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Mulgrew KE, Hinz A, Bray M, Jona CMH, Merollini KMD. A qualitative analysis of the usefulness, risks, and challenges of incorporating functionality and body compassion into the prevention and treatment of eating disorders. Body Image 2024; 51:101754. [PMID: 38861766 DOI: 10.1016/j.bodyim.2024.101754] [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: 02/21/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Abstract
Functionality appreciation and body compassion are empirically supported concepts that can help one to view their body in different and compassionate ways. However, they have yet to be applied to eating disorder (ED) samples and therefore it is important to explore the perceived benefit, risk, and nuance in this population. Semi-structured interviews (N = 25) were conducted with treatment providers, those with a lived experience of an ED, or history of body image distress. Usefulness, applicability, potential risks, benefits, and desired delivery format were probed. Thematic analysis was used. Participants reported that compassion and functionality approaches were useful, complement existing treatment approaches, and important for early intervention. Although considered safe, caveats were noted for ED samples, including introducing content at the right time (e.g., when medically stable), and when having the cognitive flexibility to think about one's body in different ways. For example, functionality appreciation could trigger thoughts about what one's body cannot do while compassion may allow for normalising negative thoughts. Both concepts were viewed as useful and safe to support positive body image at a community level and can be used with ED samples with additional support. This insight from potential users helps with co-design of appropriate content.
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Affiliation(s)
- Kate E Mulgrew
- School of Health, University of the Sunshine Coast, Australia.
| | - Angela Hinz
- School of Health, University of the Sunshine Coast, Australia
| | | | - Celine M H Jona
- School of Health, University of the Sunshine Coast, Australia
| | - Katharina M D Merollini
- School of Health, University of the Sunshine Coast, Australia; Sunshine Coast Health Institute, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
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2
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Elwyn R, Adams M, Sharpe SL, Silverstein S, LaMarre A, Downs J, Burnette CB. Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality. J Eat Disord 2024; 12:70. [PMID: 38831456 PMCID: PMC11145809 DOI: 10.1186/s40337-024-01016-w] [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: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a 'terminal' illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED 'staging' discourse. Conceptually, 'terminality' interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individual's eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a 'terminal' ED to a variety of definitions of 'recovery'. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and psychiatry, Thompson Institute, Birtinya, QLD, Australia
- University of the Sunshine Coast, Birtinya, QLD, Australia
| | | | - Sam L Sharpe
- Fighting Eating Disorders in Underrepresented Populations (FEDUP, Collective), West Palm Beach, FL, USA
| | | | | | | | - C Blair Burnette
- Department of Psychology, Michigan State University, Lansing, MI, USA.
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3
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Melisse B, van den Berg E, de Beurs E. Effectiveness of web-based guided self-help cognitive behavioral therapy-enhanced for binge-eating disorder: An implementation study. Int J Eat Disord 2024; 57:1379-1389. [PMID: 37876352 DOI: 10.1002/eat.24079] [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: 06/19/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Web-based guided self-help cognitive behavioral therapy-enhanced (CBT-E) is a 12-weeks, 12-sessions, digitalized version of part II of the self-help book Overcoming Binge Eating. This intervention is effective when offered under controlled circumstances in a randomized-controlled-trial. It is unknown how patients with binge-eating disorder (BED) respond to this intervention when offered in real-world clinical-settings. The aim of this study is to examine post-intervention effectiveness of guided self-help CBT-E for BED in real-world settings. METHOD The present study used a cohort-design examining the effectiveness of web-based guided self-help CBT-E according to an intention-to-treat (ITT) analysis. BED patients (n = 278) were assessed pre- and post-intervention. The primary outcome was reduction in binge-eating episodes. Other outcomes were full-recovery (EDE-Q score <2.77 and abstinence from binge-eating episodes), impaired psychosocial functioning, defined as secondary impairment, and general psychopathology post-intervention. RESULTS The number of binge-eating episodes reduced by an average of 16 binge-eating episodes per 4 weeks pre-intervention to five binge-eating episodes during the last 4 weeks of treatment. Abstinence from binge eating was reported by 30%, and 28% reported full recovery. Effect sizes (Cohen's d) were large (d ≥ 1.0) for all outcome measures. There were no differences in outcomes between the ITT and the completers sample. DISCUSSION Guided self-help CBT-E is associated with significant improvements. The effects of guided self-help CBT-E offered in a real-world-setting are comparable to self-help CBT-E offered in a randomized-controlled-trial. However, it should be noted that comparisons with randomized-controlled-trials requires caution. Longer-term follow-up data are necessary to measure persistence of treatment benefits. PUBLIC SIGNIFICANCE Offering CBT-E as a web-based guided self-help intervention has several benefits for patients with BED. Guided self-help CBT-E is associated with significant improvements on the short term when offered in real-world clinical settings.
