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Eating Disorder Day Programs: Is There a Best Format? Nutrients 2022; 14:nu14040879. [PMID: 35215529 PMCID: PMC8878899 DOI: 10.3390/nu14040879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
The use of a Day Program (DP) format (i.e., intensive daily treatment with no overnight admission) has been shown to be an effective treatment for eating disorders (EDs). The disadvantages, however, include higher cost than outpatient treatment (including costs of meals and staff), greater disruption to patients’ lives, and the use of a highly structured and strict schedule that may interrupt the development of patients’ autonomy in taking responsibility for their recovery. This study investigated whether reducing costs of a DP and the disruption to patients’ lives, and increasing opportunity to develop autonomy, impacted clinical outcomes. Three sequential DP formats were compared in the current study: Format 1 was the most expensive (provision of supported dinners three times/week and extended staff hours); Format 2 included only one dinner/week and provision of a take-home meal. Both formats gave greater support to patients who were not progressing well (i.e., extended admission and extensive support from staff when experiencing feelings of suicidality or self-harm). Format 3 did not provide this greater support but established pre-determined admission lengths and required the patient to step out of the program temporarily when feeling suicidal. Fifty-six patients were included in the analyses: 45% were underweight (body mass index (BMI) < 18.5), 96.4% were female, 63% were given a primary diagnosis of anorexia nervosa (or atypical anorexia nervosa), and mean age was 25.57 years. Clinical outcomes were assessed using self-reported measures of disordered eating, psychosocial impairment, and negative mood, but BMI was recorded by staff. Over admission, 4- and 8-week post-admission, and discharge there were no significant differences between any of the clinical outcomes across the three formats. We can tentatively conclude that decreasing costs and increasing the opportunities for autonomy did not negatively impact patient outcomes, but future research should seek to replicate these results in other and larger populations that allow conclusions to be drawn for different eating disorder diagnostic groups.
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Ali SI, Bodnar E, Gamberg S, Bartel SJ, Waller G, Nunes A, Dixon L, Keshen A. The costs and benefits of intensive day treatment programs and outpatient treatments for eating disorders: An idea worth researching. Int J Eat Disord 2021; 54:1099-1105. [PMID: 33825216 DOI: 10.1002/eat.23514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022]
Abstract
Outpatient care (e.g., individual, group, or self-help therapies) and day treatment programs (DTPs) are common and effective treatments for adults with eating disorders. Compared to outpatient care, DTPs have additional expenses and could have unintended iatrogenic effects (e.g., may create an overly protective environment that undermines self-efficacy). However, these potential downsides may be offset if DTPs are shown to have advantages over outpatient care. To explore this question, our team conducted a scoping review that aimed to synthesize the existing body of adult eating disorder literature (a) comparing outcomes for DTPs to outpatient care, and (b) examining the use of DTPs as a higher level of care in a stepped care model. Only four studies met the predefined search criteria. The limited results suggest that the treatments have similar effects and that outpatient care is more cost-effective. Furthermore, no studies explored the use of DTPs as a higher level of care in a stepped care model (despite international guidelines recommending this approach). Given the clear dearth of literature on this clinically relevant topic, we have provided specific avenues for further research.
