examine self-esteem as an outcome, predictor, moderator, and mediator in AN treatment. METHOD The databases PsycINFO, PSYNDEXplus, Ovid MEDLINE®, and ProQuest were searched for studies published from 1990 to 2018. To estimate aggregated effect sizes, we performed random-effects meta-analyses. RESULTS A screening of 1,596 abstracts and 203 full-texts identified 68 relevant publications. Results suggest a significantly lower global self-esteem in individuals with AN than in healthy controls (d = -1.90, p < .001). In contrast, global self-esteem of AN and bulimia nervosa (BN) patients was found to be comparable (d = 0.05, p = .529). It might be specific to AN patients that negative self-evaluations may not affect scholastic and professional abilities. Significantly moderate self-esteem increases were observed in treated AN patients at the end of treatment (d = 0.56, p < .001), short-term (d = 0.50, p < .001), and long-term (d = 0.75, p < .001) follow-up. Self-esteem did not predict end of treatment remission-or weight-related outcome and treatment dropout. However, small to moderate predictive effects were detected on short-term (r = .15, p = .007) and long-term remission or weight (r = .33, p = .017). Finally, first indications point to self-esteem as a mediator in adult AN inpatient treatment. DISCUSSION The review provides insights relevant for theory, research, and practice. Implications concern the overall support for transdiagnostic approaches and the recommendation to consider low initial self-esteem for decisions on after-care.
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Affiliation(s)
- Denise Kästner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Hamburg, Germany
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13
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Adamson J, Ozenc C, Baillie C, Tchanturia K. Self-Esteem Group: Useful Intervention for Inpatients with Anorexia Nervosa? Brain Sci 2019; 9:E12. [PMID: 30642112 PMCID: PMC6356529 DOI: 10.3390/brainsci9010012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/21/2022] Open
Abstract
Low self-esteem is a common feature in Anorexia Nervosa (AN) and has been hypothesised to act as a predisposing, precipitating, and perpetuating factor. The aim of this study was to assess the effectiveness of a Cognitive Behavioural Therapy (CBT)-based self-esteem group in a naturalistic setting of patients with AN in an inpatient treatment programme. Included in this study were 119 female patients diagnosed with AN, with all participants completing self-report questionnaires before and after the intervention. The group consisted of five to six weekly sessions. The self-esteem group led to a statistically significant improvement in self-esteem, which could not be explained by an increase in BMI alone, suggesting that the group is facilitating positive changes within an AN group. The group also had a small effect on improving patients self-perceived ability to change. These findings suggest that the brief self-esteem group has some benefits in improving patients' self-esteem/self-efficacy and should be replicated in the future with a control condition to confirm findings.
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Affiliation(s)
- James Adamson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK.
| | - Cansu Ozenc
- South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK.
| | - Claire Baillie
- South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK.
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK.
- Department of Psychology, Illia State University, Tbilisi 0162, Georgia.
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Romano KA, Ebener D. Disparities in psychological well-being based on subjective and objective eating disorder recovery statuses, and recovery status concordance. Eat Disord 2019; 27:82-99. [PMID: 29791281 DOI: 10.1080/10640266.2018.1477674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This research examines how eudaimonic psychological well-being (PWB) relates to variant levels of eating disorder (ED) recovery (full, partial, active ED), both self-defined and objectively determined, and to subjective-objective recovery status concordance. Participants (N = 132; Mage = 30.1) completed an online survey targeting ED symptomology, PWB, and recovery. MANOVAs revealed idiosyncratic relationships between recovery and PWB when objective criteria, subjective perceptions, and concordance were considered. Generally, superior levels of recovery were associated with superior PWB. PWB and clients' perceptions of recovery should be considered during treatment and in establishing a uniform definition of ED recovery.
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Affiliation(s)
- Kelly A Romano
- a Department of Educational Psychology and Learning Systems , Florida State University , Tallahassee , FL USA
| | - Deborah Ebener
- a Department of Educational Psychology and Learning Systems , Florida State University , Tallahassee , FL USA
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Bachner-Melman R, Lev-Ari L, Zohar AH, Lev SL. Can Recovery From an Eating Disorder Be Measured? Toward a Standardized Questionnaire. Front Psychol 2018; 9:2456. [PMID: 30618916 PMCID: PMC6297874 DOI: 10.3389/fpsyg.2018.02456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/20/2018] [Indexed: 01/12/2023] Open
Abstract
Background: There is a clear need for a standardized definition of recovery from eating disorders (EDs) and for self-report instruments to assess where individuals with an ED are situated at a given point of time along their process of illness and recovery. It has been acknowledged that psychological and cognitive symptoms are important to recovery in addition to physical and behavioral indices. This study proposes a 28-item multidimensional questionnaire encompassing the main features of recovery from ED, derived from the endorsement of different criteria by people with a lifetime ED diagnosis, family members and ED clinicians. Methods: Participants were 213 volunteers over the age of 18 (118 people with a lifetime ED diagnosis, 58 healthy family members of people with EDs and 37 ED clinicians), who completed the ED-15 and indicated online how important they thought each of 56 criteria were for recovery from an ED. Results: Four factors were identified in an exploratory factor analysis: Lack of Symptomatic Behavior (LSB), Acceptance of Self and Body (ASB), Social and Emotional Connection (SEC), and Physical Health (PH). Confirmatory factor analysis using the seven highest loading items from each subscale confirmed the structure validity of a shortened version of this questionnaire, the Eating Disorders Recovery Endorsement Questionnaire (EDREQ), which had excellent goodness-of-fit indices. Despite a few between-group differences, there was general agreement that LSB was most salient to recovery, followed by ASB, SEC, and PH in that order. Conclusion: Despite the absence of a standardized definition of recovery from ED, there is a general consensus about its components. The EDREQ is a psychometrically sound questionnaire containing items that people with an ED history, their family members and therapists all define as important components of recovery. The inclusion of emotional and psychosocial aspects of recovery in addition to symptomatic and medical aspects is important to expand treatment goals and the concept of recovery from EDs beyond symptom relief and the absence of disease markers. As a clinical tool, the EDREQ stands to assist in setting and refining therapeutic goals throughout therapy, and in establishing standardized, comparable norms for recovery levels in research.