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Affiliation(s)
- Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
- Section Clinical Psychology, Leiden University, Leiden, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
| | - Edwin de Beurs
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
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Driscoll DJO, Fagan J, Jennings R, Clifford M, Maher C, Corbett M, Wade S, McDevitt S. National Clinical Programme for Eating Disorders: a pragmatic review of a new national eating disorder service in Ireland. Ir J Psychol Med 2024; 41:68-77. [PMID: 35678376 DOI: 10.1017/ipm.2022.30] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Health Service Executive National Clinical Programme for Eating Disorders (NCPED) launched a Model of Care for Eating Disorder Services in Ireland in 2018. Currently, one adult and two child and adolescent eating disorder services are operational out of a total of sixteen recommended. The three objectives of this paper are to describe the early (1) referral pattern, (2) level of service activity and (3) the level of service user satisfaction. METHOD Monthly submitted service activity data from each service to the NCPED between March 2018 and October 2020 were retrospectively analysed. One hundred and fifty-nine carers and service users completed an experience of service questionnaire (ESQ). A descriptive analysis of referral pattern, level of service activity and ESQ was performed. A thematic analysis was performed on three qualitative questions on the ESQ. RESULTS There was substantial referral numbers to eating disorder services by 18 months (n = 258). The main referral source was community mental health teams. The majority (n = 222, 86%) of referrals were offered an assessment. The most common age profile was 10-17 years of age (n = 120, 54.1%), and anorexia nervosa was the most common disorder (n = 96, 43.2%). ESQ results demonstrate that most service users were satisfied with their service, and the main themes were carer involvement, staff expertise, therapeutic alliance and service access. CONCLUSIONS This preliminary service activity and service user satisfaction data highlight several issues, including trends when setting up a regional eating disorder service, potential pitfalls of pragmatic data collection and the need for adequate information-technology infrastructure.
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Affiliation(s)
- David J O Driscoll
- Cork and Kerry Regional Eating Disorder Service, National Clinical Programme for Eating Disorders (CAREDS), St. Stephens Hospital, Glanmire, Cork, Ireland
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
| | - Jennifer Fagan
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
- Linn Dara Child & Adolescent Mental Health Services, Eating Disorder Service, Cherry Orchard Hospital, Dublin, Ireland
| | - Rhona Jennings
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
| | - Michelle Clifford
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
- Linn Dara Child & Adolescent Mental Health Services, Eating Disorder Service, Cherry Orchard Hospital, Dublin, Ireland
| | - Caroline Maher
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
- Eating Disorder Service, St. Vincent's University Hospital, Dublin, Ireland
| | - Marie Corbett
- Cork and Kerry Regional Eating Disorder Service, National Clinical Programme for Eating Disorders (CAREDS), St. Stephens Hospital, Glanmire, Cork, Ireland
| | | | - Sara McDevitt
- Cork and Kerry Regional Eating Disorder Service, National Clinical Programme for Eating Disorders (CAREDS), St. Stephens Hospital, Glanmire, Cork, Ireland
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
- University College Cork, Cork, Ireland
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5
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Bray M, Heruc G, Evans L, Wright ORL. The imperative of collaboration: Lived experience perspectives on team approaches in outpatient eating disorder treatment. Int J Eat Disord 2024; 57:116-123. [PMID: 37902406 DOI: 10.1002/eat.24084] [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: 06/28/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Across healthcare broadly, team treatment approaches range from siloed multidisciplinary treatment to synergistic Interprofessional Collaborative Practice (IPCP), with IPCP increasingly favored. In eating disorders, clinical practice guidelines endorse team outpatient treatment, and these approaches are widely used in clinical practice. However, there is limited evidence to describe attitudes toward and experiences of team approaches, including IPCP, among individuals with a lived experience. METHOD Twenty-seven participants (aged 20-51 years) with a formal eating disorder diagnosis were recruited. Each