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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. [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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Shahid S, Kelson J, Saliba A. Effectiveness and User Experience of Virtual Reality for Social Anxiety Disorder: Systematic Review. JMIR Ment Health 2024; 11:e48916. [PMID: 38329804 PMCID: PMC10884902 DOI: 10.2196/48916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is a debilitating psychiatric disorder that affects occupational and social functioning. Virtual reality (VR) therapies can provide effective treatment for people with SAD. However, with rapid innovations in immersive VR technology, more contemporary research is required to examine the effectiveness and concomitant user experience outcomes (ie, safety, usability, acceptability, and attrition) of emerging VR interventions for SAD. OBJECTIVE The aim of this systematic review was to examine the effectiveness and user experience of contemporary VR interventions among people with SAD. METHODS The Cochrane Library, Emcare, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science databases were searched between January 1, 2012, and April 26, 2022. Deduplicated search results were screened based on title and abstract information. Full-text examination was conducted on 71 articles. Studies of all designs and comparator groups were included if they appraised the effectiveness and user experience outcomes of any immersive VR intervention among people with SAD. A standardized coding sheet was used to extract data on key participant, intervention, comparator, outcome, and study design items. RESULTS The findings were tabulated and discussed using a narrative synthesis. A total of 18 studies met the inclusion criteria. CONCLUSIONS The findings showed that VR exposure therapy-based interventions can generally provide effective, safe, usable, and acceptable treatments for adults with SAD. The average attrition rate from VR treatment was low (11.36%) despite some reported user experience difficulties, including potential simulator sickness, exposure-based emotional distress, and problems with managing treatment delivered in a synchronous group setting. This review also revealed several research gaps, including a lack of VR treatment studies on children and adolescents with SAD as well as a paucity of standardized assessments of VR user experience interactions. More studies are required to address these issues. TRIAL REGISTRATION PROSPERO CRD42022353891; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353891.
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Affiliation(s)
- Simon Shahid
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
| | - Joshua Kelson
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
| | - Anthony Saliba
- Faculty of Business, Justice, and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
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Bowker H, Saxon D, Delgadillo J. First impressions matter: The influence of initial assessments on psychological treatment initiation and subsequent dropout. Psychother Res 2024:1-11. [PMID: 38289694 DOI: 10.1080/10503307.2024.2308164] [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: 10/12/2022] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE This study investigated if patients' experience of an initial assessment may be associated with outcome expectations, and with subsequent treatment attendance. METHOD The sample comprised n = 6051 patients with depression/anxiety disorders, nested within k = 148 assessing therapists. Multilevel modelling (MLM) was used to examine therapist effects on treatment initiation and subsequent dropout, adjusting for patient-level characteristics. We tested associations between early outcome expectancy measured at an initial assessment with attendance at a first therapy session, and with dropout after initiation. Variability in mean expectancy ratings in the caseloads of assessing therapists was examined using the intracluster correlation coefficient (ICC). RESULTS Therapist effects partly explained the variance in treatment initiation and dropout. Pre-treatment outcome expectations significantly predicted treatment initiation but not dropout for the subgroup of patients who started treatment. Approximately 16% of variability in mean expectancy ratings was explained by therapist effects (ICC = 0.159) after controlling for patient-level covariates. CONCLUSIONS Patients assessed by some therapists are more likely to have higher outcome expectations, which influences their decision to initiate treatment thereafter. Once patients start therapy, early expectancy measured at assessment no longer influences their attendance, but the "first impression" from an initial assessment does influence their subsequent likelihood of dropout.
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Affiliation(s)
- Hannah Bowker
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - David Saxon
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Gori A, Topino E, Cacioppo M, Schimmenti A, Caretti V. Definition and Criteria for the Assessment of Expertise in Psychotherapy: Development of the Psychotherapy Expertise Questionnaire (PEQ). Eur J Investig Health Psychol Educ 2023; 13:2478-2497. [PMID: 37998063 PMCID: PMC10670582 DOI: 10.3390/ejihpe13110173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Therapist expertise is a complex, multifaceted, and continually evolving concept. Defining this construct and its constituent components can yield a substantial contribution to the field of psychotherapy, consequently enhancing the comprehension of the fundamental factors that underlie its effectiveness. Within this framework, the present research aimed at developing and assessing the psychometric properties of the Psychotherapy Expertise Questionnaire (PEQ), a self-report measure to assess therapist expertise. A sample of 260 psychotherapists of various theoretical orientations were involved in this research. They completed a survey that included the PEQ as well as other self-reported measures aimed at evaluating personality traits, self-efficacy, self-esteem, and insight orientation. The analysis provided evidence of a good fit for both a correlational model with eight factors and a higher-order model, where the eight subdimensions were grouped into subjective (performance; cognitive functioning; personal and relational qualities of the therapist; therapist self-assessment) and objective (experience; reputation with clients and colleagues; training and professional updating; deontological ethics and setting rules) factors. The eight dimensions, two higher-order factors, and total score all showed excellent levels of internal consistency. Furthermore, significant associations were found between PEQ scores and insight orientation, general self-efficacy, self-esteem, personality traits, and time exercising clinical practice. To conclude, the Psychotherapy Expertise Questionnaire (PEQ) is a valuable, theoretically guided, and psychometrically robust self-report measure designed to assess therapist expertise and its constitutive dimensions. This measure can have practical applications in guiding tailored training and customised supervision.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, 50122 Florence, Italy
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy; (E.T.); (M.C.); (V.C.)
| | - Marco Cacioppo
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy; (E.T.); (M.C.); (V.C.)
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE—Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy;
| | - Vincenzo Caretti
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy; (E.T.); (M.C.); (V.C.)
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Wood MD, Smith JL, Healey H, Görges M, Lokker C. Enhanced recovery support for people with eating disorders during the COVID-19 pandemic: quality improvement using a web-based, stepped-care programme in Canada. BMJ Open Qual 2023; 12:e002366. [PMID: 37935516 PMCID: PMC10632883 DOI: 10.1136/bmjoq-2023-002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, the number of individuals struggling with eating disorders (EDs) increased substantially. Body Brave (a not-for-profit) created and implemented a web-based stepped-care Recovery Support Programme (RSP) to improve access to community-based ED services. This quality improvement study describes the RSP and assesses its ability to deliver timely access to treatment and platform engagement. METHODS We conducted a retrospective cohort study comparing access to, and use of Body Brave services 6 months before and 12 months after implementation of the RSP platform (using 6-month increments for two postimplementation periods). Primary programme quality measures included registration requests, number of participants onboarded and time to access services; secondary measures included use of RSP action plans, attendance for recovery sessions and workshops, number of participants accessing treatment and text-based patient experience data. RESULTS A substantial increase in registration requests was observed during the first postimplementation period compared with the preimplementation period (176.5 vs 85.5; p=0.028). When compared with the preimplementation period, the second postimplementation observed a significantly larger percentage of successfully onboarded participants (76.6 vs 37.9; p<0.01) and a reduction in the number of days to access services (2 days vs 31 days; p<0.01). Although participant feedback rates were low, many users found the RSP helpful, easy to access, user-friendly and were satisfied overall. Users provided suggestions for improvement (eg, a platform instructional video, offer multiple times of day for live sessions and drop-in hours). CONCLUSIONS Although clinical benefit needs to be assessed, our findings demonstrate that the RSP enabled participants to quickly onboard and access initial services and have informed subsequent improvements. Understanding initial programme effects and usage will help assess the feasibility of adapting and expanding the RSP across Canada to address the urgent need for low-barrier, patient-centred ED care.
