Perceptions and use of empirically-supported psychotherapies among eating disorder professionals

Feasibility and preliminary effectiveness of a cognitive-behavioral, family-centered partial hospitalization program for adolescents with anorexia nervosa and atypical anorexia nervosa at six- and twelve-month follow-up

This study examined the feasibility and preliminary effectiveness of a cognitive-behavioral, family-centered partial hospitalization program (PHP) for adolescents with anorexia nervosa (AN) and atypical AN (AAN), and described the outpatient services received following discharge. Participants (N = 31) completed anthropometric and self-report assessments at admission, discharge, and six and twelve months after discharge from the PHP. Descriptive statistics explored markers of feasibility. Paired samples t-tests evaluated changes in weight and eating disorder (ED) symptomatology from admission to discharge, admission to six-month follow-up, and admission to twelve-month follow-up. Descriptive statistics and effect sizes compared symptoms at each timepoint between participants with AN and AAN. Results indicated that we were successful at recruiting greater than 50% of adolescents approached for this study. We collected follow-up data from more than 70% of participants at discharge, but did not meet this retention benchmark at six-month and twelve-month follow-ups. The entire sample demonstrated significant improvements in weight and ED symptomatology from admission to discharge, and generally maintained these improvements at six- and twelve-month follow-up. While descriptive statistics suggested that participants with AN and AAN received similar outpatient services following discharge from the PHP, those with AN experienced greater improvement in self-reported ED symptomatology than those with AAN at six- and twelve-month follow-up. These findings provide preliminary support for the efficacy of PHPs in treating adolescents with AN and AAN. Further research with larger sample sizes should investigate whether adolescents with AAN experience poorer outcomes than those with AN following discharge from a PHP.

Understanding drift in the treatment of eating disorders using a mixed-methods approach

Despite strong empirical support for treatments of eating disorders, research has demonstrated a trend of clinicians deviating from protocols outlined in empirically supported manuals. The present study used a convergent mixed-methods design to understand clinicians' use of and drift from empirically supported treatments in a sample of 114 licensed clinicians in the US who had substantial experience (i.e. one-third of caseload) working with patients with eating disorders and training in cognitive-behavioral therapy (CBT), family-based therapy (FBT), and/or interpersonal therapy (IPT) for eating disorders. Results revealed that 63.7-76.3% of clinicians drift from empirically supported treatments and 71.8% were aware they deviated from empirically supported treatments. Qualitative analyses identified client differences (57.2%) to be the primary reason why clinicians drift, with less participants describing therapist factors (20.4%), treatment shortcomings (12.6%), treatment setting (11.7%), logistic constraints (4.9%) and family factors (4.9%) as reasons why they drift. These findings suggest that drift for most clinicians may be better explained under the umbrella of evidence-based practice. Clinicians also identified a number of ways in which treatment and access to treatment can be improved. This broadened understanding of the use of empirically supported treatments within evidence-based practice may serve to help bridge the gap between research and practice.

Effectiveness of delivering evidence-based eating disorder treatment via telemedicine for children, adolescents, and youth

Barriers limit access to eating disorder treatment. Evidence-based treatment delivered using telemedicine could expand access. This study determined the effectiveness of enhanced Family-Based Treatment (FBT+) delivered using telemedicine for children and adolescents with eating disorders. Participants had a confirmed eating disorder diagnosis, lived in states where treatment was available, and lived with a family member willing to participate. Virtual FBT+ was administered by a five-person team including a therapist, dietitian, medical provider, peer mentor, and family mentor for up to 12 months. Measures were recorded at baseline and varying frequencies throughout treatment. Weight was self-reported. Eating disorder symptoms were assessed with the Eating Disorder Examination-Questionnaire Short Form (EDE-QS) and depression and anxiety were measured using the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7). Caregiver burden and self-efficacy were measured using the Burden Assessment Scale, and Parent Versus Eating Disorder scale. The majority of patients (N = 210; 6 to 24 years old [mean 16 · 1 years]) were cisgender female (83%) White, (71%), required weight restoration (78%), and had anorexia nervosa, restricting type (63%). After 16 weeks, patients on weight restoration gained on average 11 · 3 [9 · 86, 12 · 8] pounds and the average change in EDE-QS score was -6 · 31 [-8 · 67, -4 · 10] points. Similar reductions were seen for depression (-2 · 62 [-4 · 24, -1 · 04]), anxiety (-1 · 44 [-1 · 12, 0 · 78]), and caregiver burden (-4 · 41 [2 · 45, 6 · 31]). Caregiver self-efficacy increased by 4 · 56 [3 · 53, 5 · 61] points. Patients and caregivers reported satisfaction with treatment. Virtual FBT+ for eating disorders can transcend geographical and psychosocial treatment barriers, expanding access to evidence-based eating disorder treatment.