had received outpatient eating disorder treatment from a team or teams comprising a mental health professional, dietitian, and general practitioner (GP) in the past 2 years. Qualitative data were collected via semi-structured interviews and analyzed using Braun and Clarke's reflexive thematic analysis. RESULTS Four themes were derived from the qualitative analysis. Themes included: (1) working together is better; (2) the linchpin of teamwork is communication; (3) teams should foster autonomy with limit-setting; and (4) systemic failures negatively affect team treatment. Participants favored highly collaborative treatment from a team including a mental health professional, dietitian, and GP at a minimum, where the team engaged in high-quality communication and fostered autonomy with limit-setting. Systemic failures negatively affecting team treatment were reported across the care continuum. DISCUSSION Findings endorse the application of IPCP to outpatient eating disorder treatment as a strategy to improve treatment satisfaction, engagement, and outcomes. Given the paucity of evidence exploring IPCP in this field, however, the development and evaluation of interprofessional education and treatment models is a foundational necessity. PUBLIC SIGNIFICANCE Team eating disorder treatment is widely used in clinical practice, although there is limited evidence to guide interventions. This study explores attitudes toward and experiences of team outpatient eating disorder treatment among individuals with a lived experience. Understanding preferred team treatment characteristics delivers important information to improve treatment satisfaction, engagement, and outcomes for individuals receiving outpatient eating disorder treatment.
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Affiliation(s)
- Megan Bray
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Gabriella Heruc
- Eating Disorders and Nutrition Research Group (ENRG), Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Lacey Evans
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
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6
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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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Schleider JL, Smith AC, Ahuvia I. Realizing the untapped promise of single-session interventions for eating disorders. Int J Eat Disord 2023; 56:853-863. [PMID: 36815724 PMCID: PMC10159985 DOI: 10.1002/eat.23920] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/12/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Multilevel treatment barriers prevent up to 80% of individuals experiencing eating disorders (EDs) from accessing care. This treatment gap creates a critical need to identify interventions that are accessible, easily completable, and optimized for effectiveness by targeting core mechanisms linked to ED onset and maintenance. We propose single-session interventions (SSIs) as a promising path toward catalyzing innovation in the development of accessible, effective ED interventions. SSIs are structured programs that intentionally involve one encounter with a program or provider; they may serve as stand-alone or adjunctive clinical supports. All SSIs are built to acknowledge that any session might be someone's last-and that any single session can nonetheless yield meaningful clinical benefit. METHOD We define SSIs, summarize research supporting their utility for ED symptoms and other mental health problems, and recommend future directions for work in this domain. RESULTS Single-session interventions may hold promise to reduce some ED symptoms and risk factors, including restrictive eating and negative body image. Steps toward realizing this promise include (1) testing whether existing evidence-based SSIs (e.g., for depression) can also reduce EDs, risk factors, and symptoms; (2) developing novel SSIs that target modifiable ED risk factors and symptoms largely unaddressed by SSIs, such as purging and binge eating; (3) studying diverse implementation pathways; (4) capitalizing on SSIs' transdiagnostic utility to broaden funding opportunities; and (5) educating ED researchers and clinicians about SSIs. DISCUSSION Understanding the strengths and limits of mechanism-targeted SSIs for ED-related problems could be a low-risk, high-reward avenue toward reducing EDs at scale. PUBLIC SIGNIFICANCE Most individuals experiencing EDs never access any form of treatment, creating an urgent need to identify ED interventions built to overcome barriers to engaging with care. This Forum article introduces SSIs as a promising path to rapidly developing and testing accessible, evidence-based ED supports; supplementing existing ED treatment models; and reducing the individual, familial, and societal burdens of EDs at scale.