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Affiliation(s)
- Sarrah I Ali
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Emma Bodnar
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Susan Gamberg
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara J Bartel
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura Dixon
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Aaron Keshen
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Slesinger NC, Hayes NA, Washburn JJ. Understanding predictors of change in a day treatment setting for non-suicidal self-injury. Psychol Psychother 2021; 94 Suppl 2:517-535. [PMID: 32662182 DOI: 10.1111/papt.12295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/29/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To examine change in non-suicidal self-injury (NSSI) frequency, quality of life, and functional impairment from admission to discharge in patients enrolled in partial hospitalization and intensive outpatient programmes (PHP/IOP) designed to treat NSSI. Demographic, clinical, and treatment-related predictors of changes were also examined. DESIGN Data were collected as part of routine clinical assessment procedures at admission and discharge from patients enrolled in a PHP/IOP programme designed to treat NSSI. The clinical assessment included measures examining quality of life, functional impairment, and NSSI behaviour. METHODS Paired t-tests were used to examine change in NSSI frequency, quality of life, and functional impairment. Reliable clinical change analyses were used to identify clinically significant change in quality of life and functional impairment. Multilevel mixed-effects regression was used to examine predictors of change for quality of life and functional impairment. Negative binomial regression was used to examine predictors of change for NSSI frequency. RESULTS From admission to discharge, NSSI frequency significantly decreased and quality of life and functional impairment evidenced clinically significant change. Age, race/ethnicity, and insurance type predicted change in functional impairment, while gender predicted change in quality of life. Urge to self-injure predicted change in NSSI frequency. Borderline symptoms predicted change across all outcome variables. CONCLUSIONS Patients who completed a day treatment programme for NSSI evidenced significant change in NSSI frequency, functional impairment, and quality of life at discharge; however, several demographic and clinical variables were associated with change. PRACTITIONER POINTS Patients who engage in NSSI show significant change from admission to discharge in a day treatment programme dedicated to the treatment of NSSI. Quality of life and functional impairment are important outcome variables to consider and evaluate in higher levels of care. It is important to consider demographic and clinical variables when creating a treatment plan for NSSI. Although BPD symptoms may be important to consider in day treatment for NSSI, interpersonal dysfunction, depressive symptoms, and mood lability may also affect change in symptoms.
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Affiliation(s)
- Noël C Slesinger
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nicole A Hayes
- Counseling and Psychological Services, University of California Los Angeles, California, USA
| | - Jason J Washburn
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Evaluating empirically valid and clinically meaningful change in intensive residential treatment for severe eating disorders at discharge and at a 6-month follow-up. Eat Weight Disord 2020; 25:1609-1620. [PMID: 31673985 DOI: 10.1007/s40519-019-00798-2] [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: 07/03/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The present study evaluated the statistical and clinical significance of symptomatic change at discharge and after 6 months of an intensive residential treatment for patients with eating disorders (ED), and explored the individual factors that may affect therapeutic outcomes. METHODS A sample of 118 female ED patients were assessed at intake and discharge on the following dimensions: BMI, ED-specific symptoms, depressive features, and overall symptomatic distress. A subsample of 59 patients filled out the same questionnaires at a 6-month follow-up after discharge. RESULTS Findings evidenced statistically significant changes in all outcome measures at both discharge and follow-up. Between 30.1 and 38.6% of patients at discharge and 35.2-54.2% at the 6-month follow-up showed clinically significant symptomatic change; additionally, 19.8-29.1% of patients at discharge and 22.9-38.3% at follow-up improved reliably. However, 34.9-39.8% remained unchanged and 2-4.8% worsened. At the 6-month follow-up, 21.3-25.9% showed no symptomatic change and 0-3.7% had deteriorated. Unchanged and deteriorated patients had an earlier age of ED onset and were more likely to suffer a comorbid personality pathology and to be following concurrent pharmacological treatment. CONCLUSIONS Results suggested that intensive and multimodal residential treatment may be effective for the majority of ED patients, and that therapeutic outcomes tend to improve over time. Prevention strategies should focus on early onset subjects and those with concurrent personality pathology. LEVEL OF EVIDENCE Level III, evidence obtained from a longitudinal cohort study.
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Examining DBT Day Treatment in Treating Mood Dysregulation Expectancy and Anxiety in Women Diagnosed with Eating Disorders. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-020-09475-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Brown TA, Cusack A, Berner LA, Anderson L, Nakamura T, Gomez L, Trim J, Chen JY, Kaye WH. Emotion Regulation Difficulties During and After Partial Hospitalization Treatment Across Eating Disorders. Behav Ther 2020; 51:401-412. [PMID: 32402256 PMCID: PMC7225176 DOI: 10.1016/j.beth.2019.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/19/2023]
Abstract
Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.