Barriers and Facilitators to the Implementation of an Eating Disorders Knowledge Exchange Program for Non-specialist Professionals

Despite availability of evidence-based treatments for eating disorders (EDs), individuals with EDs often do not receive informed treatment. Training of non-specialized clinicians by experienced professionals through knowledge exchange (KE) programs is an effective way to enhance accessibility to evidence-based treatments for EDs. The authors conducted a qualitative analysis of factors that facilitated or impeded the uptake of an ED-focused KE program. Semi-structured interviews were conducted with mental health professionals (n = 43) and managers (n = 11) at 13 community mental-health sites at which the KE program was offered. Data were analyzed using a qualitative content analysis. Key facilitators identified were management support for the program and building competence through ongoing supervision of clinicians. Main barriers were limited access to ED patients to treat and having insufficient time to apply ED interventions in front-line settings. The results provide insights into the practical imperatives involved in implementing a KE initiative for ED treatment.

Challenging rigidity in Anorexia (treatment, training and supervision): questioning manual adherence in the face of complexity

BACKGROUND

Anorexia Nervosa is a debilitating illness. While there have been many advancements to treatment protocols and outcomes for people with eating disorders, the field acknowledges there remains considerable room for improvement. This timely Special Edition of the Journal of Eating Disorders has invited those of us in the field to consider a range of topics in aid of this task, including potential modifications and implementation of evidence-based practice, specific and common psychotherapy factors, treatment manuals, adherence and individualising treatment approaches for individuals and families. BODY: In this paper, we briefly outline the key manualised treatments currently available to treat children, adolescents and adults with Anorexia Nervosa, considering the benefits, potential reasons for adaptations and limitations. We then review the current evidence for training strict adherence to treatment manuals which is often a key focus in training and supervision, questioning the association of increased treatment adherence with improved therapeutic outcome. We then summarise some key evidence behind other therapeutic factors which have been demonstrated to affect outcome regardless of which manual is implemented, such as readiness to change and therapeutic alliance.

CONCLUSION

The paper concludes with implications and considerations for future research, clinical guidelines, training and supervision, highlighting the need to consider the therapeutic relationship and processes alongside manual content to conduct best evidence-informed practice.

Implementing evidence-based individual psychotherapies for adults with eating disorders in a real world clinical setting

OBJECTIVE

This study aimed to evaluate the effectiveness of evidenced-based psychological treatments (specifically, Cognitive-Behaviour Therapy for Eating Disorders [CBT-ED] and Maudsley Anorexia Nervosa Treatment for Adults [MANTRA]) for a transdiagnostic eating disorder population in a routine clinical setting. In particular, it aimed to determine the extent to which treatment was provided in line with current clinical guidelines (NICE, 2017) and how effective treatment was in improving eating disorder and general psychopathology.

METHOD

Three hundred and seventy-nine participants meeting criteria for DSM-5 anorexia nervosa, bulimia nervosa, binge-eating disorder or other specified feeding or eating disorder completed pre- and posttreatment measures of eating disorder pathology and general distress. Clinicians recorded weight and episodes of bingeing and purging.

RESULTS

Ninety seven percent of participants received treatment in line with evidence-based psychotherapies. Treatment was completed by 59.9% of the whole sample. Using stringent criteria and ITT analysis 21.4% met criteria for remission at end of treatment. In the underweight sample, there was a significant increase in BMI, averaging 1.38 kg/m² over treatment, with similar outcomes for MANTRA and CBT-ED.