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Affiliation(s)
| | | | - Isaac Ahuvia
- Department of Psychology, Stony Brook University
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Melisse B, Berg EVD, Jonge MD, Blankers M, Furth EV, Dekker J, Beurs ED. Efficacy of Web-Based, Guided Self-help Cognitive Behavioral Therapy-Enhanced for Binge Eating Disorder: Randomized Controlled Trial. J Med Internet Res 2023; 25:e40472. [PMID: 37126386 PMCID: PMC10186189 DOI: 10.2196/40472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/07/2022] [Accepted: 03/08/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Owing to the gap between treatment supply and demand, there are long waiting periods for patients with binge eating disorder, and there is an urgent need to increase their access to specialized treatment. Guided self-help cognitive behavioral therapy-enhanced (CBT-E) may have great advantages for patients if its efficacy can be established. OBJECTIVE The aim of this study was to examine the efficacy of guided self-help CBT-E compared with that of a delayed-treatment control condition. METHODS A single-blind 2-arm randomized controlled trial was designed to evaluate guided self-help CBT-E according to an intention-to-treat analysis. A total of 180 patients were randomly assigned to guided self-help CBT-E (n=90, 50%) or the delayed-treatment control condition (n=90, 50%) for which guided self-help CBT-E was provided after the initial 12-week delay. The primary outcome was reduction in binges. The secondary outcome was full recovery at the end of treatment, as measured using the Eating Disorder Examination during the last 4 weeks of treatment. A linear mixed model analysis was performed to compare treatment outcomes at the end of treatment. A second linear mixed model analysis was performed to measure between- and within-group effects for up to 24 weeks of follow-up. The Eating Disorder Examination-Questionnaire and clinical impairment assessment were conducted before and after treatment and during follow-up. In addition, dropout rates were assessed in both conditions. RESULTS During the last 4 weeks of treatment, objective binges reduced from an average of 19 (SD 16) to 3 (SD 5) binges, and 40% (36/90) showed full recovery in the guided self-help CBT-E group. Between-group effect size (Cohen d) was 1.0 for objective binges. At follow-up, after both groups received treatment, there was no longer a difference between the groups. Of the 180 participants, 142 (78.9%) completed treatment. The overall treatment dropout appeared to be associated with gender, level of education, and number of objective binges at baseline but not with treatment condition. CONCLUSIONS This is the first study to investigate the efficacy of guided self-help CBT-E. Guided self-help CBT-E appeared to be an efficacious treatment. This study's findings underscore the international guidelines recommending this type of treatment for binge eating disorder. TRIAL REGISTRATION Netherlands Trial Registry (NTR) NL7994; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7994. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-020-02604-1.
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Affiliation(s)
- Bernou Melisse
- Novarum Center for Eating Disorders, Amstelveen, Netherlands
- Section Clinical Psychology, Leiden University, Leiden, Netherlands
| | | | - Margo de Jonge
- Novarum Center for Eating Disorders, Amstelveen, Netherlands
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Amsterdam, Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
- Department of Psychiatry, Location AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eric van Furth
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Edwin de Beurs
- Section Clinical Psychology, Leiden University, Leiden, Netherlands
- Research Department, Arkin Mental Health Institute, Amsterdam, Netherlands
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Allen KL, Mountford VA, Elwyn R, Flynn M, Fursland A, Obeid N, Partida G, Richards K, Schmidt U, Serpell L, Silverstein S, Wade T. A framework for conceptualising early intervention for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023; 31:320-334. [PMID: 36426567 PMCID: PMC10100476 DOI: 10.1002/erv.2959] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders. METHOD AND RESULTS Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence-based approaches to early intervention for eating disorders and progress is being made in scaling these. CONCLUSIONS We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics.