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Affiliation(s)
- Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lilac Lev-Ari
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
| | - Ada H. Zohar
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
| | - Shay Lee Lev
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
- Student Counselling Service, University of Haifa, Haifa, Israel
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Albertz J, Boersma GJ, Tamashiro KL, Moran TH. The effects of scheduled running wheel access on binge-like eating behavior and its consequences. Appetite 2018; 126:176-184. [PMID: 29654852 DOI: 10.1016/j.appet.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 11/19/2022]
Abstract
Binge eating disorder (BED) is an eating disorder involving repeated, intermittent over consumption of food in brief periods of time, usually with no compensatory behaviors. There are few successful treatments and the underlying neural mechanisms remain unclear. In the current study, we hypothesized that voluntary running wheel (RW) activity could reduce binge-like eating behavior in a rat model. Rats were given intermittent (3 times/wk) limited (1hr) access to a high-fat food (Crisco), in addition to continuously available chow. Crisco was available every Mon, Wed, and Fri for 1hr before dark onset. Rats were divided into 2 groups: those with RW access during the first half of the experiment and sedentary during the second half (RW-SED) and those that were sedentary during the first half of the experiment and had RW access during the second half (SED-RW). Crisco intake was significantly less in both groups during the period of time with a RW present. Within the bingeing RW-SED rats, the gene expression of the orexigenic neuropeptides AgRP and NPY were similar to a non-bingeing sedentary control (CON) group, while the expression of the anorexigenic neuropeptide POMC was significantly increased relative to the SED-RW and CON groups. Despite elevated POMC, the rats continued to binge. Additionally, within both groups, the gene expression of the D2R and Oprm1 in the NAc and the VTA were altered suggesting that the reward system was stimulated by both the bingeing behavior and the running wheel activity. Overall, access to a RW and the resulting activity significantly reduced binge-like behavior as well as modulated the effects of binging on brain appetite and reward systems.
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Affiliation(s)
- Jennifer Albertz
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gretha J Boersma
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kellie L Tamashiro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy H Moran
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Brockmeyer T, Friederich HC, Schmidt U. Advances in the treatment of anorexia nervosa: a review of established and emerging interventions. Psychol Med 2018; 48:1228-1256. [PMID: 28889819 DOI: 10.1017/s0033291717002604] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a disabling, deadly and costly mental disorder. Until recently, treatment recommendations were based on expert opinion and limited evidence. The aim of this systematic review is to synthesise recent evidence on established and emerging AN treatments and to forecast trends for future developments. METHODS We systematically review trials of established treatments and associated process outcome studies from the last 5 years, published since a previous review in this journal. 'Established' treatments were those that are widely used in AN, recommended by guidelines and/or have been tested in at least one large randomised controlled trial. Secondly, we summarise emerging treatments for AN, i.e. those that have only been (or are currently being) tested in proof-of concept, feasibility or pilot trials. RESULTS We identified 19 published trials of established treatments (15 of high or moderate quality), mostly assessing psychological therapies (n = 17). We also found 11 published trials of emerging treatments, and a total of 34 registered, as yet unpublished trials. Promising emerging treatments include cognitive remediation therapy, exposure therapy and non-invasive neuromodulation. CONCLUSIONS Evidence generation on the treatment of AN has dramatically accelerated, with our understanding of the role of family-based approaches for adolescents more nuanced and a range of psychological approaches available for the treatment of adults. Evidence on emerging treatments and from forthcoming trials suggests that there is a shift towards more targeted brain-based interventions. Future studies need to focus on elucidating mechanisms of action of treatments and what works best for whom.
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Affiliation(s)
- T Brockmeyer
- Department of Psychosomatic Medicine and Psychotherapy,LVR Clinic,Medical Faculty of the Heinrich-Heine-University Düsseldorf,Düsseldorf,Germany
| | - H-C Friederich
- Department of Psychosomatic Medicine and Psychotherapy,LVR Clinic,Medical Faculty of the Heinrich-Heine-University Düsseldorf,Düsseldorf,Germany
| | - U Schmidt
- Section of Eating Disorders,Department of Psychological Medicine,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
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Bakland M, Sundgot-Borgen J, Wynn R, Rosenvinge JH, Stornæs AV, Pettersen G. Therapists' experiences with a new treatment combining physical exercise and dietary therapy (the PED-t) for eating disorders: an interview study in a randomised controlled trial at the Norwegian School of Sport Sciences. BMJ Open 2018; 8:e019386. [PMID: 29330176 PMCID: PMC5781022 DOI: 10.1136/bmjopen-2017-019386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim of the current study is to explore how therapists running a guided physical exercise and dietary therapy programme (PED-t) experience their contribution to the treatment of patients with bulimia nervosa and binge eating disorder. METHODS Ten therapists running the PED-t were semistructurally interviewed and the transcribed interviews were analysed using a systematic text condensation approach. SETTING The study was run within the context of a randomised controlled trial at the Norwegian School of Sport Sciences. RESULTS The therapists experienced their knowledge about physical exercise and nutrition as important and useful, and that they could share their knowledge with the patients in different ways and with confidence in their own role. They also believed that their knowledge could serve as tools for the patients' post-treatment recovery and management of their daily lives. Moreover, the therapists put much effort in adjusting their teaching to fit each individual participant. Finally, they reported their personal qualities as important to build trust and therapeutic alliance. CONCLUSIONS The terms 'clinical confidence' and 'alliance' may stand out as the overarching 'metacategories' covering the experiences revealed in this study. The clinical implication is that new groups of professionals may have an important role in the treatment of eating disorders. TRIAL REGISTRATION NUMBER NCTO2079935; Results.