DISCUSSION

These findings, in a large transdiagnostic population, add to emerging literature on the translation of evidence-based psychotherapies to real-world clinical settings. Our results converge well with prior similar studies. Findings highlight the need for routine data collection in services and for the ongoing improvement of treatments for the eating disorders.

Workforce Diversity in Eating Disorders: A Multi-Methods Study

Despite growing recognition of the importance of workforce diversity in health care, limited research has explored diversity among eating disorder (ED) professionals globally. This multi-methods study examined diversity across demographic and professional variables. Participants were recruited from ED and discipline-specific professional organizations. Participants' (n = 512) mean age was 41.1 years (SD = 12.5); 89.6% (n=459) of participants identified as women, 84.1% (n = 419) as heterosexual/straight, and 73.0% (n = 365) as White. Mean years working in EDs was 10.7 years (SD = 9.2). Qualitative analysis revealed three themes resulting in a theoretical framework to address barriers to increasing diversity. Perceived barriers were the following: "stigma, bias, stereotypes, myths"; "field of eating disorders pipeline"; and "homogeneity of the existing field." Findings suggest limited workforce diversity within and across nations. The theoretical model suggests a need for focused attention to the educational pipeline, workforce homogeneity, and false assumptions about EDs, and it should be tested to evaluate its utility within the EDs field.

Reasons for non-response and recommendations for optimal outpatient treatment of bulimia nervosa: A survey on German expert therapists' views

Objectives: Remission rates after treatment for bulimia nervosa can be considered insufficient. The study aimed to explore the perspective of expert psychotherapists on possible reasons for non-response and recommendations for an optimized treatment. Methods: Experts filled in a questionnaire that comprised questions about possible reasons for low remission rates as well as ratings of interventions suggested for different treatment phases and subgroups of patients. Results: 56 experienced therapists could be included in the survey. Ambivalence of patients, insufficient training of therapists and heterogeneity of the patient group were most often rated as possible reasons for insufficient outcomes. For optimized treatment, therapists recommended a combination of cognitive-behavioral and psychodynamic techniques, depending on treatment phase and patient characteristics. Conclusions: Further research should examine, if a more specific training of therapists, a more integrative approach and flexible adaptations of interventions to patients' characteristics are effective strategies to improve outcome.

A Tertiary-Care/Primary-Care Partnership Aimed at Improving Care for People with Eating Disorders

We describe the implementation and impact of a province-wide program of knowledge exchange (KE), aimed at developing capacity for the treatment of people with eating disorders (EDs). The program is designed to equip clinicians working in nonspecialized health-care installations with skills to evaluate and treat people with EDs. Trainings were conducted at 21 institutions. The majority of clinicians reported satisfaction with the KE program and indicated that the trainings enhanced their confidence and ability to treat patients with EDs. A subset of clinicians received case supervision with a specialist ED therapist and followed patients with EDs (n = 119). Treated patients showed significant improvements on eating and depressive symptoms, and reported satisfaction with the treatments they received.

Outpatient CBT for Underweight Patients with Eating Disorders: Effectiveness Within a National Health Service (NHS) Eating Disorders Service

Background: Underweight eating disorders (EDs) are notoriously difficult to treat, although a growing evidence base suggests that outpatient cognitive behaviour therapy for EDs (CBT-ED) can be effective for a large proportion of individuals. Aims: To investigate the effectiveness of CBT-ED for underweight EDs in a ‘real-world’ settings. Method: Sixty-three adults with underweight EDs (anorexia nervosa or atypical anorexia nervosa) began outpatient CBT-ED in a National Health Service setting. Results: Fifty-four per cent completed treatment, for whom significant changes were observed on measures of ED symptoms, psychological distress and psychosocial impairment. There was also a large effect on body weight at end-of-treatment. Conclusions: The results suggest that good outcomes can be achieved by the majority of those who complete treatment, although treatment non-completion remains a significant barrier to recovery. Future studies should focus on improving treatment retention, as evidence suggests that CBT-ED in ‘real-world’ settings is effective.