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Affiliation(s)
- Karina L Allen
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Victoria A Mountford
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,LightHouse Arabia, Dubai, United Arab Emirates
| | - Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Gubbi Gubbi Country, Queensland, Australia
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Georgina Partida
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Katie Richards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Eating Disorder Service, North East London NHS Foundation Trust, Essex, UK
| | | | - Tracey Wade
- Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
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10
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Bray M, Heruc G, Byrne S, Wright ORL. Collaborative dietetic and psychological care in Interprofessional Enhanced Cognitive Behaviour Therapy for adults with Anorexia Nervosa: a novel treatment approach. J Eat Disord 2023; 11:31. [PMID: 36849895 PMCID: PMC9972764 DOI: 10.1186/s40337-023-00743-w] [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: 11/29/2022] [Accepted: 02/02/2023] [Indexed: 03/01/2023] Open
Abstract
Clinical practice guidelines for anorexia nervosa (AN) and atypical anorexia nervosa recommend treatment from a team including a mental health professional and a dietitian. To date, however, AN treatment models such as Enhanced Cognitive Behaviour Therapy (CBT-E) seldom include dietitians and have low to moderate treatment efficacy. Given interprofessional approaches to healthcare have been shown to improve treatment outcomes and enhance patient and clinician satisfaction, formalising collaborative dietetic and psychological treatment may be a feasible strategy to improve treatment outcomes and the patient and clinician experience of treatment. Moreover, malnutrition is a serious consequence of AN, and dietitians are considered experts in its diagnosis and treatment. This paper proposes a novel treatment approach, Interprofessional Enhanced Cognitive Behaviour Therapy (CBT-IE), an adaptation of CBT-E where dietitians deliver content related to malnutrition and dietary restraint and mental health professionals deliver content related to cognitive and behavioural change. The rationale for developing CBT-IE, treatment structure, and future research directions is discussed.
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Affiliation(s)
- Megan Bray
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
| | - Gabriella Heruc
- Eating Disorders and Nutrition Research Group (ENRG), School of Medicine, Western Sydney University, Penrith, Australia
| | | | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
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Luangapichart P, Saisavoey N, Viravan N. Efficacy and Feasibility of the Minimal Therapist-Guided Four-Week Online Audio-Based Mindfulness Program 'Mindful Senses' for Burnout and Stress Reduction in Medical Personnel: A Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10122532. [PMID: 36554056 PMCID: PMC9778772 DOI: 10.3390/healthcare10122532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Previous online mindfulness-based interventions for burnout and stress reduction in medical personnel had limited effect size and high dropout rate, so we developed a new online mindfulness program 'Mindful Senses (MS)' with aims to increase effect size and lower dropout rate. To test its efficacy and feasibility, ninety medical personnel with moderate or high levels of burnout and stress from across Thailand were recruited and randomly allocated into Group A and Group B equally. Group A read psychological self-help articles (PSA) and attended MS program through smartphone application during weeks 1-4. Group B read PSA during weeks 1-4 and attended MS program during weeks 9-12. Burnout, stress, anxiety, depression, mindfulness, and quality of life were measured at baseline, week 4, and week 8 for both groups, and at weeks 12 and 16 for Group B. Group x time interaction was analyzed by repeated-measures ANOVA. The results showed that, compared to PSA only, MS + PSA had statistically significant improvement of burnout, stress, anxiety, depression, mindfulness, and quality of life with moderate-to-very large effect sizes at week 4 (d = 1.33, 1.42, 1.04, 1.14, 0.70, and 1.03, respectively) and moderate-to-large effect sizes at week 8 (d = 0.84, 0.98, 0.73, 0.73, 0.66, and 0.94, respectively). The dropout rate was 4.4%. In conclusion, the MS program has potential to be an alternative intervention for medical personnel suffering from burnout and stress.