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Affiliation(s)
- Maria Bakland
- Department of Health and Care Science, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | | | - Rolf Wynn
- Department of Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Jan H Rosenvinge
- Department of Psychology, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | | | - Gunn Pettersen
- Department of Health and Care Science, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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Pettersen G, Rosenvinge JH, Bakland M, Wynn R, Mathisen TF, Sundgot-Borgen J. Patients' and therapists' experiences with a new treatment programme for eating disorders that combines physical exercise and dietary therapy: the PED-t trial. A qualitative study protocol. BMJ Open 2018; 8:e018708. [PMID: 29317417 PMCID: PMC5781017 DOI: 10.1136/bmjopen-2017-018708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/09/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Women with bulimia nervosa and binge eating disorder often suffer for many years before they seek professional help. Evidence-based treatments like cognitive-behavioural therapy (CBT) might be poorly accessible, and about 50% of those who receive CBT respond to it. Such outcome may reflect the heterogeneous nature of eating disorders, and addressing this heterogeneity calls for expanding the portfolio of treatment options. In particular, it is important to explore such options' acceptability, tolerability and affordability expressed through experiences with the treatment. This protocol outlines the rationale and design of a qualitative study. It captures experiences from patients and therapists who were involved in a randomised controlled trial (RCT) exploring the efficacy of a new group-based treatment programme combining physical exercise and dietary therapy. METHODS AND ANALYSIS 15 patients with bulimia nervosa or binge eating disorder, 10 therapists (physical trainers and dietitians) and 6-10 patients who dropped out of the RCT will be semistructurally interviewed. All interviews will be analysed using a systematic text condensation approach. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed international journals, and at relevant international conferences. Key findings will be available to study participants as well as to patient organisations and health authorities. The overall study meets the intent and requirements of the Health Research Act and the Declaration of Helsinki. It is approved by the regional committee for medical research ethics (2013/1871). TRIAL REGISTRATION NUMBER NCT02079935; Pre-results.
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Affiliation(s)
- Gunn Pettersen
- Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Jan H Rosenvinge
- Department of Psychology, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Maria Bakland
- Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
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Abstract
OBJECTIVES The aim of the current study is to investigate what males experience as helpful in their recovery process from eating disorders (ED). METHODS Qualitative in-depth interviews within a phenomenological approach, and using content analysis to excavate overarching text themes. SETTING Norway and Sweden. PARTICIPANTS Included were 15 males with an age range from 19 to 52 years. Duration of illness varied between 3 and 25 years of experience with anorexia nervosa (n=10), bulimia nervosa (n=4) or ED not otherwise specified (n=1). RESULTS The content analysis revealed four main categories, that is, 'the need for a change', 'a commitment to leave the eating disorder behind', 'interpersonal changes' and 'searching for a life without an eating disorder'. These categories comprise features like motivation to change, gaining structure in eating situations, a re-learning of personal and interpersonal skills as well as accepting losses and starting a reorientation of identity and meaning. We noted a rather goal-oriented approach to help seeking and a variation in how the males engaged their social network in resolving the challenges associated with the recovery process. Still, the overall nature of the recovery process highly accords with what has been reported for women. DISCUSSION A clinical implication from our findings is that symptom relief is important to facilitate good circles of improvement, but that the nature of the recovery process would require a wider perspective in treatment. Clinicians may also be informed about challenges related to an instrumental approach to help seeking reported in this study.
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Affiliation(s)
- Gunn Pettersen
- Department of Health and Care Science, University of Tromsø-The Artic University of Norway, Tromsø, Norway
| | - Karin Wallin
- Department of Clinical Science Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Tabita Björk
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
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21
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Vancampfort D, Rosenbaum S, Probst M, Connaughton J, Du Plessis C, Yamamoto T, Diedens J, Stubbs B. Top 10 research questions to promote physical activity research in people with binge eating disorder. Eat Disord 2016; 24:326-37. [PMID: 26694684 DOI: 10.1080/10640266.2015.1123988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite emerging evidence illustrating the benefits of physical activity for people with binge eating disorder, engaging this population in physical activity is challenging. The International Organization of Physical Therapists in Mental Health (IOPTMH) set out to summarize, appraise, and strengthen the direction of physical activity endeavors. This process led to the identification of 10 important research questions which are discussed. Addressing these 10 research questions is critical for developing evidence-based approaches for promoting and sustaining an active lifestyle in people with binge eating disorder.