Subgrouping the users of a specialized app for eating disorders

Although mobile technologies for eating disorders (EDs) are burgeoning, there is limited data about the clinical characteristics of individuals using specialized smartphone applications (apps) without accompanying traditional forms of treatment. This study evaluated whether the users of an ED app cluster in clinically meaningful groups. Participants were 1,280 app users (91.3% female; mean age 27) who reported not being in a weekly treatment for their ED. A hierarchical cluster analysis distinguished five groups of participants, all approximating DSM-5 ED categories. One cluster comprised of non-female, ethnically diverse users with Bulimia Nervosa features. Findings suggest that app users resemble known patient classifications.

Implementation of enhanced cognitive behaviour therapy (CBT-E) for adults with anorexia nervosa in an outpatient eating-disorder unit at a public hospital

BACKGROUND

Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is supported by robust evidence. A few studies, most of which were performed by highly specialized research units, have indicated that enhanced cognitive behaviour therapy (CBT-E) for eating disorders can be effective. However, the dropout rate is high and the evidence from non-research clinical units is sparse.

METHODS

This quality assessment project implemented CBT-E in an outpatient setting at a public hospital. Forty-four patients with AN started therapy. Each patient received at least 40 sessions of CBT-E over a 12-month period. Their body mass index (BMI) was recorded at baseline and after 3, 6 and 12 months. Reasons for not starting therapy or for leaving therapy prematurely were recorded.

RESULTS

Half (n = 22) of the 44 patients who started outpatient CBT-E did not complete the treatment. In the remaining sample there was a large (and statistically significant) weight gain after 12 months. The percentage of patients achieving the target BMI of > 18.5 kg/m² was 36.4, 50.0 and 77.3% after 3, 6 and 12 months, respectively.

CONCLUSIONS

This quality assessment project shows that it is possible to establish effective CBT-E in an outpatient eating-disorder unit at a public hospital. Although half of the patients did not complete CBT-E, the remaining patients achieved a significant increase in BMI at 1 year after the start of therapy.

Empirical Examinations of Modifications and Adaptations to Evidence-Based Psychotherapies: Methodologies, Impact, and Future Directions

This review describes methods used to examine the modifications and adaptations to evidence-based psychological treatments (EBPTs), assesses what is known about the impact of modifications and adaptations to EBPTs, and makes recommendations for future research and clinical care. One hundred eight primary studies and three meta-analyses were identified. All studies examined planned adaptations, and many simultaneously investigated multiple types of adaptations. With the exception of studies on adding or removing specific EBPT elements, few studies compared adapted EBPTs to the original protocols. There was little evidence that adaptations in the studies were detrimental, but there was also limited consistent evidence that adapted protocols outperformed the original protocols, with the exception of adding components to EBPTs. Implications for EBPT delivery and future research are discussed.

Frontline clinicians' perspectives on and utilization of trauma-focused therapy with individuals with eating disorders

With this study, we sought to survey clinicians regarding their perspectives and use of concurrent or integrated psychotherapy for co-occurring eating disorders (EDs) and posttraumatic stress disorder. We conducted a quantitative survey of 184 frontline ED clinicians to investigate whether, and to what extent, they view concurrent EDs and trauma-focused therapy as clinically important. We also assessed clinicians' specific concerns regarding concurrent EDs and trauma-focused treatment, as well as barriers to implementation of an evidence-based concurrent treatment. On the whole, clinicians reported that addressing trauma-related symptoms in individuals with EDs is highly important and should be administered concurrently. Although clinicians reported anticipating many important benefits of concurrent treatment, they also reported anticipating several potential negative side effects, and they reported a number of perceived barriers to implementation. Clinicians working in hospital settings anticipated more complications, expected fewer benefits, and perceived more barriers to the administration of concurrent treatment.

Complexity in eating disorders: a case for simple or complex formulation and treatment?