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Affiliation(s)
- Michael D Wood
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
- Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Hannah Healey
- Department of Health and Rehabilitation Sciences, Health Professional Education, Western University, London, Ontario, Canada
| | - Matthias Görges
- Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
- Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Cynthia Lokker
- Department of Health Research, Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Miskovic-Wheatley J, Bryant E, Ong SH, Vatter S, Le A, Touyz S, Maguire S. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disord 2023; 11:85. [PMID: 37254202 DOI: 10.1186/s40337-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality. METHODS This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review. RESULTS Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates. CONCLUSION Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.
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Affiliation(s)
- Jane Miskovic-Wheatley
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Emma Bryant
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Shu Hwa Ong
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sabina Vatter
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Stephen Touyz
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
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7
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Friedlich CE, Covarrubias A, Park H, Murray SB. Updates in the treatment of Eating Disorders in 2022: a year in review in Eating Disorders : The Journal of Treatment & Prevention. Eat Disord 2023; 31:128-138. [PMID: 36794482 DOI: 10.1080/10640266.2023.2179774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
A broad array of important and diverse studies surrounding the treatment of eating disorders were published in Eating Disorders: The Journal of Treatment & Prevention in 2022. Novel interventions such as neurosurgical and neuromodulatory treatments were discussed, as evidence continues to mount around their potential utility in treating eating disorders, in particular namely anorexia nervosa. Important pragmatic and theoretical developments around feeding and refeeding approaches emerged, and are also discussed. In this review, we carefully review evidence alluding to the potential efficacy of exercise in partially ameliorating binge eating disorder symptomatology, while examining broader evidence underscoring the importance of therapeutically ameliorating compulsive exercise in anorexia nervosa and bulimia nervosa. In addition, we overview evidence relating to the risk and sequelae associated with premature discharge from intensive eating disorder treatment, as well as the efficacy of CBT versus group therapy-based maintenance treatments. Finally, important developments around the use of open versus blind weighing in treatment are assessed. Overall, the articles published in Eating Disorders: The Journal of Treatment & Prevention in 2022 evidence the promise of treatment advances in the field and requires further work to address the development of efficacious treatments to achieve greater outcomes for those with eating disorders.
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Affiliation(s)
- Cassandra E Friedlich
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, Califonia, USA
| | - Andrea Covarrubias
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, Califonia, USA
| | - Hyoungjin Park
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, Califonia, USA
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, Califonia, USA
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Gorrell S, Rienecke RD, Duffy A, Huston E, Mehler PS, Johnson C, Manwaring J, McClanahan S, Blalock DV, Le Grange D. Understanding non-routine discharge: Factors that are associated with premature termination from higher levels of care in adults with anorexia nervosa. Eat Disord 2022; 30:686-699. [PMID: 35175902 PMCID: PMC9869711 DOI: 10.1080/10640266.2021.2011648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study sought to replicate and extend associations between clinical and demographic features at admission and types of premature treatment termination for adults diagnosed with anorexia nervosa (AN) in higher-level-of-care settings. Secondary data analyses examined a study population comprised of adults with AN (N = 565) who were admitted to one of two United States eating disorder treatment centers (April 2015-April 2020) for intensive outpatient, partial hospitalization, residential, or inpatient services. There were no significant differences in the type of non-routine discharge according to level of care. At admission, those with lower BMI were more likely to discharge against medical advice, and those with lower cognitive restraint and elevated binge eating were more likely to discharge against medical advice or by staff-initiated request, respectively. Discharge by parent/patient request was more likely among those who were older or who reported lower baseline desire for muscularity. Overall older age, elevated binge eating, and lower weight, desire for muscularity, and cognitive restraint may be associated with less tolerance/acceptability for AN treatment. Increased understanding of how to better support patients who admit to higher levels of care with these clinical features will contribute to better odds of completion of a full course of treatment.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Emma Huston
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychology and Counseling, Palo Alto University, PGSP - Stanford PsyD Consortium, Palo Alto, California, USA
| | - Philip S Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Acute Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Craig Johnson
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Susan McClanahan
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago (Emeritus), Chicago, Illinois, USA
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Lam SU, Kirvin-Quamme A, Goldberg SB. Overall and Differential Attrition in Mindfulness-Based Interventions: A Meta-Analysis. Mindfulness (N Y) 2022; 13:2676-2690. [PMID: 36506616 PMCID: PMC9728563 DOI: 10.1007/s12671-022-01970-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 12/15/2022]
Abstract
Objectives Attrition is very common in longitudinal research, including randomized controlled trials (RCTs) testing psychological interventions. Establishing rates and predictors of attrition in mindfulness-based interventions (MBIs) can assist clinical trialists and intervention developers. Differential attrition in RCTs that compared MBIs with structure and intensity matched active control conditions also provides an objective metric of relative treatment acceptability. Methods We aimed to evaluate rates and predictors of overall and differential attrition in RCTs of MBIs compared with matched active control conditions. Attrition was operationalized as loss to follow-up at post-test. Six online databases were searched. Results Across 114 studies (n = 11,288), weighted mean attrition rate was 19.1% (95% CI [.16, .22]) in MBIs and 18.6% ([.16, .21]) in control conditions. In the primary model, no significant difference was found in attrition between MBIs and controls (i.e., differential attrition; odds ratio [OR] = 1.05, [0.92, 1.19]). However, in sensitivity analyses with trim-and-fill adjustment, without outliers, and when using different estimation methods (Peto and Mantel-Haenszel), MBIs yielded slightly higher attrition (ORs = 1.10 to 1.25, ps < .050). Despite testing numerous moderators of overall and differential attrition, very few significant predictors emerged. Conclusions Results support efforts to increase the acceptability of MBIs, active controls, and/or RCTs, and highlight the possibility that for some individuals, MBIs may be less acceptable than alternative interventions. Further research including individual patient data meta-analysis is warranted to identify predictors of attrition and to characterize instances where MBIs may or may not be recommended. Meta-Analysis Review Registration: Open Science Framework (https://osf.io/c3u7a/).
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Affiliation(s)
- Sin U Lam
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
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Premature dropout from psychotherapy: Prevalence, perceived reasons and consequences as rated by clinicians. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e6695. [DOI: 10.32872/cpe.6695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background
Why clients discontinue their psychotherapies has attracted more attention recently as it is a major problem for many healthcare services. Studies suggest that dropout rates may be affected by the mode of therapy, low-quality therapeutic alliance, low SES, and by conditions such personality disorders or substance abuse. The aims of the study were to investigate what happens in therapies which end in a dropout, and to estimate how common dropout is as reported by practicing clinicians.
Method
An online questionnaire was developed and completed by 116 therapists working in clinical settings. They were recruited via social media (Facebook and different online psychotherapy groups) in Sweden and worked with Cognitive Behavioural Therapy (CBT), Psychodynamic Therapy (PDT), Interpersonal Psychotherapy (IPT) and Integrative Psychotherapy (IP).