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Affiliation(s)
- Tiffany A. Brown
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Anne Cusack
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Laura A. Berner
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Leslie Anderson
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Tiffany Nakamura
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Lauren Gomez
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Julie Trim
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Joanna Y. Chen
- Department of Psychology, Drexel University; 3201 Chestnut St, Philadelphia, PA 19104
| | - Walter H. Kaye
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
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Combining day treatment and outpatient treatment for eating disorders: findings from a naturalistic setting. Eat Weight Disord 2020; 25:519-530. [PMID: 30706362 DOI: 10.1007/s40519-019-00643-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Day treatment programs for individuals with eating disorders (ED) have been the subject of research and are promoted as an alternative to inpatient treatment due to their therapeutic and economic advantages, but have not regularly been implemented in regular care. PURPOSE We investigated the long-term effectiveness of a transdiagnostic combined eating disorder treatment program which consisted of an 8-week day treatment phase followed by an average of 19 sessions of outpatient treatment over an average of 39 weeks in a naturalistic setting. METHODS We accepted 148 patients with different diagnoses of eating disorders into our combined treatment program. We assessed weight, behavioral eating disorder symptoms and eating disorder related cognitions and attitudes at the beginning and the end of the day treatment phase and after 6, 12 and 26 months. RESULTS Over the course of the 8-week day treatment phase, patients with initial binge eating, purging and/or fasting behavior reduced these symptoms by 91%, 90% and, 86%. Patients who were underweight at baseline gained on average 1.05 BMI points (d = 0.76). In addition, eating disorder related cognitions and attitudes of all patients significantly improved with large effect sizes (d = 1.12). On average, all improvements remained stable during the follow-up period. CONCLUSIONS Our findings add to the existing studies on day treatment and support previously found encouraging effects of treatment programs that combine day treatment and consecutive outpatient treatment for eating disorders. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
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Ben-Porath D, Duthu F, Luo T, Gonidakis F, Compte EJ, Wisniewski L. Dialectical behavioral therapy: an update and review of the existing treatment models adapted for adults with eating disorders. Eat Disord 2020; 28:101-121. [PMID: 32129724 DOI: 10.1080/10640266.2020.1723371] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite the effectiveness of CBT in reducing shape/weight concerns and dietary restraint, research suggests that patients considered recovered may still exhibit emotional difficulties related to eating disorders (EDs). Dialectical behavior therapy (DBT) has been adapted for a variety of mental disorders characterized by emotion dysregulation and, more recently, for EDs specifically. The current review found that the majority of the research studies employed one of the following three adaptations of DBT for EDs: The Stanford Model, Radically Open-DBT (RO-DBT), or Multidiagnostic ED-DBT (MED-DBT). Therefore, this review sought to review and update the empirical research on each adaptation and (2) offer preliminary recommendations for when and which adaptation of DBT to use when treating adults with EDs. Findings from the empirical literature on DBT and EDs indicate that the Stanford Model has the most rigorous and numerous studies demonstrating efficacy and effectiveness in those diagnosed with binge eating disorder. Fewer studies have been conducted using the Stanford Model with bulimia nervosa; therefore, less strong assertions can be made about DBT with those diagnosed with bulimia. The MED-DBT model has been evaluated in several open trials within higher levels of care with promising results, but the lack of randomized clinically-controlled trials prevents a definitive statement about its efficacy. Finally, research on applying the RO-DBT model to anorexia-nervosa, restricting subtype is in its infancy, prohibiting solid conclusions or recommendations regarding its efficacy or effectiveness.