Eating disorders are commonly regarded as complex psychiatric conditions, although this perception might be a product of the high levels of physical and psychological co-morbidity that are present in many such cases, rather than being about complexity in the eating disorderper se. This paper will consider the reasons that eating disorders are seen as complex, and whether or not that perceived complexity should be seen as a genuine reason to deviate from existing evidence-based cognitive behavioural therapy (CBT) protocols. Case examples will be used to illustrate how complex presentations can require clinicians to work skilfully with relatively simple formulations to achieve the best outcome, rather than using unnecessarily complex formulations and treatments. The importance of clear supervision is also stressed, as it can play a role in clinicians’ perception of the need for a complex or simple formulation, it can support the clinician in developing a collaborative, focused and efficient formulation, and it can keep the clinician on track with an evidence-based CBT approach.

The effectiveness of family-based treatment for full and partial adolescent anorexia nervosa in an independent private practice setting: Clinical outcomes

OBJECTIVE

Anorexia nervosa (AN) is a severe psychiatric illness with little evidence supporting treatment in adults. Among adolescents with AN, family-based treatment (FBT) is considered first-line outpatient approach, with a growing evidence base. However, research on FBT has stemmed from specialist services in research/public health settings. This study investigated the effectiveness of FBT in a case series of adolescent AN treated in a private practice setting.

METHOD

Thirty-four adolescents with full or partial AN, diagnosed according to DSM-IV criteria, participated, and were assessed at pretreatment and post-treatment. Assessments included change in % expected body weight, mood, and eating pathology.

RESULTS

Significant weight gain was observed from pretreatment to post-treatment. 45.9% of the sample demonstrated full weight restoration and a further 43.2% achieved partial weight-based remission. Missing data precluded an examination of change in mood and ED psychopathology.

DISCUSSION

Effective dissemination across different service types is important to the wider availability of evidence-based treatments. These weight restoration data lend preliminary support to the implementation of FBT in real world treatment settings. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1023-1026).

Effectiveness of enhanced cognitive behavioral therapy (CBT-E) in the treatment of anorexia nervosa: a prospective multidisciplinary study

BACKGROUND

Anorexia nervosa (AN) is a debilitating psychiatric disorder associated with a wide array of negative health complications and psychiatric comorbidity. Existing evidence for AN treatment in adults is weak, and no empirically supported treatment has been reliably established. The primary objective of this study is to gain knowledge about the effectiveness of enhanced cognitive behavioral therapy (CBT-E) for anorexia nervosa delivered in a public hospital setting. Baseline predictors of treatment outcome and dropout are studied. Furthermore, there will be collected blood and stool samples for a general biobank to be able to initiate research on possible pathophysiological mechanisms underlying AN.

METHODS

The study will assess the potency of outpatient CBT-E in a sample of patients suffering from AN (age >16) admitted to the Section for Eating Disorders at the Department for Psychosomatic Medicine, Haukeland University Hospital in Bergen, Norway. The study has a longitudinal design with five main assessment time points: before treatment, at 3 months, at the end of treatment, at 20 weeks, and at 12 months follow-up including biobank samples. A control group without an eating disorder will also be recruited.

DISCUSSION

Treatment research in a public hospital setting is important for gaining knowledge about the transportability of treatments evaluated in research clinics into ordinary clinical practice. Furthermore, biological material from the thoroughly described patient cohort will serve as a basis for further research on the pathophysiological mechanisms in AN.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02745067 . Registered 14 April 2016. .

Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track

Therapist drift occurs when clinicians fail to deliver the optimum evidence-based treatment despite having the necessary tools, and is an important factor in why those therapies are commonly less effective than they should be in routine clinical practice. The research into this phenomenon has increased substantially over the past five years. This review considers the growing evidence of therapist drift. The reasons that we fail to implement evidence-based psychotherapies are considered, including our personalities, knowledge, emotions, beliefs, behaviours and social milieus. Finally, ideas are offered regarding how therapist drift might be halted, including a cognitive-behavioural approach for therapists that addresses the cognitions, emotions and behaviours that drive and maintain our avoidance of evidence-based treatments.