Results
Psychotherapists rated the frequency of premature dropout in psychotherapy to be on average 8.89% (MD = 5, SD = 8.34, Range = 0-50%). The most common reasons for a dropout, as stated by the therapists, were that clients were not satisfied with the type of intervention offered, or that clients did not benefit from the treatment as they had expected. The most common feeling following a dropout was self-doubt.
Conclusion
In conclusion, premature dropout is common in clinical practice and has negative emotional consequences for therapists. Premature dropout may lead to feelings of self-doubt and powerlessness among therapists. The therapeutic alliance was mostly rated as good in dropout therapies. Further research is needed to validate the findings with data on the prevalence and subjective reasons behind a dropout from point of view of clients.
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Urmanche AA, Lipner LM, Bloch-Elkouby S, Hunter E, Kaufmann J, Warren JT, Weil GT, Eubanks CF, Muran JC. The beginning of the end: A comparison of treatment completers and early dropouts in trainee-provided time-limited Cognitive Behavioral Therapy. COUNSELLING PSYCHOLOGY QUARTERLY 2022; 35:763-788. [PMID: 36684503 PMCID: PMC9856216 DOI: 10.1080/09515070.2021.1997916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
About one in five clients drops out of treatment prematurely. Premature termination has been found to correlate with patient, therapist, and treatment factors, as well as complex interpersonal processes, including ruptures in the therapeutic alliance. This study examines the therapeutic alliance using a qualitative approach to patient-, therapist-, and observer-based data. The sample includes five trainee therapists, each of whom worked with one patient who terminated after the first or second session, and one who completed a cognitive-behavioral therapy protocol. The session(s) preceding premature termination in the drop case and the corresponding session(s) in the completer case were examined. Rupture resolution process was prevalent in both groups, though confrontation ruptures seemed more prevalent with completers and withdrawal ruptures were more clinically impactful with dropouts. Therapist awareness of process and responsiveness or contribution to rupture were identified as potential factors contributing to patient retention.
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Affiliation(s)
- Adelya A. Urmanche
- Derner School of Psychology, Adelphi University, Hy Weinberg Center, 158 Cambridge Avenue, Garden City, NY 11530, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Lauren M. Lipner
- Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Sarah Bloch-Elkouby
- Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Elaine Hunter
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Jerzy Kaufmann
- The New School for Social Research, 80 Fifth Avenue, New York, NY 10011,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Jonathan T. Warren
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Gregory T. Weil
- The New School for Social Research, 80 Fifth Avenue, New York, NY 10011,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - Catherine F. Eubanks
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY 10461, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
| | - J. Christopher Muran
- Derner School of Psychology, Adelphi University, Hy Weinberg Center, 158 Cambridge Avenue, Garden City, NY 11530, USA,Brief Psychotherapy Research Program, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003
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Oliveira JT, Sousa I, Ribeiro AP, Gonçalves MM. Premature termination of the unified protocol for the transdiagnostic treatment of emotional disorders: The role of ambivalence towards change. Clin Psychol Psychother 2021; 29:1089-1100. [PMID: 34791753 DOI: 10.1002/cpp.2694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/13/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022]
Abstract
Ambivalence towards change is an expected, recurrent process in psychological change. However, the prolonged experience of ambivalence in psychotherapy contributes to client disengagement, which could result in treatment dropout. Considering the negative effects of premature termination of therapy and the convenience of the identification of clients who are at risk of dropping out before achieving good-outcome, the current study explored the predictive power of ambivalence for premature therapy termination using a multilevel time-backwards model (i.e., considering the session of the dropout as session zero and then modelling what occurred from the dropout until session 1). Participants included a total of 96 psychotherapy clients (38 dropouts) treated in a university-based clinic following the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Multilevel modelling using a time-backwards model to analyse dropout data provided evidence of the predictive power of ambivalence evolution throughout treatment on the decision to prematurely discontinue treatment (p < .0001; R2 adj = .29). Specifically, good-outcome dropouts presented a decreasing ambivalence trend throughout treatment, whereas poor-outcome dropouts tended to experience the same levels of ambivalence before deciding to drop out (time × dropout; β11 = .64, p = .014). Additionally, poor-outcome dropouts presented higher levels of ambivalence (β01 = 9.92, p < .0001) in the last session. The results suggest that the pattern of client ambivalence towards change is a predictor of premature termination of therapy. Implications for clinical and research contexts are discussed.
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Affiliation(s)
- João Tiago Oliveira
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Inês Sousa
- Department of Mathematics, University of Minho, Braga, Portugal
| | - António P Ribeiro
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Miguel M Gonçalves
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
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Poster K, Bennemann B, Hofmann SG, Lutz W. Therapist Interventions and Skills as Predictors of Dropout in Outpatient Psychotherapy. Behav Ther 2021; 52:1489-1501. [PMID: 34656201 DOI: 10.1016/j.beth.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/23/2022]
Abstract
The current study employed machine learning to investigate whether the inclusion of observer-rated therapist interventions and skills in early sessions of psychotherapy improved dropout prediction beyond intake assessments. Patients were treated by postgraduate clinicians at a university outpatient clinic. Psychometric instruments were assessed at intake and therapeutic interventions and skills in the third session were routinely rated by independent observers. After variable preselection, an elastic net algorithm was used to build two dropout prediction models, one including and one excluding observer-rated session variables. The best model included observer-rated variables and was significantly superior to the model including intake variables only. Alongside intake variables, two observer-rated variables significantly predicted dropout: therapist use of feedback and summaries and treatment difficulty. Although not retained in the final prediction model, the observer-rated use of cognitive techniques was also significantly correlated with dropout. Observer ratings of therapist interventions and skills in early sessions of psychotherapy improve predictors of dropout from psychotherapy beyond intake variables alone. Future research could work toward personalizing dropout predictions to the specific dyad, thereby improving their validity and aiding therapists to recognize and react to increased dropout risk.
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Semmlinger V, Ehring T. Predicting and preventing dropout in research, assessment and treatment with refugees. Clin Psychol Psychother 2021; 29:767-782. [PMID: 34585469 DOI: 10.1002/cpp.2672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/17/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022]
Abstract
Refugees and asylum seekers are exposed to multiple burdensome experiences and suffer from ongoing post-migration stressors that are known to affect the physical and mental health. In psychological treatment offered to refugees and asylum seekers, dropout is an important challenge. The current practice-oriented review aims to provide for the first time knowledge on the prevalence, prediction and prevention of dropout in psychological treatment for refugees and asylum seekers. Due to the limited empirical evidence for this specific population, we synthesized refugee-specific research but also reviewed the existing evidence on dropout from treatment in general and specifically discuss how the findings can be adapted to refugee populations. The review integrates literature from online databases, grey literature, hand search and expert contacts. Prevalence rates of dropout from psychological treatment in Western samples are reported at about 20%. For refugees and asylum seekers, evidence from single efficacy trials showed considerable variability in dropout rates (0%-64.7%). Further, for refugees and asylum seekers, specific sociodemographic variables, high initial impairment, deviating expectations and perceptions of mental health and psychological treatment, as well as external barriers seem to be important predictors for dropout. To prevent dropout, it is important to develop and promote cultural competencies, adapt the treatment to refugee-specific needs and focus on role induction, preparation for treatment, fostering the therapeutic alliance and strengthening hope. Future specific research on dropout in treatment offered to refugees and asylum seekers is needed.