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Johnson C, Cook L, Cadman K, Andersen T, Williamson P, Wade TD. Evaluating an implementation model of evidence-based therapy for eating disorders in non-specialist regional mental health settings. J Eat Disord 2022; 10:170. [PMID: 36397157 PMCID: PMC9670061 DOI: 10.1186/s40337-022-00695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many people with eating disorders (EDs) either do not access treatment, access it well after symptoms first start, or drop out of treatment. This study evaluated ways to improve early access to evidence-based interventions for those with EDs in a non-specialist community setting. METHODS In an Australian regional community, links were formed between general medical practitioners and treatment providers (psychologists, mental health social workers and dietitians), who received ongoing training, feedback and support. Service users had access to 20-40 subsidised treatment sessions. Data were collected from 143 patients over 18 months. Our outcomes are reported according to the RE-AIM implementation framework: Reach (we measured uptake and treatment completion); Effectiveness (impact on disordered eating cognitions, body mass index, remission, and moderators of effectiveness including illness duration, previous treatment, presence of comorbidities, presence of a normative level of disordered eating, presence of any ED behaviours, weighing in treatment, multidisciplinary case conferencing, number of dietetic sessions); Adoption (drop-out and predictors); Implementation (barriers encountered); Maintenance (subsequent activity designed to embed new practices). RESULTS Treatment was completed by 71%; significant large decreases in eating disorder cognitions were achieved; remission was obtained by 37% (intent-to-treat). Treatment completion was predicted by lower baseline levels of disordered eating, uptake of ≥ 3 dietetic sessions, and ≥ 2 team case conferences. Greater improvement over time was predicted by regular case conferencing and in-session weighing. CONCLUSIONS Implementation of this model in a regional community setting produced completion rates and outcomes comparable to those found in specialist clinical trials of ED treatments. Service providers identified care coordination as the most important factor to connect users to services and help navigate barriers to ongoing treatment. TRIAL REGISTRATION This research was an invited evaluation of a project implemented by the Australian Department of Health. The project did not introduce any new clinical practice but sought to improve access to evidence-based multidisciplinary treatment for people with EDs by removing four known systemic barriers: securing an accurate diagnosis, availability of multidisciplinary treatment, cost of treatment, and intensity of treatment. As such, the project did not require trial registration. Notwithstanding, this evaluation obtained ethics approval (Bellberry Human Research Ethics Committee, Application No: 2018-09-728-FR-1).
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Affiliation(s)
| | | | - Kath Cadman
- The Butterfly Foundation, Crows Nest, Australia
| | | | - Paul Williamson
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Tracey D Wade
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
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13
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Models of care for eating disorders: findings from a rapid review. J Eat Disord 2022; 10:166. [PMID: 36380363 PMCID: PMC9667640 DOI: 10.1186/s40337-022-00671-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Delayed diagnosis, gaps in services and subsequent delays in specialist care and treatment lead to poorer health outcomes for individuals with eating disorders (EDs) and drive significant government healthcare expenditure. Given the significant disease burden associated with EDs, it is imperative that current implementation research is summarised to identify gaps in care and enable refinement for optimal patient outcomes. This review aimed to provide an updated synthesis on models of care for EDs in developed healthcare systems. METHODS This paper was conducted as part of a series of Rapid Reviews (RRs) to be published in a special series in the Journal of Eating Disorders. To provide a current and rigorous review, peer-reviewed articles published in the English language between 2009 and 2021 across three databases (ScienceDirect, PubMed and Ovid/Medline) were searched, with priority given to higher level evidence (e.g., meta-analyses, large population studies, Randomised Control Trials (RCTs)). The current review synthesises data from included studies investigating models of care for people with EDs. RESULTS Sixty-three studies (4.5% of the original RR) were identified, which included several diagnostic populations, the most common being Anorexia Nervosa (AN) (30.51%). Across EDs, specialist care was found to improve patient outcomes, with many patients effectively being treated in outpatient or day programs with multi-disciplinary teams, without the need for lengthy inpatient hospitalisation. Few studies investigated the interaction of different ED services (e.g., inpatient, community services, primary care), however stepped care models emerged as a promising approach to integrate ED services in a targeted and cost-effective way. Issues surrounding low treatment uptake, underdiagnosis, long waiting lists and limited hospital beds were also evident across services. CONCLUSION Findings suggested further research into alternatives to traditional inpatient care is needed, with partial and shorter 'hospitalisations' emerging as promising avenues. Additionally, to tackle ongoing resource issues and ensure timely detection and treatment of EDs, further research into novel alternatives, such as active waiting lists or a greater role for primary care clinicians is needed. This paper is part of a larger Rapid Review series carried out to guide Australia's National Eating Disorders Research and Translation Strategy 2021-2031. Rapid reviews aim to thoroughly summarise an area of research over a short time period, typically to help with policymaking in this area. This Rapid Review summarises the evidence relating to how we care for people with eating disorders in Western healthcare systems. Topics covered include inpatient/hospital care, residential care, day programs, outpatient/community care, and referral pathways. Findings suggested specialist eating disorder services may enhance detection, referral, and patient care. Stepped care models presented as a cost-effective approach which may help with linkage between different eating disorder services. There was a trend towards shorter hospital stays and approaches which allow for greater connection with the community, such as day programs. Evidence was also found of treatment delays, due to system issues (long waiting lists, lack of accurate assessment and diagnosis) and patient-related barriers (stigma, recognition). Upskilling and involving primary care clinicians in diagnosis and referral as part of a stepped care model may help to address some of these concerns. Further efforts to improve mental health literacy and de-stigmatise help-seeking for eating disorders are needed.