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Affiliation(s)
- Davy Vancampfort
- a Department of Neurosciences , KU Leuven - University of Leuven , Kortenberg , Belgium.,b Department of Rehabilitation Sciences , University of Leuven , Leuven , Belgium
| | - Simon Rosenbaum
- c School of Psychiatry , University of New South Wales , Sydney , New South Wales , Australia
| | - Michel Probst
- b Department of Rehabilitation Sciences , University of Leuven , Leuven , Belgium
| | - Joanne Connaughton
- d School of Physiotherapy , University of Notre Dame , Fremantle , Western Australia , Australia
| | - Christy Du Plessis
- e Physiotherapy Department , Free State University , Bloemfontein , South Africa
| | - Taisei Yamamoto
- f Department of Medical Rehabilitation , Kobe Gakuin University , Kobe , Japan
| | - Jolien Diedens
- b Department of Rehabilitation Sciences , University of Leuven , Leuven , Belgium
| | - Brendon Stubbs
- g Physiotherapy Department , South London and Maudsley NHS Foundation Trust , London , UK.,h Health Service and Population Research Department, Institute of Psychiatry , King's College London , London , UK
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Collin P, Karatzias T, Power K, Howard R, Grierson D, Yellowlees A. Multi-dimensional self-esteem and magnitude of change in the treatment of anorexia nervosa. Psychiatry Res 2016; 237:175-81. [PMID: 26837476 DOI: 10.1016/j.psychres.2016.01.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 12/02/2015] [Accepted: 01/21/2016] [Indexed: 11/16/2022]
Abstract
Self-esteem improvement is one of the main targets of inpatient eating disorder programmes. The present study sought to examine multi-dimensional self-esteem and magnitude of change in eating psychopathology among adults participating in a specialist inpatient treatment programme for anorexia nervosa. A standardised assessment battery, including multi-dimensional measures of eating psychopathology and self-esteem, was completed pre- and post-treatment for 60 participants (all white Scottish female, mean age=25.63 years). Statistical analyses indicated that self-esteem improved with eating psychopathology and weight over the course of treatment, but that improvements were domain-specific and small in size. Global self-esteem was not predictive of treatment outcome. Dimensions of self-esteem at baseline (Lovability and Moral Self-approval), however, were predictive of magnitude of change in dimensions of eating psychopathology (Shape and Weight Concern). Magnitude of change in Self-Control and Lovability dimensions were predictive of magnitude of change in eating psychopathology (Global, Dietary Restraint, and Shape Concern). The results of this study demonstrate that the relationship between self-esteem and eating disorder is far from straightforward, and suggest that future research and interventions should focus less exclusively on self-esteem as a uni-dimensional psychological construct.
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Affiliation(s)
- Paula Collin
- NHS Tayside Eating Disorders Service/Psychological Therapies Service, Dundee, UK
| | - Thanos Karatzias
- Edinburgh Napier University, Faculty of Health, Life & Social Sciences, Edinburgh, UK; NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK.
| | - Kevin Power
- NHS Tayside Eating Disorders Service/Psychological Therapies Service, Dundee, UK; Stirling University, School of Natural Sciences, Stirling, UK
| | - Ruth Howard
- Edinburgh Napier University, Faculty of Health, Life & Social Sciences, Edinburgh, UK
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Savuskoski M, Uusiautti S, Määttä K. From fear of eating to appetite for life: food and eating in an anorectic mind. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2016. [DOI: 10.1080/02673843.2012.709175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Soundy A, Stubbs B, Probst M, Gyllensten AL, Skjaerven LH, Catalan-Matamoros D, Vancampfort D. Considering the Role of Physical Therapists Within the Treatment and Rehabilitation of Individuals With Eating Disorders: An International Survey of Expert Clinicians. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2015; 21:237-246. [PMID: 26267762 DOI: 10.1002/pri.1637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/27/2015] [Accepted: 04/19/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE Recent research has demonstrated that physical therapy may benefit the physical and mental health of people with eating disorders (EDs). Because this is a new and developing field, this study aimed to investigate the experience, practices and knowledge of international physical therapy experts to inform clinical practice, education and research. METHODS An international cross-sectional survey design was undertaken with experienced physical therapists within the field of EDs. Physical therapist responses were analysed with descriptive statistics and thematic analysis as appropriate. RESULTS Twenty-eight international physical therapists participated. On average, participants had 6.9 years (95% confidence interval: 3.1-10.7, n = 27) of clinical experience working in ED settings and devoted approximately 39.3% (95% confidence interval: 23.8-54.8, n = 27) of their time to treating individuals with EDs. Participants reported that physical therapy interventions have a diverse range of benefits on the physical, mental and disease-specific factors (e.g. binges) in people with EDs. The key role of physical therapists includes improving body awareness, especially during physical activity combined with psycho-education about healthy doses of physical activity. Physical therapists were able to identify a range of barriers and facilitators to physical activity in people with EDs. DISCUSSION This paper provides a first step towards understanding the role and value of physical therapists working with individuals with EDs. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andy Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Brendon Stubbs
- School of Health and Social Care, University of Greenwich, London, SE9 2UG, UK
| | - Michel Probst
- University Psychiatric Centre, KU Leuven, Leuvensesteenweg 517, B-3070, Kortenberg, Belgium.,Department of Neurosciences, KU Leuven, Leuvensesteenweg 517, B-3070, Kortenberg, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium
| | | | - Liv Helvik Skjaerven
- Faculty of Health and Social Sciences, Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - Daniel Catalan-Matamoros
- University Carlos III of Madrid, Madrid, Spain.,Spanish Association of Physiotherapists in Mental Health, Madrid, Spain
| | - Davy Vancampfort
- University Psychiatric Centre, KU Leuven, Leuvensesteenweg 517, B-3070, Kortenberg, Belgium.,Department of Neurosciences, KU Leuven, Leuvensesteenweg 517, B-3070, Kortenberg, Belgium.,Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium
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Abstract
BACKGROUND Recent quantitative studies provide support for an "enhanced" transdiagnostic approach of Cognitive Behaviour Therapy (CBT-E) for eating disorders; however it is not yet known how recipients of CBT-E experience therapy. AIMS The current study used a qualitative approach to explore service users' experiences of CBT-E. METHOD Individuals with a diagnosis of bulimia nervosa and who had completed CBT-E from one service in Wales were invited to participate. Semi-structured interviews were completed with eight individuals and analysed using Interpretative Phenomenological Analysis (IPA). RESULTS Participants valued both specific and non-specific elements of CBT-E. Therapist specialism in eating disorders was considered to enhance therapist empathy. The most helpful aspects specific to CBT-E were gaining insight into maintenance cycles and experiential learning. The most challenging aspects of CBT-E were changing behaviours and cognitions "in the moment" and in the longer-term. CONCLUSIONS The implication of therapist specialism and empathy is further discussed, as well as the difficulty for CBT-E in changing service users' long-standing core beliefs.