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Affiliation(s)
- Verena Semmlinger
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas Ehring
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
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15
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[Psychoeducation for Parents of Children with Learning Disorders: A Satisfaction Study]. Prax Kinderpsychol Kinderpsychiatr 2021; 70:298-315. [PMID: 33977877 DOI: 10.13109/prkk.2021.70.4.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Psychoeducation for Parents of Children with Learning Disorders: A Satisfaction Study The present study investigates the implementation of psychoeducation for conveying a diagnosis of specific learning disorders to the parents of affected children. It addresses the question of how such consultations are structured and which factors predict how satisfied parents are with the psychoeducation they receive. 167 parents of children with specific learning disorders from Germany were surveyed via an online questionnaire and asked about their experiences and satisfaction with the psychoeducational aspects of their individual consultation. The results show that the implementation of psychoeducation was strongly heterogeneous. For example, the duration of the consultation varied from 4 to 120 minutes and the child in question was only present in around half of the cases. The methodical diversity was rather limited and the causes of learning disorders were rarely discussed with the parents. 54 % of the parents were satisfied or very satisfied with the psychoeducation. The findings of a regression analysis show that the consultant's professional and emotional competence as well as the practical value significantly predicted the parents' satisfaction. Overall, this regression model is able to explain 81.8 % variance in parents' satisfaction. An open and empathetic atmosphere during the consultation as well as specific and practical tips on how to support their child are particularly important.
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16
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Danielsen M, Bjørnelv S, Weider S, Myklebust TÅ, Lundh H, Rø Ø. The outcome at follow-up after inpatient eating disorder treatment: a naturalistic study. J Eat Disord 2020; 8:67. [PMID: 33292634 PMCID: PMC7709321 DOI: 10.1186/s40337-020-00349-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/03/2020] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Patients with eating disorders may experience a severe and enduring course of illness. Treatment outcome for patients provided with inpatient treatment is reported as poor. Research to date has not provided consistent results for predictors of treatment outcome. The aims of the study were to investigate rates of remission at follow-up after inpatient treatment, symptom change from admission to follow-up, and predictors of treatment outcome. METHODS The follow-up sample consisted of 150 female adult former patients (69.4% of all eligible female patients) with eating disorders. Mean age at admission was 21.7 (SD = 4.9) years. Diagnostic distribution: 66% (n = 99) anorexia nervosa, 21.3% (n = 32) bulimia nervosa and 12.7% (n = 19) other specified feeding or eating disorder, including binge eating. Data were collected at admission, discharge and follow-up (mean 2.7 (SD = 1.9) years). Definition of remission was based on the EDE-Q Global score, body mass index and binge/purge behavior. Paired T-tests were performed to investigate change over time. Univariate and multivariate logistic regressions were estimated to investigate predictors of remission. RESULTS At follow-up, 35.2% of the participants were classified as in remission. Significant symptom reduction (in all patients) (p < 0.001) and significant increase in body mass index (BMI) (in underweight participants at admission) (p < 0.001) was found. Increased BMI (p < 0.05), the level of core eating disorder symptoms at admission (p < 0.01) and reduced core eating disorder symptoms (p < 0.01) during inpatient treatment were found significant predictors of outcome in the multivariate model. CONCLUSIONS All participants had an eating disorder requiring inpatient treatment. Approximately one-third of all participants could be classified as in remission at follow-up. However, most participants experienced significant symptom improvement during inpatient treatment and the improvements were sustained at follow-up. Increased probability of remission at follow-up was indicated by lower core ED symptoms at admission for all patients, raised BMI during admission for patients with AN, and reduced core ED symptoms during inpatient treatment for all patients. This finding contributes important information and highlights the importance of targeting these core symptoms in transdiagnostic treatment programs.
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Affiliation(s)
- Marit Danielsen
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Hospital Trust Nord-Trøndelag, NO-7600, Levanger, Norway. .,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sigrid Bjørnelv
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Hospital Trust Nord-Trøndelag, NO-7600, Levanger, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Siri Weider
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Hospital Trust Nord-Trøndelag, NO-7600, Levanger, Norway.,Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Henrik Lundh
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Hospital Trust Nord-Trøndelag, NO-7600, Levanger, Norway
| | - Øyvind Rø
- Regional Eating Disorder Service, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Guarda AS, Cooper M, Pletch A, Laddaran L, Redgrave GW, Schreyer CC. Acceptability and tolerability of a meal-based, rapid refeeding, behavioral weight restoration protocol for anorexia nervosa. Int J Eat Disord 2020; 53:2032-2037. [PMID: 33026118 DOI: 10.1002/eat.23386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Safe, tolerable, effective approaches to weight restoration are needed for adults with anorexia nervosa (AN). We examined weight outcomes and patient satisfaction with an integrated, inpatient-partial hospitalization, meal-based behavioral program that rapidly weight restores a majority of patients. METHOD Consecutively discharged inpatients (N = 149) treated on weight gain protocol completed an anonymous questionnaire assessing treatment satisfaction at inpatient discharge. Responders (107/149) rated their satisfaction with program components, feeling included in treatment, and likelihood of returning, or recommending the program to others. Clinical and demographic data were abstracted by chart review on all cases. RESULTS Over 70% of adult patients met BMI≥19 kg/m2 by program discharge. Mean inpatient rate of gain was 1.85 kg/week (SD = 0.89). A majority (83.2%) would recommend the program to others and 71.4% endorsed a willingness to return if needed. The behavioral treatment focus was rated highly by 82.9% of respondents and was the strongest predictor of likelihood of referring others. DISCUSSION Results indicate a behaviorally focused, integrated, meal-based specialty program for eating disorders that includes rapid weight gain is acceptable to most participants. Data have implications for quality care, outcome reporting, and cost-effectiveness of inpatient behavioral weight restoration programs for individuals with AN.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allisyn Pletch
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lori Laddaran
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Svedlund NE, Norring C, Ginsberg Y, von Hausswolff-Juhlin Y. Are attention deficit hyperactivity disorder symptoms stable irrespective of recovery from eating disorders? A 1-year follow-up of adult females. EUROPEAN EATING DISORDERS REVIEW 2020; 29:133-143. [PMID: 33022853 DOI: 10.1002/erv.2794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/28/2020] [Accepted: 09/19/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore the influence of recovery from eating disorders (ED) at 1-year follow-up on self-reported attention deficit hyperactivity disorder (ADHD) symptoms in an unselected group of patients in a specialized ED clinic. METHODS Four hundred and eight adult females with an ED were assessed with the World Health Organization adult ADHD Self-Report Scale-Screener, and for comorbid psychiatric symptoms at baseline and 1-year follow-up. Recovery was registered at follow-up. RESULTS ADHD symptoms decreased between baseline and follow-up in recovered patients treated for bulimic ED. In not recovered patients, ADHD symptoms were stable. Decreased depressive symptoms were associated to decreased ADHD symptoms at 1-year follow-up. CONCLUSIONS Bulimic ED and ADHD are linked together. This link, although not known in every detail, has clinical implications with possible value for bulimic ED patients. Clinical studies exploring implementation of ADHD treatment strategies for Bulimia Nervosa are recommended.