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14
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Fowler PJ, Marcal KE, Hovmand PS. Meeting housing needs of child welfare-involved families: Policy insights from simulation modeling. CHILD ABUSE & NEGLECT 2022; 132:105809. [PMID: 35882089 DOI: 10.1016/j.chiabu.2022.105809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/24/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Inadequate housing contributes to the risk of family separation in nearly one-quarter of child maltreatment investigations. Child welfare struggles to identify and address the demand for housing assistance. A range of housing interventions shows promise for stabilizing families. Still, aid remains difficult to access, and little evidence exists for prioritizing households to interventions. Inefficient decisions about who to serve with scarce housing resources threaten to diminish resources and unintentionally place children at greater risk. OBJECTIVE The present study leverages computational modeling to simulate the complex dynamics of coordinated child welfare response to inadequate housing. Simulations address the lack of microdata on current service delivery to inform policy-making that protects children from family insecurity. PARTICIPANTS AND SETTINGS A series of simulated policy experiments test strategies for maximizing access to appropriate housing assistance and minimizing system-wide family separations using US estimates of housing insecurity and child welfare involvement. Models incorporate the feedback loops involved in seeking and waiting for needed services, using information on national rates of housing insecurity among child welfare-involved families. RESULTS Results demonstrate population-level improvements in family stability from enhanced targeting of housing assistance to families most likely to benefit, plus expanded access to housing interventions. Neither improved screening procedures nor more housing supports alone improve child welfare outcomes. CONCLUSIONS Findings emphasize the importance of data-driven upstream policies for protecting inadequately housed children at risk of maltreatment.
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Affiliation(s)
- Patrick J Fowler
- The Brown School, Washington University in St. Louis, USA; Division of Computational and Data Sciences, Washington University in St. Louis, USA.
| | | | - Peter S Hovmand
- School of Medicine, Case Western Reserve University, USA; Mandel School of Applied Social Sciences, Case Western Reserve University, USA
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15
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Experiencing eight psychotherapy approaches devoted to eating disorders in a single-day workshop increases insight and motivation to engage in care: a pilot study. Eat Weight Disord 2022; 27:2213-2222. [PMID: 35133642 DOI: 10.1007/s40519-022-01365-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE For patients with eating disorders (EDs), early engagement in care is usually considered a positive prognostic factor. The aim of the study was to investigate how a single-day intervention devoted to early, brief, experiential exposure to a variety of psychotherapy approaches might support commitment to change and the decision to engage in care in patients with EDs. METHODS One hundred and sixty-nine adult outpatients newly diagnosed with an ED took part in a single-day workshop for groups of up to ten patients, where they experienced eight psychotherapeutic approaches. Motivation to change care and level of insight were assessed at baseline and 10 days after the intervention. RESULTS Motivation and commitment to take active steps toward change (expressed by the "Committed Action" composite score) significantly improved after the intervention (p < 0.001), and a significant number of patients specifically moved from "contemplation" to "action" stage (p < 0.001). The improvement of motivation to change was significantly associated with an increase in insight capacity (p < 0.001), and this increase was observed for almost all related dimensions such as recognition of illness or awareness of need for psychological treatment. CONCLUSION A single-day session devoted to experiencing a range of group psychotherapies increased patients' insight and motivation to actively engage in care. To confirm potential longer-term benefits of this intervention, further studies are needed to explore the contribution of each approach and process specifically involved in patients' increased motivation for care, as well as the clinical characteristics of patients associated with better outcomes. LEVEL OF EVIDENCE V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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16