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Duncan TK, Sebar B, Lee J. Reclamation of power and self: a meta-synthesis exploring the process of recovery from anorexia nervosa. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21662630.2014.978804] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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27
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Vancampfort D, Probst M, Adriaens A, Pieters G, De Hert M, Stubbs B, Soundy A, Vanderlinden J. Changes in physical activity, physical fitness, self-perception and quality of life following a 6-month physical activity counseling and cognitive behavioral therapy program in outpatients with binge eating disorder. Psychiatry Res 2014; 219:361-6. [PMID: 24929440 DOI: 10.1016/j.psychres.2014.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/02/2014] [Accepted: 05/12/2014] [Indexed: 11/16/2022]
Abstract
The aim of the current study was to explore the associations between changes in the number of binges, physical activity participation, physical fitness, physical self-perception and quality of life following a 6-month physical activity counseling and cognitive behavioral program in patients with binge eating disorder (BED). In total 34 (31 women) outpatients with BED (38.5±10.7 years) completed a 6-month 1-day per week group-based program. Participants completed the 36-item Short Form Health Survey, the Baecke Physical Activity questionnaire, the Physical Self Perception Profile and performed a 6-min walk test (6MWT) at baseline, after 3 and 6 months. Except for physical activity at work, physical strength and self-worth perception, all parameters significantly improved after 6 months. The effect sizes ranged from -0.33 for the number of binges to 1.67 for participation in sports activities. Significant increases in leisure time physical activity were associated with significant improvements in physical health related quality of life, perceived sports competence and physical fitness and in perceived body attractiveness. The significant reduction in the number of binges was associated with significant improvements in physical health related quality of life. Future research should focus on detailing which techniques can stimulate physical activity participation in patients with BED.
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Affiliation(s)
- Davy Vancampfort
- UPC KU Leuven, Campus Kortenberg, KU Leuven Department of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Michel Probst
- UPC KU Leuven, Campus Kortenberg, KU Leuven Department of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - An Adriaens
- UPC KU Leuven, Campus Kortenberg, KU Leuven Department of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium
| | - Guido Pieters
- UPC KU Leuven, Campus Kortenberg, KU Leuven Department of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium
| | - Marc De Hert
- UPC KU Leuven, Campus Kortenberg, KU Leuven Department of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium
| | - Brendon Stubbs
- School of Health and Social Care, University of Greenwich, Eltham, London SE9 2UG, UK
| | - Andy Soundy
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Birmingham B15 2TT, UK
| | - Johan Vanderlinden
- UPC KU Leuven, Campus Kortenberg, KU Leuven Department of Neurosciences, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium
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Rosenvinge JH, Pettersen G. Epidemiology of eating disorders, part I: introduction to the series and a historical panorama. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21662630.2014.898206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Waterman-Collins D, Renwick B, Lose A, Kenyon M, Serpell L, Richards L, Boughton N, Treasure J, Schmidt U. Process Evaluation of the MOSAIC Trial, Part I: Therapist Experiences of Delivering Two Psychological Therapies for Treatment of Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:122-30. [DOI: 10.1002/erv.2278] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 12/09/2013] [Accepted: 12/12/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Daniella Waterman-Collins
- Section of Eating Disorders, Department of Psychological Medicine; Institute of Psychiatry, King's College London; London
| | - Beth Renwick
- Section of Eating Disorders, Department of Psychological Medicine; Institute of Psychiatry, King's College London; London
| | - Anna Lose
- Section of Eating Disorders, Department of Psychological Medicine; Institute of Psychiatry, King's College London; London
| | - Martha Kenyon
- Section of Eating Disorders, Department of Psychological Medicine; Institute of Psychiatry, King's College London; London
| | - Lucy Serpell
- Hope Wing, Porters Avenue Health Centre, North East London Foundation Trust; Dagenham Essex UK
- Eating Disorders Research Group, Research Dept. of Clinical, Educational & Health Psychology; University College London; London
| | - Lorna Richards
- The Phoenix Wing, St Ann's Hospital, Barnett, Enfield and Haringey Mental Health Trust; Tottenham London
| | - Nicky Boughton
- Oxford Adult Eating Disorder Service, Cotswold House, Warneford Hospital, Oxford NHS Foundation Trust; Oxford UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine; Institute of Psychiatry, King's College London; London
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine; Institute of Psychiatry, King's College London; London
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Noordenbos G, Aliakbari N, Campbell R. The relationship among critical inner voices, low self-esteem, and self-criticism in eating disorders. Eat Disord 2014; 22:337-51. [PMID: 24678635 DOI: 10.1080/10640266.2014.898983] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hilde Bruch (1978) was one of the first to describe the phenomenon of anorectic patients experiencing a critical inner voice. Although several qualitative studies regarding eating disorder patients report this experience, few quantitative studies have been conducted in which hearing voices was examined in eating disorder patients. This motivated us to investigate whether eating disorder patients (N = 74) experience critical inner voices significantly more often than a healthy control group (N = 58). Is voice hearing related to the severity of the eating disorder and to low self-esteem and high self-criticism? These questions will be addressed in this article.