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Affiliation(s)
- Nils Erik Svedlund
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Ylva Ginsberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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19
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Characteristics of patients in an eating disorder sample who dropped out: 2-year follow-up. Eat Weight Disord 2019; 24:767-775. [PMID: 28717972 DOI: 10.1007/s40519-017-0416-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/04/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This manuscript explores the characteristics of individuals diagnosed with an eating disorder who dropped out of treatment, compared with those who completed it. METHOD The participants were 196 patients diagnosed with eating disorders (according to DSM-IV-TR criteria) who consecutively began treatment for the first time in an eating disorders unit. They were assessed at baseline with a set of questionnaires evaluating eating habits, temperament, and general psychopathology. During the follow-up period, patients who dropped out were re-assessed via a telephone interview. RESULTS In the course of a 2-year follow-up, a total of 80 (40.8%) patients were labeled as dropouts, and 116 (59.2%) remaining subjects were considered completers. High TCI scores in the character dimensions of Disorderliness (NS4) (p < .01) and total Novelty Seeking (NST), along with low scores in Dependency (RD4), were significantly associated with dropout in the course of 2 years. Once the results were submitted to logistic regression analysis, dropout only remained associated with high scores in Disorderliness (NS4) and, inversely, with an initial Anorexia Nervosa (AN) diagnosis (p < .05). Reasons for dropout stated by the patients included logistic difficulties, subjective improvement of their condition, and lack of motivation. DISCUSSION Clinicians should handle the first therapeutic intervention with particular care in order to enhance their understanding of clients and their ability to rapidly identify those who are at risk of dropping out of treatment. LEVEL OF EVIDENCE Level III: Cohort Study.
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20
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Benbow AA, Anderson PL. A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. J Anxiety Disord 2019; 61:18-26. [PMID: 30646997 DOI: 10.1016/j.janxdis.2018.06.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 11/24/2022]
Abstract
A proposed advantage of virtual reality exposure therapy for anxiety disorders is that people will be less likely to drop out of treatment prematurely if the treatment involves facing one's fear in a virtual world rather than the real world, but this has yet to be empirically tested. The present meta-analyses assess the odds of dropout from virtual reality exposure therapy compared to in vivo exposure therapy, estimate the overall rate of dropout from virtual reality exposure treatment, and test potential moderating variables. The odds ratio meta-analysis indicated that there was no significant difference in the likelihood of attrition from virtual reality exposure therapy relative to in vivo exposure therapy. The overall attrition rate for virtual reality exposure therapy across 46 studies with a combined sample size of 1057 participants was 16%. This rate is slightly lower than other estimates of dropout from in vivo therapy and from cognitive-behavioral therapy for anxiety disorders. Incorporation of between-session intervention (i.e., homework) was identified as a moderator; specifically, inclusion of between-session interventions in the treatment was associated with better retention. Overall, the findings of the present study indicate that virtual reality exposure and in vivo exposure therapy show similar rates of attrition.
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21
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Petersson S, Clinton D, Brudin L, Perseius KI, Norring C. Perfectionism in Eating Disorders: Are Long-Term Outcomes Influenced by Extent and Changeability in Initial Perfectionism? J Pers Oriented Res 2018; 4:1-14. [PMID: 33569128 PMCID: PMC7842640 DOI: 10.17505/jpor.2018.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Perfectionism has been found to predict outcomes in the treatment of eating disorders (ED). In the present study, we took advantage of longitudinal data to: a) investigate whether there are different patterns of perfectionism during the first six months after admission in a clinical sample of patients with ED, and b) describe how these patterns are related to long-term outcome. Methods A sample of patients (N=294) from the Coordinated Evaluation and Research at Specialized Units for Eating Disorders database was divided into clusters according to perfectionism patterns measured with the EDI-2 perfectionism scale at baseline, and six months in treatment. Cluster analysis was performed on the extent and perseverance/changeability of self-oriented and socially described perfectionism. Outcome was measured with the EDI-2 and the SCL-63. Frequencies of eating disorder diagnoses were investigated. Results Five clusters were identified. Low perfectionism was associated with lower levels of ED and psychiatric symptomatology at baseline. There were no significant differences between clusters on outcome variables at 36-month follow-up. Conclusions Results indicated better psychiatric and psychological health three years after the initial measure. Patterns of relations between the extent and possible changes of perfectionism, measured with the EDI-P at baseline and after six months, did not appear to be associated with long-term outcomes on psychiatric health ratings.
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Affiliation(s)
- Suzanne Petersson
- Department of Psychology, Lund University and AnorexiBulimiCenter, Division of Psychiatry, Kalmar County Council, S-391 85 Kalmar, Sweden
| | - David Clinton
- Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, S-113 64 Stockholm, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Council, S-391 85 Kalmar, Sweden
| | - Kent-Inge Perseius
- Department of Clinical Neuroscience (CNS), Red Cross University College, Box 55676, S-102 15 Stockholm, Sweden
| | - Claes Norring
- Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, S-113 64 Stockholm, Sweden
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Hall SB, Brown NW, Humphries JR. Premature Termination From Outpatient Psychotherapy in a University-Based Counseling Center. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/21501378.2017.1302786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sean B. Hall
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - J. Ryan Humphries
- Behavioral Health Crisis Center of Cobb Douglas Public Health, Marietta, GA, USA
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Jolles MP, Flick JA(J, Wells R, Chuang E. Caregiver involvement in behavioural health services in the context of child welfare service referrals: a qualitative study. CHILD & FAMILY SOCIAL WORK 2017; 22:648-659. [PMID: 28706461 PMCID: PMC5502353 DOI: 10.1111/cfs.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Human service agencies serve a growing number of adults with behavioral health needs. Despite these agencies' key role in identifying need and facilitating services, many individuals do not receive care or end services prematurely. Few studies have explored the experiences of families referred to behavioral health services by such agencies or the extent to which families' perceptions of service need align with those of treatment providers and frontline workers. This study presents findings from a qualitative study of caregivers involved with child welfare agencies who were referred to behavioral health services. Researchers reviewed agencies' case records and conducted in-depth interviews with 16 caregivers, 9 child welfare caseworkers, and 12 behavioral health treatment counselors. Findings suggest that when deciding to engage in services, caregivers weigh not only their individual and family behavioral health needs but also potential agency intervention, including loss of child custody. Many professionals reported that involvement with a child welfare agency hindered the caregiver's disclosure of behavioral health care needs. Implications for managers and practitioners are discussed.
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Affiliation(s)
| | - Jodon Anne (Jodi) Flick
- School of Social Work, Rm 228-E 301 Pittsboro St, 3550, University
of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3550, Phone: (919)
962-4988,
| | - Rebecca Wells
- School of Public Health, Management, Policy and Community Health,
University of Texas, P.O. Box 20186, Houston, TX 77025, Phone: 713-500-9184,
| | - Emmeline Chuang
- Fielding School of Public Health, University of California Los
Angeles, 650 Charles E. Young Dr. South, 31-299D CHS Mail Code 177220, Los
Angeles, CA 90095-1772, Phone: 310.825.8908,
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Watson HJ, Levine MD, Zerwas SC, Hamer RM, Crosby RD, Sprecher CS, O'Brien A, Zimmer B, Hofmeier SM, Kordy H, Moessner M, Peat CM, Runfola CD, Marcus MD, Bulik CM. Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial. Int J Eat Disord 2017; 50:569-577. [PMID: 27862108 PMCID: PMC5429209 DOI: 10.1002/eat.22644] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout. METHOD Participants (N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors. RESULTS Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96). DISCUSSION Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:569-577).