Disseminating evidence-based psychological treatments for eating disorders

The research-practice gap is of concern in the treatment of eating disorders. Despite the existence of empirically supported treatments, few receive them. The barriers to wider dissemination and implementation of evidence-based treatment include clinician attitudes towards such treatments and the lack of sufficient numbers of suitably trained therapists to provide treatment. In this review we discuss these barriers in the context of the wider issue of the dissemination and implementation of psychological treatments and review the research with regard to the treatment of eating disorders. Particular emphasis is placed on examining recent efforts to expand the availability and reach of treatments by making treatment delivery and training more scalable. We highlight promising developments and areas where further research is needed.

Clinician adherence to guidelines in the delivery of family-based therapy for eating disorders

OBJECTIVE

Clinicians have been shown to drift away from protocol in their delivery of evidence-based treatments. This study explores this phenomenon in the delivery of family-based therapy (FBT) for eating disorders, and the clinician characteristics that might explain such therapist drift.

METHOD

The participants were 117 clinicians who reported using FBT for eating disorders. They completed an online survey, which included questions relating to clinician characteristics, caseload, and reported use of FBT manuals and core therapeutic tasks, as well as a measure of anxiety.

RESULTS

The use of core FBT tasks was higher than for other therapies, but there were still noteworthy gaps between recommended and reported practice. Approximately a third of clinicians reported delivering "FBT" that deviated very substantially from evidence-based protocols, often appearing to be on an individual therapy basis. Using an FBT manual to guide treatment delivery was associated with greater adherence to recommended techniques. Clinician caseload and anxiety were associated with differences in the use of specific FBT tasks.

DISCUSSION

Consistent with previous research regarding clinicians' use of other therapies, the delivery of FBT for the eating disorders is not homogeneous.

CONCLUSION

Further investigation of this phenomenon is needed to determine the impact of deviating from treatment protocols on the effectiveness of FBT for the eating disorders.

Medication and psychotherapy in eating disorders: is there a gap between research and practice?

BACKGROUND

Little research has investigated the use of evidence-based guidelines by eating disorder (ED) therapists, or prescribing of psychotropic medication. Moreover, people with EDs have rarely been surveyed on these topics, and their clinical and demographic features have not been presented. This study investigated perception of psychotherapy, psychotropic medication and the clinical characteristics of a community sample of people with EDs.

METHOD

An online survey methodology was used to recruit 253 people with eating disorders in the community. Where feasible, comparisons were made between four types of eating disorder, anorexia nervosa, bulimia nervosa, and two types of atypical or 'sub-threshold' eating disorder.

RESULTS

Unlike medication, reported psychotherapy showed some congruence with evidence based and other guidance. Most participants were currently receiving either psychotherapy, medication or both, and most had a severe and chronic ED.

CONCLUSIONS

Findings are considered in light of use of evidence-based treatment for EDs, calls for greater dissemination of cognitive behaviour therapy (CBT); indications that much may be poor quality; and the importance of what treatments to offer those who are chronically and severely ill. Development of theory and novel treatments is considered a priority.

The influence of clinician emotion on decisions in child and adolescent eating disorder treatment: a survey of self and others

Eating disorder clinicians from various disciplines participated in one of two surveys: the "self" group (n = 143) completed a survey assessing the negative influence of emotions on their own clinical decisions, while the "other" group (n = 145) completed a parallel version of the survey that assessed their perceptions of the negative influence of emotion in their colleagues. Both groups endorsed this phenomenon to some degree, although differences in reporting were noted between groups. The perceived negative influence of emotion with regards to specific treatment decisions fell within three categories: decisions regarding food and weight, decisions regarding the involvement of the family in treatment, and decisions related to autonomy and control. Decisions regarding the involvement of the family were perceived to be the most emotionally charged, in particular the involvement of a critical or dismissive parent.