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Affiliation(s)
- Greta Noordenbos
- a Department of Clinical Psychology , Leiden University , Leiden , The Netherlands
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Abstract
BACKGROUND Anorexia nervosa (AN) is a serious psychiatric disorder with high mortality rates a poor outcome and no empirically supported treatment of choice for adults. Weight increase is essential for recovery from AN why research exploring important contributors is crucial. AIMS The current study examined the importance of motivation to change eating behaviour, treatment expectations and experiences, eating disorder symptomatology, self-image and treatment alliance for predicting weight increase. METHODS Female patients (n = 89) between 18 and 46 years of age with AN were assessed pre-treatment and at 6- and 36-month follow-ups with interviews and self-report questionnaires. At the 6-month follow-up the response rates differed from n = 58 (65%) to 66 (74%), and at the 36-month follow-up the response rates differed from n = 71 (80%) to 82 (92%). RESULTS At treatment start, expressed motivation to change eating habits, social insecurity and self-neglect were predictors of weight increase from 0 to 6 months, while duration, the time from onset to entering treatment, body dissatisfaction and interoceptive awareness were predictors of weight increase from 0 to 36 months. CONCLUSIONS In designing treatment for adult patients with AN, it is essential to include multifaceted interventions addressed to patients' motivation to change, social relations, negative self-image and body dissatisfaction in order to achieve weight increase. Early detection and thereby short duration is an additional important factor that contributes to weight increase.
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Vancampfort D, Vanderlinden J, De Hert M, Soundy A, Adámkova M, Skjaerven LH, Catalán-Matamoros D, Lundvik Gyllensten A, Gómez-Conesa A, Probst M. A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa. Disabil Rehabil 2013; 36:628-34. [PMID: 23826882 DOI: 10.3109/09638288.2013.808271] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa. METHOD EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale. RESULTS Eight randomised controlled trials involving 213 patients (age range: 16-36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score≥3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported. CONCLUSIONS The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research. Implications for Rehabilitation Supervised physical therapy might increase weight in anorexia nervosa patients. Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa. Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating disorder.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Centre Catholic University Leuven, campus Kortenberg , Kortenberg , Belgium
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33
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Besser MC, Moncada L. Proceso Psicoterapéutico Desde la Perspectiva de Terapeutas que Tratan Trastornos Alimentarios: Un Estudio Cualitativo. PSYKHE 2013. [DOI: 10.7764/psykhe.22.1.633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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34
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Vancampfort D, Vanderlinden J, De Hert M, Adámkova M, Skjaerven LH, Catalán-Matamoros D, Lundvik-Gyllensten A, Gómez-Conesa A, Ijntema R, Probst M. A systematic review on physical therapy interventions for patients with binge eating disorder. Disabil Rehabil 2013; 35:2191-6. [DOI: 10.3109/09638288.2013.771707] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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35
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Traviss GD, Heywood-Everett S, Hill AJ. Understanding the 'guide' in guided self-help for disordered eating: a qualitative process study. Psychol Psychother 2013; 86:86-104. [PMID: 23386557 DOI: 10.1111/j.2044-8341.2011.02049.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aimed to explore how guidance contributes to the outcome of self-help for disordered eating. METHOD A sample of guides and clients with a range of disordered eating was interviewed on completion of a randomized control trial and analysed using thematic framework analysis. RESULTS Four themes emerged; the necessity of having a guide as a facilitator, features of the therapeutic relationship in clients with positive outcomes, features of the therapeutic relationship in clients with poor outcomes, and client suitability. CONCLUSIONS These findings have implications for the delivery of guided self-help interventions for disordered eating. They suggest the value of assessing clients' readiness to change, working with clients with less severe and complex conditions, and the importance of guide qualities and skills. PRACTITIONER POINTS Guidance is a necessary adjunct to self-help approaches for the effective treatment of a range of disordered eating and can be delivered by trained non-eating disorder specialists. Guided self-help appears most appropriate for less severe, binge-related eating disorders, including eating disorders not otherwise specified (EDNOS), further work is needed for use with anorexic-type presentations. While it is important to establish and maintain a strong, open, and collaborative therapeutic relationship, client 'readiness' appears fundamental in the relationship and consequent treatment outcome.
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Affiliation(s)
- Gemma D Traviss
- Leeds Institute of Health Sciences, Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, UK.