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Affiliation(s)
- Denise Ben-Porath
- Department of Psychology, John Carroll University, University Heights, Ohio, USA
| | - Florencia Duthu
- DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina
| | - Tana Luo
- Eating Disorders Center for Treatment and Research, University of California, San Diego, California, USA
| | - Fragiskos Gonidakis
- Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilio J Compte
- DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina.,School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina.,Research Department, Comenzar De Nuevo Treatment Center, Monterrey, México
| | - Lucene Wisniewski
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA.,Center for Evidence Based Treatment Ohio, Shaker Heights, Ohio, USA
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Brown TA, Wisniewski L, Anderson LK. Dialectical Behavior Therapy for Eating Disorders: State of the Research and New Directions. Eat Disord 2020; 28:97-100. [PMID: 32301685 DOI: 10.1080/10640266.2020.1728204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Tiffany A Brown
- Eating Disorder Center for Treatment and Research, Department of Psychiatry, University of California, San Diego, California, USA
| | | | - Leslie K Anderson
- Eating Disorder Center for Treatment and Research, Department of Psychiatry, University of California, San Diego, California, USA
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10
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Hayes NA, Welty LJ, Slesinger N, Washburn JJ. Moderators of treatment outcomes in a partial hospitalization and intensive outpatient program for eating disorders. Eat Disord 2019; 27:305-320. [PMID: 30204570 DOI: 10.1080/10640266.2018.1512302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Eating disorders cause a number of severely impairing symptoms that may require more intensive intervention that is available through outpatient therapy services. The PHP/IOP level of care may be an effective mode of treatment in these cases, but few studies have examined overall outcomes or treatment moderators for this level of care. Using a large sample from a PHP/IOP specifically designed for the treatment of eating disorders, the current study examines a variety of symptoms (eating disorder severity, quality of life, depression, etc.) from admission to discharge, as well as potential moderators of treatment, including demographic and clinical factors. Overall, the PHP/IOP level of care was found to improve treatment outcomes. Age, race, gender, and depression were found to moderate the change in quality of life and functional impairment. Additionally, patients diagnosed with anorexia nervosa had significantly lowered quality of life and greater eating disorder symptomatology than all other diagnoses. The results of this study can help to inform clinical practice and help guide in treatment decisions at the partial hospitalization level of care.
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Affiliation(s)
- Nicole A Hayes
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Leah J Welty
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,b Department of Preventative Medicine, Division of Biostatistics , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Noel Slesinger
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Jason J Washburn
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,c Center for Evidence-Based Practice , AMITA Health Behavioral Medicine, Hoffman Estates , IL , USA
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Early Versus Later Improvements in Dialectical Behavior Therapy Skills Use and Treatment Outcome in Eating Disorders. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10006-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Matthews K, Gordon L, van Beusekom J, Sheffield J, Patterson S. A day treatment program for adults with eating disorders: staff and patient experiences in implementation. J Eat Disord 2019; 7:21. [PMID: 31304014 PMCID: PMC6600879 DOI: 10.1186/s40337-019-0252-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Eating disorders are serious conditions which are increasing in prevalence internationally. The causes of these conditions are complex and incompletely understood, and clinical presentations can vary over time. The complexity of these conditions can also complicate treatment. Therefore, stepped care treatment comprising a hierarchy of interventions, including access to day treatment programs (DTPs), is recommended. While studies have examined patient outcomes and provided narrative accounts of these programs, no published studies describe DTP development. This study aims to address this gap by examining development and implementation of a DTP from service providers and patients' perspectives. METHODS This study utilised a mixed-methods design to examine the design and implementation of a publicly funded, closed group DTP in Australia. Data from service records and documents were analysed, alongside interviews with patients and interview and focus groups with service providers conducted between June 2016 and July 2017. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using the Framework Approach. RESULTS Seventeen service providers (n = 4 in managerial and n = 13 clinical positions, with clinical experience of 3 months to 20 years) and 11 patients (100% F, 17-33 years) were interviewed. The service providers reported that implementation was a stressful undertaking due to tight timeframes to achieve multiple tasks. Patients had diverse opinions regarding the DTP content and the group treatment experience. Despite this, all patients reported benefits from attending the DTP, varying from improvements in mood, weight gain, development of personal skills and strengths, to living independently. For further benefit, patients suggested that programs could be shaped and targets towards differing patient groups, with fewer breaks throughout treatment. CONCLUSIONS Designing and implementing a DTP is a challenge and can be a time-intensive undertaking, however the result can be beneficial for both service providers and patients. The closed group format was beneficial in creating a supportive environment, though may have led to increases in additional eating disordered behaviours. While the current structure of this DTP may require reconsideration, organisations considering implementing a new DTP may find usefulness in the overall design described in this study, alongside learning from the issues experienced.