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Affiliation(s)
- Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
- Eating Disorders Program, Child and Adolescent Health Service, Department of Health in Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Australia
- School of Psychology and Speech Pathology, Curtin University, Australia
| | - Michele D. Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, United States
| | - Stephanie C. Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
- Department of Biostatistics, University of North Carolina at Chapel Hill, United States
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, United States
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States
| | - Caroline S. Sprecher
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Amy O'Brien
- Eating Disorders Program, Child and Adolescent Health Service, Department of Health in Western Australia, Australia
| | - Benjamin Zimmer
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
| | - Sara M. Hofmeier
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Hans Kordy
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
| | - Christine M. Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Cristin D. Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Marsha D. Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, United States
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
- Department of Nutrition, University of North Carolina at Chapel Hill, United States
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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25
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Rubin A, Dolev T, Zilcha-Mano S. Patient demographics and psychological functioning as predictors of unilateral termination of psychodynamic therapy. Psychother Res 2016; 28:672-684. [DOI: 10.1080/10503307.2016.1241910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Avinadav Rubin
- The Department of Psychology, University of Haifa, Haifa, Israel
| | - Tohar Dolev
- The Department of Psychology, University of Haifa, Haifa, Israel
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Hergenroeder AC, Wiemann CM, Henges C, Dave A. Outcome of adolescents with eating disorders from an adolescent medicine service at a large children's hospital. Int J Adolesc Med Health 2016; 27:49-56. [PMID: 24887950 DOI: 10.1515/ijamh-2013-0341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/17/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe outcomes of adolescents with eating disorders treated by an interdisciplinary adolescent medicine service at a large children's hospital and to identify factors, including hospitalization, associated with outcome. DESIGN The study design was a retrospective chart review of patients. SETTING The setting was an inpatient and outpatient adolescent service in a large urban children's hospital. PARTICIPANTS A total of 218 adolescents diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified participated in the study. INTERVENTION Interdisciplinary inpatient and outpatient treatment for eating disorders was adopted for intervention. OUTCOME MEASURES Patient outcomes were categorized as fully recovered, partially recovered/improved, or poorly recovered/exhibiting chronicity. RESULTS Being admitted to the study hospital once and longer duration of follow-up were associated with full or partial recovery. In contrast, being readmitted to the study hospital and longer duration of illness prior to the initial contact with this service were associated with poor recovery. Premorbid obesity was unrelated to outcome. CONCLUSIONS Earlier detection and referral of adolescents with eating disorders are needed because a high percentage of patients, especially those with anorexia nervosa, required hospitalization at initial contact. The benefits of inpatient admission may extend beyond medical stabilization of the most medically compromised patients to include improved therapeutic relationship with the treatment team and improved follow-up. Many patients prematurely terminate treatment; factors contributing to premature termination of therapy need further exploration.
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Sidani S, Epstein DR. Toward a Conceptualization and Operationalization of Satisfaction With Nonpharmacological Interventions. Res Theory Nurs Pract 2016; 30:242-257. [PMID: 28304269 DOI: 10.1891/1541-6577.30.3.242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although satisfaction is recognized as an essential aspect in the evaluation of interventions' effectiveness, there is lack of clarity on its conceptualization and operationalization. In this article, we present conceptual and operational definitions that specify the domains and attributes of satisfaction with nonpharmacological interventions. METHODS An integrative review of conceptual and empirical literature was conducted to generate the conceptual and operational definitions of satisfaction with interventions. Fifty-six publications were included in the review. The definitions of satisfaction and the content of instruments measuring satisfaction were reviewed, compared, and contrasted to identify the domains and attributes of the concept. RESULTS Satisfaction is defined as the appraisal of the interventions' process and outcome. It is operationalized in 4 domains of process: (a) suitability and utility of the intervention's components, (b) attitude toward and desire to continue with the intervention, (c) competence and interpersonal style of interventionist, and (d) implementation (format and dose) of the intervention. The outcome domain includes improvement in the health problem and in everyday functions, discomfort, and attribution of the outcomes to the intervention. CONCLUSIONS The conceptual and operational definitions can guide the development of instruments to assess satisfaction with nonpharmacological interventions, which can point to aspects of interventions that are viewed favorably or unfavorably.
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Högdahl L, Levallius J, Björck C, Norring C, Birgegård A. Personality predicts drop-out from therapist-guided internet-based cognitive behavioural therapy for eating disorders. Results from a randomized controlled trial. Internet Interv 2016; 5:44-50. [PMID: 30135806 PMCID: PMC6096309 DOI: 10.1016/j.invent.2016.07.002] [Citation(s) in RCA: 8] [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: 02/02/2016] [Revised: 06/23/2016] [Accepted: 07/13/2016] [Indexed: 12/22/2022] Open
Abstract
Internet-based guided self-help cognitive behavioural therapy (ICBT) seems a promising way of delivering eating disorder treatment. However, treatment drop-out is a common problem and little is known about the correlates, especially in clinical settings. The study aimed to explore prediction of drop-out in the context of a randomized controlled trial within specialized eating disorder care in terms of eating disorder symptomatology, personality traits, comorbidity, and demographic characteristics. 109 outpatients diagnosed with bulimia nervosa or similar eating disorder were randomized to two types of ICBT. Participants were assessed with several clinical- and self-ratings. The average drop-out rate was 36%. Drop-out was predicted by lower scores in the personality traits Dutifulness and Assertiveness as measured by the NEO Personality Inventory Revised, and by higher scores in Self-affirm as measured by the Structural Analysis of Social Behaviour. Drop-out was also predicted by therapist factors: one therapist had significantly more drop-outs (82%) than the other three (M = 30%). Theoretical and clinical implications of the impact of the predictors are discussed.
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Affiliation(s)
| | - Johanna Levallius
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatric Research, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Caroline Björck
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatric Research, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Claes Norring
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatric Research, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatric Research, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
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Mantilla EF, Birgegård A. The enemy within: the association between self-image and eating disorder symptoms in healthy, non help-seeking and clinical young women. J Eat Disord 2015; 3:30. [PMID: 26309737 PMCID: PMC4549025 DOI: 10.1186/s40337-015-0067-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous research has shown self-image according to the interpersonal Structural Analysis of Social Behavior model, to relate to and predict eating disorder symptoms and outcomes. METHODS We examined associations between self-reported self-image and ED symptoms in three groups of 16-25 year old females: healthy (N = 388), non help-seeking (N = 227) and clinical (N = 6384). Analyses were divided into age groups of 16-18 and 19-25 years, and the patient sample was divided into diagnostic groups. RESULTS Stepwise regressions with self-image aspects as independent variables and eating disorder symptoms as dependent showed that low self-love/acceptance and high self-blame were associated with more eating disorder symptoms in all groups, except older patients with bulimia nervosa where self-hate also contributed. Associations were generally weaker in the healthy groups and the older samples. CONCLUSIONS We put forward that older age, low desirability of symptoms, poorly working symptoms, and being acknowledged as ill, may weaken the association, with implications for treatment and prevention.