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36
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Zugai J, Stein-Parbury J, Roche M. Effective nursing care of adolescents with anorexia nervosa: a consumer perspective. J Clin Nurs 2013; 22:2020-9. [PMID: 23398386 DOI: 10.1111/jocn.12182] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2012] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To establish how nurses ensure weight gain and a positive inpatient experience for the treatment of adolescents with anorexia nervosa by considering consumer perspectives. BACKGROUND Consumer perspective literature indicates approval and dissatisfaction with certain aspects of the inpatient experience, and there is a limited understanding of what consumers perceive to be effective nursing practice. DESIGN The design of this study was qualitative, the data being interpreted with a thematic analysis. METHODS This study sought the perspectives of eight (n = 8) recovered consumers through semi-structured interviews. RESULTS Nurses were considered highly influential over the inpatient experience. The findings of this study are characterised by three overall themes regarding nursing practice: (1) ensuring weight gain, (2) maintaining a therapeutic milieu, and (3) the nursing relationship. CONCLUSIONS Consumers have clear perspectives of how nurses effectively ensure weight gain and how nurses ensure a positive inpatient experience. The quality of relationships between consumers and nurses had implications for both weight gain and the perceived quality of the inpatient experience. By relying on the strength of positive, thoughtful and well-timed interactions, nurses may contribute to productive physical outcomes and a positive inpatient experience. Consumers indicated that motivation to adhere to care was derived from strong relationships with nurses. Ensuring both weight gain and a positive experience involves achieving a productive 'balance of restrictions'. Consumers also valued nurses that created a comfortable and productive environment. RELEVANCE TO CLINICAL PRACTICE This study indicates that the process of weight gain may be enhanced when accompanied by a process of therapeutic engagement. Therapeutic alliance may be an effective way for nurses to ensure weight gain and an enhanced inpatient experience. Therapeutically beneficial relationships may enhance treatment and possibly enhance outcomes for consumers.
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Affiliation(s)
- Joel Zugai
- University of Technology, Sydney, Cherrybrook, NSW, Australia.
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Brockmeyer T, Holtforth MG, Bents H, Kämmerer A, Herzog W, Friederich HC. The Thinner the Better: Self-Esteem and Low Body Weight in Anorexia Nervosa. Clin Psychol Psychother 2012; 20:394-400. [DOI: 10.1002/cpp.1771] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/14/2011] [Accepted: 01/05/2012] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Hinrich Bents
- Department for Psychology; Centre for Psychological Psychotherapy; University of Heidelberg; Heidelberg; Germany
| | - Annette Kämmerer
- Department for Psychology; Centre for Psychological Psychotherapy; University of Heidelberg; Heidelberg; Germany
| | - Wolfgang Herzog
- Centre for Psychosocial Medicine; University Hospital Heidelberg; Department of General Internal Medicine and Psychosomatics; Heidelberg; Germany
| | - Hans-Christoph Friederich
- Centre for Psychosocial Medicine; University Hospital Heidelberg; Department of General Internal Medicine and Psychosomatics; Heidelberg; Germany
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Abstract
In the treatment of eating disorders (ED), no consensus exists on relevant criteria for recovery and goals for treatment. Which criteria do ED patients and therapists evaluate as most relevant for recovery? And do patients and therapists differ in their evaluations? This article presents a review of research on the opinions about recovery criteria of former patients and therapists. Criteria most often mentioned by the patients could be divided into the following themes: eating and drinking; physical activity and exercising; attitude towards food and weight; body evaluation; relaxation; physical recovery; psychological recovery; emotion regulation; social relations; sexual attitude; and comorbidity. Only slight differences were found between the opinions of former patients and therapists.
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Affiliation(s)
- Greta Noordenbos
- Psychological Institute, Leiden University, Leiden, The Netherlands.
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Nordbø RHS, Espeset EMS, Gulliksen KS, Skårderud F, Geller J, Holte A. Reluctance to recover in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2011; 20:60-7. [PMID: 21305676 DOI: 10.1002/erv.1097] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reluctance to recover may explain poor treatment outcome and high dropout and relapse rates in the treatment of anorexia nervosa (AN). This study systematically explored what AN patients describe as interfering with their wish to recover. METHOD Two independent samples of women with AN (total N = 36) were interviewed in-depth using a phenomenological study design. Interviews were tape recorded, transcribed and analysed using QSR-NVivo7 (QSR International, Melbourne, Australia) software. RESULTS Seven core obstacles were found to interfere with informants' wish to recover as follows: (i) 'perceiving judgements'; (ii) 'feeling stuck'; (iii) 'feeling distressed'; (iv) 'denying AN'; (v) 'eating'; (vi) 'gaining weight'; and (vii) 'appreciating the benefits'. CONCLUSION The wish to recover is an autonomously based, fundamental motivational requirement for becoming ready to change. Understanding factors that contribute to this wish adds to the clinician's toolbox in motivational work with AN patients.
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Affiliation(s)
- Ragnfrid H S Nordbø
- Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway.
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One size fits all: or horses for courses? Recovery-based care in specialist mental health services. Soc Psychiatry Psychiatr Epidemiol 2011; 46:127-36. [PMID: 21391337 DOI: 10.1007/s00127-009-0174-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The ‘recovery approach’ to the management of severe mental health problems has become a guiding vision of service provision amongst many practitioners, researchers, and policy makers as well as service users. METHOD This qualitative pilot study explored the meaning of ‘recovery’ with users of three specialist mental health services (eating disorders, dual diagnosis, and forensic) in 18 semi-structured interviews. RESULTS The relevance of themes identified in mainstream recovery literature was confirmed; however, the interpretation and relative weight of these themes appeared to be affected by factors that were specific to the diagnosis and treatment context. ‘Clinical’ recovery themes were also seen as important, as were aspects of care that reflect core human values, such as kindness.