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Affiliation(s)
- Kylie Matthews
- 1Royal Brisbane and Women's Hospital, Nutrition and Dietetics, Level 2 James Mayne Building, RBWH, Herston, 4006 Australia
| | - Leanne Gordon
- 2Psychology, University of Queensland, St Lucia, 4067 Australia
| | | | | | | | - Susan Patterson
- Royal Brisbane and Women's Hopsital, Mental Health Centre, J Floor, Herston, 4006 Australia
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Clinton D, Birgegård A. Classifying empirically valid and clinically meaningful change in eating disorders using the Eating Disorders Inventory, version 2 (EDI-2). Eat Behav 2017; 26:99-103. [PMID: 28213339 DOI: 10.1016/j.eatbeh.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
The study examined the ability of the EDI-2 to classify empirically valid and clinically meaningful change using clinical significance and the Reliable Change Index (CS/RCI), and compared CS/RCI to classification based on diagnostic change. Eating disorder (ED) patients (N=363) were assessed at intake and after 36months on measures of ED and psychiatric symptoms, self-image, interpersonal relationships, treatment satisfaction and general outcome. Patients were categorized using a four-way classification scheme as "Deteriorated", "Unchanged", "Improved" or "No ED"; and using a two-way classification scheme as either in remission or not in remission. Compared to similar two- and four-way classification based on diagnostic change, CS/RCI using the EDI-2 total score demonstrated greatest overall utility in explaining outcome variance. The EDI-2 can generate empirically valid and clinically meaningful classification of change. Systematic application of CS/RCI using the EDI-2 benefits both clinicians and researchers by providing a simple, clinically relevant, scientifically robust, and cost-effective means of classifying outcome. It may be especially relevant in alerting clinicians to problem cases in need of additional or alternative treatment strategies.
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Affiliation(s)
- David Clinton
- Centre for Psychiatry Research, Stockholm Health Care Services, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 7 tr, 113 64 Stockholm, Sweden; Institute for Eating Disorders, Kruses gate 8, 0263 Oslo, Norway.
| | - Andreas Birgegård
- Centre for Psychiatry Research, Stockholm Health Care Services, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, 7 tr, 113 64 Stockholm, Sweden
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Diedrich A, Schlegl S, Greetfeld M, Fumi M, Voderholzer U. Intensive inpatient treatment for bulimia nervosa: Statistical and clinical significance of symptom changes. Psychother Res 2016; 28:297-312. [DOI: 10.1080/10503307.2016.1210834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Alice Diedrich
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
| | | | - Markus Fumi
- Schön Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Schön Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
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15
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Kelly AC, Wisniewski L, Martin-Wagar C, Hoffman E. Group-Based Compassion-Focused Therapy as an Adjunct to Outpatient Treatment for Eating Disorders: A Pilot Randomized Controlled Trial. Clin Psychol Psychother 2016; 24:475-487. [DOI: 10.1002/cpp.2018] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/05/2016] [Accepted: 04/08/2016] [Indexed: 11/06/2022]
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16
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Thaler L, Wilson S, Coelho JS, Mazanek Antunes J, Israel M, Steiger H. Mandating weekly weight gain in a day treatment program for eating disorders. Int J Eat Disord 2014; 47:500-6. [PMID: 24431323 DOI: 10.1002/eat.22246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/20/2013] [Accepted: 12/26/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined differences in treatment outcome associated with a "self-directed"- versus "external-incentive"-based day treatment protocol for individuals with eating disorders (EDs) with below normal body mass index. The self-directed protocol recommended a weekly 500 g weight gain, but allowed participants freedom to gain weight at their own rate; the "external-incentive" protocol required a minimum weight gain of 500 g/week as a requirement for staying in the program. METHOD Weight outcome was available for 49 individuals who were treated with the recommended weight gain protocol, and 40 individuals who were treated with the required weight gain protocol. RESULTS Post-treatment weight was significantly higher in patients treated in the required weight gain protocol compared to those treated in the recommended weight gain protocol. All patients, regardless of which program they completed, showed improvements in the measures of eating-disorder and comorbid-psychiatric symptoms. DISCUSSION This study demonstrated the benefits of an alteration in protocol that required no additional financial or human resources. Further studies are needed to validate the effectiveness of various day treatment protocol parameters.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Psychiatry Department, McGill University, Montreal, Quebec, Canada
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Ben-Porath DD, Federici A, Wisniewski L, Warren M. Dialectical Behavior Therapy: Does It Bring About Improvements in Affect Regulation in Individuals with Eating Disorders? JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2014. [DOI: 10.1007/s10879-014-9271-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Henderson K, Buchholz A, Obeid N, Mossiere A, Maras D, Norris M, Harrison M, Feder S, Spettigue W. A family-based eating disorder day treatment program for youth: examining the clinical and statistical significance of short-term treatment outcomes. Eat Disord 2014; 22:1-18. [PMID: 24365524 DOI: 10.1080/10640266.2014.857512] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes an innovative family-based day treatment program (DTP) for youth with moderate to severe eating disorders. A sample of 65 youth completed a battery of psychological measures pre- and post-treatment and 6 months after program completion. Treatment outcomes were assessed in three main domains: (a) medical stabilization, (b) normalization of eating behavior, and (c) improved psychological functioning. Overall, patients demonstrated statistically significant and clinically meaningful improvements on all outcome measures. Findings indicate that a comprehensive DTP can successfully facilitate positive outcomes in youth with eating disorders and that these improvements can be maintained 6 months post-treatment.