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Affiliation(s)
- Emma Forsén Mantilla
- Karolinska Institute, Department of Clinical neuroscience, Resource center for eating disorders, Norra Stationsgatan 69, plan 7, 113 64 Stockholm, Sweden
| | - Andreas Birgegård
- Karolinska Institute, Department of Clinical neuroscience, Resource center for eating disorders, Norra Stationsgatan 69, plan 7, 113 64 Stockholm, Sweden
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Jordan J, McIntosh VVW, Carter FA, Joyce PR, Frampton CMA, Luty SE, McKenzie JM, Bulik CM. Clinical characteristics associated with premature termination from outpatient psychotherapy for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:278-84. [PMID: 24842307 DOI: 10.1002/erv.2296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 11/10/2022]
Abstract
AIM The literature on clinical characteristics associated with premature termination of treatment (PTT) is beset with conflicting and non-replicated findings. This study explores clinical characteristics potentially associated with PTT in a randomised controlled outpatient psychotherapy trial for anorexia nervosa (AN). METHODS Participants were 56 women aged 17-40 years with spectrum AN. The completer group (n = 35) included those completing at least 15/20 planned sessions with the remainder of the sample comprising the PTT group (n = 21). Variables examined included demographic factors, psychosocial functioning, psychiatric history, lifetime comorbidity, temperament and eating disorder characteristics. Logistic regression was used to examine significant variables. A Kaplan-Meier survival curve was used to illustrate time taken to PTT. RESULTS The mean number of sessions in the PTT group was 8.1. Lower self-transcendence scores on the Temperament and Character Inventory were associated with PTT. CONCLUSIONS Recognising and addressing personality factors have the potential to enhance retention in treatment.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
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Runfola CD, Thornton LM, Pisetsky EM, Bulik CM, Birgegård A. Self-image and suicide in a Swedish national eating disorders clinical register. Compr Psychiatry 2014; 55:439-49. [PMID: 24332388 PMCID: PMC3965622 DOI: 10.1016/j.comppsych.2013.11.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/23/2013] [Accepted: 11/09/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Using a prospective design, to examine the relation between self-image (assessed using the Structural Analysis of Social Behavior) and suicide attempts/completions in women with anorexia nervosa-restricting type (ANR), anorexia nervosa-binge/purge type (ANBP), bulimia nervosa (BN), binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS); and to assess whether these self-image variables add unique predictive value to suicide when considering other baseline predictors. METHOD Women (N=2269) aged 12 to 45 (M=22.1) presenting to specialist eating disorders clinics in Sweden between 2005 and 2009 were identified through the Stepwise Eating Disorders Quality Register. Data on age, body mass index, eating disorder severity (Eating Disorder Examination-Questionnaire scores), psychiatric comorbidity, global assessment of functioning, and self-image were abstracted from Stepwise and included as baseline predictors or covariates. Suicide information (prior attempt and attempt/completion after Stepwise registration) was obtained from the National Patient Register and Cause of Death Register. RESULTS Prevalence of detected suicide attempts/completions over the study period was 9.2%. Negative self-image variables were associated with prior suicide attempts in ANR and EDNOS and later suicide attempts/completions in women with BN. In a stepwise Cox proportional hazards model, only low self-affirmation predicted time to suicide attempts/completions in women with BN when accounting for age and prior suicide attempt. CONCLUSION Assessing self-image might assist with identifying women with BN at elevated risk for suicide.
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Affiliation(s)
- Cristin D Runfola
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Emily M Pisetsky
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA; Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Forsén Mantilla E, Bergsten K, Birgegård A. Self-image and eating disorder symptoms in normal and clinical adolescents. Eat Behav 2014; 15:125-31. [PMID: 24411765 DOI: 10.1016/j.eatbeh.2013.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/28/2013] [Accepted: 11/20/2013] [Indexed: 11/19/2022]
Abstract
Eating disorders (ED) are psychiatric disorders of multifactorial origin, predominantly appearing in adolescence. Negative self-image is identified as risk factor, but the association between self-image and ED in adolescents or sex differences regarding such associations remains unclear. The study aimed to investigate the relationship between specific self-image aspects and ED symptoms in normal and clinical adolescents, including sex differences. Participants included 855 ED patients (girls=813, boys=42) and 482 normal adolescents (girls=238, boys=244), 13-15 years. Stepwise regression demonstrated strong associations between self-image and ED in normal adolescents (girls: R(2)=.31, boys: R(2)=.08), and stronger associations in patients (girls: R(2)=.64, boys: R(2)=.69). Qualitative sex differences were observed in patients. Connections between specific self-image aspects and ED have implications for clinical management of ED. The strong link between self-image variables and ED symptoms in normal girls, but not boys, is discussed in terms of the continuity-discontinuity hypothesis.
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Affiliation(s)
- Emma Forsén Mantilla
- Karolinska Institute, Dept. of Clinical Neuroscience, Resource Center for Eating Disorders, Norra Stationsgatan 69, Plan 7, 113 64 Stockholm, Sweden.
| | - Katja Bergsten
- Uppsala University, Dept. of Psychology, S:t Olofsgatan 10B, 753 12 Uppsala, Sweden.
| | - Andreas Birgegård
- Karolinska Institute, Dept. of Clinical Neuroscience, Resource Center for Eating Disorders, Norra Stationsgatan 69, Plan 7, 113 64 Stockholm, Sweden.
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Experience of an eating disorders out-patient program in an internal medicine hospital. Eat Weight Disord 2013; 18:429-35. [PMID: 24097344 DOI: 10.1007/s40519-013-0073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The aim of this study was to develop a successful low budget out-patient program, in an internal medicine hospital, for patients presenting eating disorders in an emerging nation. METHODS A total of 144 patients were included in a 6 month intervention centered in medical support, with fortnightly medical consultations, monthly counseling by a nutritionist and by a psychiatrist and three psycho-educational courses. The Three Factor Eating Questionnaire and the Eating Disorders Inventory-2 were performed at the beginning and at the end of the study. RESULTS After 6 months, more than half of the patients who completed the intervention were on remission. Substantial improvement was observed regarding the scores of both instruments after completion of the program. CONCLUSIONS The outcome of this study compares favorably to previous published data of more intensive programs. These results were obtained having little infrastructure, a low budget and limited human resources, making this a suitable eating disorders program for emerging nations.
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Carter O, Pannekoek L, Fursland A, Allen KL, Lampard AM, Byrne SM. Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Behav Res Ther 2012; 50:487-92. [DOI: 10.1016/j.brat.2012.03.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/09/2012] [Accepted: 03/09/2012] [Indexed: 10/28/2022]
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Watson HJ, Allen K, Fursland A, Byrne SM, Nathan PR. Does enhanced cognitive behaviour therapy for eating disorders improve quality of life? EUROPEAN EATING DISORDERS REVIEW 2012; 20:393-9. [PMID: 22730260 DOI: 10.1002/erv.2186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Quality of life (QOL) is the degree of enjoyment and satisfaction experienced in life, and embraces emotional well-being, physical health, economic and living circumstances, and work satisfaction. QOL recovery with eating disorder treatment has received sparse attention, and until now, no study has investigated QOL recovery with enhanced cognitive behaviour therapy (CBT-E). Patients (n = 196) admitted to a specialist eating disorders outpatient programme and receiving CBT-E completed measures of QOL, eating disorder psychopathology, depression, anxiety and self-esteem, before and after treatment. QOL at intake was compared with community norms, and QOL below the norm was predicted from sociodemographic and clinical correlates with logistic regression. Baseline QOL below the norm was associated with depression and anxiety Axis I comorbidity, and severity of depressive symptoms. Predictors of post-treatment QOL were baseline QOL and level of depressive symptoms and self-esteem at post-treatment. CBT-E was associated with gains in QOL over the course of treatment, in addition to eating disorder symptom relief.