Clinicians' concerns about delivering cognitive-behavioural therapy for eating disorders

Despite research supporting the effectiveness of evidence-based interventions in the treatment of eating disorders, those interventions are under-utilised in routine clinical practice, possibly due to clinicians' concerns about delivering the relevant techniques. This study examined what elements of therapy clinicians worry about when delivering cognitive-behavioural therapy (CBT) for the eating disorders, and what clinician variables are associated with such concerns. The participants were 113 clinicians who used individual CBT with eating disorder patients. They completed a novel measure of concerns about delivering elements of CBT, as well as demographic characteristics and a standardised measure of intolerance of uncertainty. Clinicians worried most about body image work and ending treatment, but least about delivering psychoeducation. Their concerns fell into four distinct factors. Older, more experienced clinicians worried less about delivering the CBT techniques, but those with greater levels of prospective and inhibitory anxiety worried more about specific factors in the CBT techniques. Clinicians' capacity to tolerate uncertainty might impair their delivery of evidence-based CBT, and merits consideration as a target in training and supervision of CBT clinicians.

Psychological treatments for eating disorders

PURPOSE OF REVIEW

This review summarizes recent evidence on psychological treatments for eating disorders.

RECENT FINDINGS

Eating disorders are serious psychiatric conditions requiring evidence-based intervention. Treatments have been evaluated within each eating disorder diagnosis and across diagnoses. For adults with anorexia nervosa, no one specialist treatment has been shown to be superior. Cognitive behavioral therapy and interpersonal psychotherapy remain the most established treatments for bulimia nervosa and binge eating disorder, with stepped-care approaches showing promise and new behavioral treatments under study. Enhanced cognitive behavioral therapy has improved symptoms in adults and youth. Maudsley family-based therapy is the most established treatment for youth with anorexia nervosa and may be efficacious for youth with bulimia nervosa. Interpersonal psychotherapy for the prevention of excess weight gain may be efficacious for reducing loss of control eating and weight gain in overweight youth.

SUMMARY

Significant advances in treatments have been made, including evaluation of long-term outcomes, novel approaches, and tailored extension for specific patient profiles. However, widespread access to effective eating disorder treatments remains limited. Increasing the potency and expanding the implementation of psychological treatments beyond research settings into clinical practice has strong potential to increase access to care, thereby reducing the burden of eating disorders.

A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder

This study examined the efficacy of guided self-help based on dialectical behaviour therapy (DBTgsh) for binge eating disorder (BED). Individuals (88.3% female; mean 42.8 years) were randomized to DBTgsh (n=30) or wait-list (WL; n=30). DBTgsh participants received an orientation, DBT manual, and six 20-min support calls over 13 weeks. All participants were assessed pre- and post-treatment using interview and self-report; also, DBTgsh participants were re-assessed six months post-treatment. At treatment end, DBTgsh participants reported significantly fewer past-month binge eating episodes than WL participants (6.0 versus 14.4) and significantly greater rates of abstinence from binge eating (40.0% versus 3.3%). At six-month follow-up, DBTgsh participants reported significantly improved quality of life and reduced ED psychopathology compared to baseline scores. In addition, most improvements in the DBTgsh group were maintained, although binge eating abstinence rates decreased to 30%. These preliminary positive findings indicate that DBTgsh may offer an effective, low-intensity treatment option for BED.

The research-practice gap: bridging the schism between eating disorder researchers and practitioners

OBJECTIVE

The field of eating disorders (EDs) treatment has been beset by a marked disjunction between scientific evidence and clinical application. We describe the nature and scope of the research-practice gap in the ED field.

METHOD

We draw on surveys and broader literature to better understand the research-practice gap in ED treatment and reasons for resistance to evidence-based practice.

RESULTS

We identify three sources of the research-practice gap: (1) attitudinal factors, (2) differences in the definition of "evidence," and (3) cognitive factors, especially naïve realism and confirmation bias. We affirm the role of science as a safeguard against human fallibility and as a means of bridging the research-practice gap, and delineate key principles of scientific thinking for ED researchers and practitioners.

DISCUSSION

We conclude with proposals for narrowing the research-practice gap in ED treatment and enhancing the quality of interventions for ED clients.

A system of evidenced-based techniques and collaborative clinical interventions with a chronically ill patient

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.