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Fitzsimmons EE, Bardone-Cone AM. Differences in coping across stages of recovery from an eating disorder. Int J Eat Disord 2010; 43:689-93. [PMID: 19950115 PMCID: PMC2888938 DOI: 10.1002/eat.20781] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study examined the relation between coping skills and eating disorder recovery by comparing these skills across healthy controls, fully recovered, partially recovered, and active eating disorder cases. Full recovery was defined using physical, behavioral, and psychological components. METHOD Individuals formerly seen for an eating disorder at a Midwestern clinic were categorized as having an active eating disorder (n = 53), as partially recovered (n = 15), or as fully recovered (n = 20). The coping skills of these groups were compared to each other and to 67 healthy controls. RESULTS Healthy controls and fully recovered individuals utilized similarly high levels of task- and avoidance-oriented coping and similarly low levels of emotion-oriented coping. Partially recovered individuals looked more similar to those with an active eating disorder. DISCUSSION Results provide support for a comprehensive definition of eating disorder recovery, of which healthy coping may be an integral component, and for the re-evaluation of the notion of "maladaptive" coping.
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Affiliation(s)
| | - Anna M. Bardone-Cone
- Department of Psychology, University of North Carolina at Chapel Hill,Correspondence to: Anna M. Bardone-Cone, PhD, Department of Psychology, University of North Carolina at Chapel Hill, CB#3270-Davie Hall, Chapel Hill, NC 27599.
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Lázaro L, Font E, Moreno E, Calvo R, Vila M, Andrés-Perpiñá S, Canalda G, Martínez E, Castro-Fornieles J. Effectiveness of self-esteem and social skills group therapy in adolescent eating disorder patients attending a day hospital treatment programme. EUROPEAN EATING DISORDERS REVIEW 2010; 19:398-406. [PMID: 24081715 DOI: 10.1002/erv.1054] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate self-esteem and social skills in adolescent eating disorder patients before and after specific group therapy as part of a Day Hospital Programme. METHOD One hundred and sixty adolescent eating disorder patients, classified as anorexia nervosa and related disorders (AN-rd) (N = 116) or bulimia nervosa and related disorders (BN-rd) (N = 44) received structured group therapy for developing self-esteem and social skills. RESULTS BN-rd patients had poorer perceptions of some self-esteem and social skills variables. After group therapy, both groups presented significant improvements in their perceptions of physical appearance, their self-concept related to weight and shape and to others, happiness and satisfaction, social withdrawal and leadership. BN-rd patients presented more changes on many of the variables. DISCUSSION Specific self-esteem and social skills group therapy in patients with eating disorders can be useful in improving certain core features.
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Affiliation(s)
- L Lázaro
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic Universitari, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
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Bardone-Cone AM, Schaefer LM, Maldonado CR, Fitzsimmons EE, Harney MB, Lawson MA, Robinson DP, Tosh A, Smith R. Aspects of Self-Concept and Eating Disorder Recovery: What Does the Sense of Self Look Like When an Individual Recovers from an Eating Disorder? JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2010. [DOI: 10.1521/jscp.2010.29.7.821] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thörnborg U, Mattsson M. Rating body awareness in persons suffering from eating disorders – A cross-sectional study. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/14038190903220362] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Anorexia nervosa (AN) mainly affects girls or women between 13 and 45 years of age. According to previous studies, one of the reasons for the desire to be thin is low self-esteem. The purpose of the study was to examine the self-esteem of 38 female patients with AN between 16 and 25 years of age, before and after 3 months of treatment at a specialist ward for eating disorders in Göteborg, Sweden. A quantitative pre- and post-assessment based on two self-rating questionnaires, the Rosenberg Self-Esteem Scale (RSE-S) and three subscales (weight phobia, body dissatisfaction, and ineffectiveness) of Eating Disorder Inventory-2 (EDI-2), together with body mass index (BMI), were used in the study, which was conducted between June 2005 and March 2008. The results reveal that self-esteem, BMI, weight phobia, and body dissatisfaction improved significantly between pre- and post-treatment. The RSE-S and EDI-2 ineffectiveness correlate highly with one another, which lends support to convergent validity, and the internal consistency was high for both the RSE-S and EDI-2 ineffectiveness. The results indicate that the treatment was effective, as both patients' self-esteem and BMI increased after completed treatment, which was the primary goal of the treatment at this ward. Future studies should focus on follow up and the way self-esteem manifests itself at different points in time within an individual.
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Affiliation(s)
- Ewa Karpowicz
- Anorexia-Bulimia Unit, Queen Silvia Children's Hospital, Göteborg, Sweden.
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Abstract
PURPOSE OF REVIEW Adolescence is the most common period for the onset of eating disorders, and early intervention is critical. Primary care providers should feel equipped to discuss psychotherapy approaches for eating disorders with adolescents and their families and to provide appropriate referrals. The present review focuses on six prominent treatment modalities and the evidence supporting each approach. RECENT FINDINGS Although the majority of studies about psychotherapy approaches for eating disorders focus on adult women, there is a growing body of research on effective treatments for an adolescent population. Family-based treatment (the 'Maudsley method') and supportive psychotherapy appear to be promising approaches for anorexia in teens. Treatments for bulimia yield extremely high relapse rates, but cognitive-behavioral therapy and family-based treatment are favored modalities. Dialectical behavior therapy and interpersonal psychotherapy may also be applicable to adolescent bulimia and binge eating. Most psychotherapists draw upon a variety of these treatment approaches, depending upon the patient's unique presentation. Regardless of the modality used, some degree of family involvement is important in limiting dropout and improving outcomes. SUMMARY Adolescent health providers need to be aware of the psychotherapy approaches recommended for teens with eating disorders in order to effectively refer patients to and collaborate with mental health providers.
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