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Affiliation(s)
- Hunna J Watson
- Centre for Clinical Interventions, Perth, Western Australia, Australia.
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Nilsson K, Engström I, Hägglöf B. Family climate and recovery in adolescent onset eating disorders: a prospective study. EUROPEAN EATING DISORDERS REVIEW 2011; 20:e96-102. [PMID: 21774042 DOI: 10.1002/erv.1127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This prospective study investigated the self-assessed family climate of adolescent patients and their parents during treatment of and recovery from eating disorders. METHOD One hundred two girls aged 13-17 years with eating disorders, answered the self-report Family Climate Scale (FCS) and Eating Disorders Inventory for Children at initial assessment and after 18 and 36 months. The FCS was also answered by their parents at the same time points. RESULTS Self-assessed family climate and eating disorder symptoms were similar for recovered (R) and nonrecovered (NR) adolescents at initial assessment and at 18 months. At 36 months, FCS Closeness was higher for R, and FCS Distance was lower for R compared with NR. Parents of R adolescents had higher scores on FCS Closeness and lower scores on FCS Chaos compared with parents of NR adolescents at the 36-month follow-up. CONCLUSION Self-reported family climate was associated with recovery. Changes in eating disorder symptoms preceded changes in family climate.
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Affiliation(s)
- Karin Nilsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Umeå University, Sweden.
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Schulte SJ, Meier PS, Stirling J. Dual diagnosis clients' treatment satisfaction - a systematic review. BMC Psychiatry 2011; 11:64. [PMID: 21501510 PMCID: PMC3101156 DOI: 10.1186/1471-244x-11-64] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 04/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this systematic review is to synthesize existing evidence about treatment satisfaction among clients with substance misuse and mental health co-morbidity (dual diagnoses, DD). METHODS We examined satisfaction with treatment received, variations in satisfaction levels by type of treatment intervention and by diagnosis (i.e. DD clients vs. single diagnosis clients), and the influence of factors other than treatment type on satisfaction. Peer-reviewed studies published in English since 1970 were identified by searching electronic databases using pre-defined search strings. RESULTS Across the 27 studies that met inclusion criteria, high average satisfaction scores were found. In most studies, integrated DD treatment yielded greater client satisfaction than standard treatment without explicit DD focus. In standard treatment without DD focus, DD clients tended to be less satisfied than single diagnosis clients. Whilst the evidence base on client and treatment variables related to satisfaction is small, it suggested client demographics and symptom severity to be unrelated to treatment satisfaction. However, satisfaction tended to be linked to other treatment process and outcome variables. Findings are limited in that many studies had very small sample sizes, did not use validated satisfaction instruments and may not have controlled for potential confounders. A framework for further research in this important area is discussed. CONCLUSIONS High satisfaction levels with current treatment provision, especially among those in integrated treatment, should enhance therapeutic optimism among practitioners dealing with DD clients.
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Affiliation(s)
- Sabrina J Schulte
- International Studies Department, American University of Sharjah, United Arab Emirates.
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK
| | - John Stirling
- Department of Psychology, Elizabeth Gaskell Campus, Manchester Metropolitan University, Manchester, UK
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Ackard DM, Cronemeyer CL, Franzen LM, Richter SA, Norstrom J. Number of different purging behaviors used among women with eating disorders: psychological, behavioral, self-efficacy and quality of life outcomes. Eat Disord 2011; 19:156-74. [PMID: 21360366 DOI: 10.1080/10640266.2010.511909] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to examine differences between a number of different purging behaviors used and outcome measures among eating disorder patients. Among 211 females who received inpatient or partial hospitalization eating disorder treatment, analyses of covariance and cross-tabulations identified associations among a number of different purging behaviors (vomiting, laxative use, diuretic use) used and psychological, behavioral, self-efficacy and quality of life measures at follow-up. Most patients (80.1%) reported purging for weight control. Use of different purging behaviors was significantly associated at follow-up with lower self-esteem, greater depression, higher state and trait anxiety, higher BMI, poorer self-efficacy for normative eating and body image, compromised quality of life, greater dietary restraint, and eating, shape and weight concerns. Furthermore, a higher percentage of those who used purging behaviors met criteria for a subthreshold or threshold eating disorder at follow-up compared to their non-purging peers. Eating disorder patients who use different purging behaviors are more compromised at follow-up than patients who do not purge. Due to the severe medical complications associated with different purging behaviors, future research should address best practices for clinical intervention and prevention.
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Affiliation(s)
- Diann M Ackard
- Park Nicollet Melrose Institute, St Louis Park, Minnesota, USA.
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Carrard I, Fernandez-Aranda F, Lam T, Nevonen L, Liwowsky I, Volkart AC, Rouget P, Golay A, Van der Linden M, Norring C. Evaluation of a guided internet self-treatment programme for bulimia nervosa in several European countries. EUROPEAN EATING DISORDERS REVIEW 2010; 19:138-49. [PMID: 20859989 DOI: 10.1002/erv.1043] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purposes of this study were to evaluate the use of an online guided self-treatment programme for bulimia nervosa (BN) and to determine predictors of outcome. Data were collected in four European countries where the programme was simultaneously used. METHOD One hundred and twenty-seven BN or subthreshold BN female patients (mean age of 24.7 years) participated in a 4-month intervention using a CBT based online-guided self-help programme. Contact during the treatment period included weekly e-mails with a coach. ASSESSMENT Measures included the Eating Disorders Inventory-2 (EDI-2) and the Symptom Check List-Revised (SCL-90R). RESULTS Severity of eating disorders symptoms and general psychopathology improved significantly. Twenty-three per cent of patients were symptom free at the end of treatment. The dropout rate was 25.2%. A better score of general psychological health was a predictor of a better outcome. CONCLUSIONS This study encourages further developments and research on innovative therapy approaches, particularly for those disorders such as BN, with difficult therapy and unclear prognosis.
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Affiliation(s)
- I Carrard
- University Hospitals of Geneva, Geneva, Switzerland.
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Abstract
OBJECTIVE To review recent studies describing eating disorder course and outcome. METHOD Electronic and manual searches were conducted to identify relevant articles published since 2004. RESULTS Twenty-six articles were identified. For anorexia nervosa (AN), most patients ascertained through outpatient settings achieved remission by 5-year follow-up. Inpatient treatment predicted poor prognosis as inpatient samples demonstrated lower remission rates. Outcome differed between bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS), including binge eating disorder (BED), for shorter follow-up durations; however, outcomes appeared similar between BN and related EDNOS by 5-year follow-up. Greater psychiatric comorbidity emerged as a significant predictor of poor prognosis in BN, whereas few prognostic indicators were identified for BED or other EDNOS. DISCUSSION Results support optimism for most patients with eating disorders. However, more effective treatments are needed for adult AN inpatients and approximately 30% of patients with BN and related EDNOS who remain ill 10-20 years following presentation.
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Affiliation(s)
- Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida 32306, USA.
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