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Affiliation(s)
- Katherine Henderson
- a Department of Psychology , Carleton University , Ottawa , Ontario , Canada
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Fallon P, Wisniewski L. A system of evidenced-based techniques and collaborative clinical interventions with a chronically ill patient. Int J Eat Disord 2013; 46:501-6. [PMID: 23658100 DOI: 10.1002/eat.22108] [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: 11/08/2022]
Abstract
Although evidence-based treatments (EBTs) exist for both bulimia nervosa and binge eating disorder, there is far less evidence underpinning the treatment of anorexia nervosa (AN). Furthermore, there is no clearly defined standardized approach to patients who have not responded to treatment over an extended period of time. Chronic eating disorder patients in particular might need long-term engagement with treatment providers offering a wide range of interventions. This case study highlights how an experienced private practitioner systematically employed a variety of EBT techniques for a patient with a severe, long-term eating disorder and its comorbidities, within a model of attachment and collaboration. The practice of utilizing a wide variety of EBT techniques in a systematic manner guided by clinical expertise and supported by a therapy relationship of collaboration and attachment may prove to be a fruitful avenue for future research.
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Affiliation(s)
- Patricia Fallon
- Department of Psychology, University of Washington, Seattle, Washington, USA.
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Olmsted MP, McFarlane T, Trottier K, Rockert W. Efficacy and intensity of day hospital treatment for eating disorders. Psychother Res 2013; 23:277-86. [DOI: 10.1080/10503307.2012.721937] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Gale C, Gilbert P, Read N, Goss K. An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders. Clin Psychol Psychother 2012; 21:1-12. [PMID: 22740105 DOI: 10.1002/cpp.1806] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study explored the outcome of introducing Compassion Focused Therapy (CFT) into a standard treatment programme for people with eating disorders. In particular, the aim was to evaluate the principle that CFT can be used with people with eating disorders and improve eating disorder symptomatology. METHOD Routinely collected questionnaire data were used to assess cognitive and behavioural aspects of eating disorders and social functioning/well being (n = 99). RESULTS There were significant improvements on all questionnaire measures during the programme. An analysis by diagnosis found that people with bulimia nervosa improved significantly more than people with anorexia nervosa on most of the subscales. Also, in terms of clinical significance, 73% of those with bulimia nervosa were considered to have made clinically reliable and significant improvements at the end of treatment (compared with 21% of people with anorexia nervosa and 30% of people with atypical eating disorders). CONCLUSION This study demonstrates the potential benefits of using CFT with people with eating disorders and highlights the need for further research on this new approach. KEY PRACTITIONER MESSAGE CFT offers new ways to conceptualize and formulate some of the self-critical and shame-based difficulties associated with eating disorders. CFT offers a framework that can enable people with eating disorders to conceptualize their difficulties in different ways. CFT can be combined with standard therapies especially cognitive behavioural therapy. CFT can be especially useful in a group context where the relationships between members can become increasingly compassionate, validating, supportive and encouraging.
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Affiliation(s)
- Corinne Gale
- Mental Health Research Unit, Kingsway, Derby, UK
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