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Vinchenzo C, Lawrence V, McCombie C. Patient perspectives on premature termination of eating disorder treatment: a systematic review and qualitative synthesis. J Eat Disord 2022; 10:39. [PMID: 35296356 PMCID: PMC8928624 DOI: 10.1186/s40337-022-00568-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND High rates of premature treatment termination are a well-reported issue in eating disorder treatment, and present a significant barrier for treatment effectiveness and longer term health outcomes of patients with eating disorders. Understanding patient perspectives on this phenomenon is essential in improving treatment completion rates and informing research and intervention development. The aim of this review is to synthesise qualitative literature on patient perspectives of premature termination of eating disorder treatment and to summarise the key issues leading to discontinuation of treatment. METHODS A systematic review of 1222 articles was conducted to identify studies using qualitative methods to investigate patient experiences of prematurely terminating eating disorder treatment. Ten articles were included in the review, with thematic synthesis used to analyse the primary research and develop overarching analytical themes. RESULTS Conflict around enmeshment of eating disorder with identity, and lack of support with reconstructing a sense of self without the eating disorder; challenges of managing pressures of social and clinical relationships while feeling unheard and misunderstood by both; expectations and disappointments around treatment; and dissatisfaction with progress were key themes behind premature termination of treatment. CONCLUSIONS The findings of this review demonstrate the key issues influencing the decision to end treatment early, highlighting the contribution of individual, environmental, and service-level factors. Implications of these factors are discussed and suggestions raised for future research and service development.
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Affiliation(s)
- Cecilia Vinchenzo
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, De Crespigny Lane, PO26, London, SE5 8AF, UK
| | - Vanessa Lawrence
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, De Crespigny Lane, PO26, London, SE5 8AF, UK
| | - Catherine McCombie
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, De Crespigny Lane, PO26, London, SE5 8AF, UK.
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17
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Austin A, Flynn M, Shearer J, Long M, Allen K, Mountford VA, Glennon D, Grant N, Brown A, Franklin-Smith M, Schelhase M, Jones WR, Brady G, Nunes N, Connan F, Mahony K, Serpell L, Schmidt U. The First Episode Rapid Early Intervention for Eating Disorders - Upscaled study: Clinical outcomes. Early Interv Psychiatry 2022; 16:97-105. [PMID: 33781000 PMCID: PMC9291113 DOI: 10.1111/eip.13139] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND First Episode Rapid Early Intervention for Eating Disorders (FREED) is a service model and care pathway for emerging adults aged 16 to 25-years with a recent onset eating disorder (ED) of <3 years. A previous single-site study suggests that FREED significantly improves clinical outcomes compared to treatment-as-usual (TAU). The present study (FREED-Up) assessed the scalability of FREED. A multi-centre quasi-experimental pre-post design was used, comparing patient outcomes before and after implementation of FREED in participating services. METHODS FREED patients (n = 278) were consecutive, prospectively ascertained referrals to four specialist ED services in England, assessed at four time points over 12 months on ED symptoms, mood, service utilization and cost. FREED patients were compared to a TAU cohort (n = 224) of similar patients, identified retrospectively from electronic patient records in participating services. All were emerging adults aged 16-25 experiencing a first episode ED of <3 years duration. RESULTS Overall, FREED patients made significant and rapid clinical improvements over time. 53.2% of FREED patients with anorexia nervosa reached a healthy weight at the 12-month timepoint, compared to only 17.9% of TAU patients (X2 [1, N = 107] = 10.46, p < .001). Significantly fewer FREED patients required intensive (i.e., in-patient or day-patient) treatment (6.6%) compared to TAU patients (12.4%) across the follow-up period (X2 [1, N = 40] = 4.36, p = .037). This contributed to a trend in cost savings in FREED compared to TAU (-£4472, p = .06, CI -£9168, £233). DISCUSSION FREED is robust and scalable and is associated with substantial improvements in clinical outcomes, reduction in inpatient or day-patient admissions, and cost-savings.
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Affiliation(s)
- Amelia Austin
- Eating Disorders Section, Department of Psychological Medicine, King's College London, London, UK
| | - Michaela Flynn
- Eating Disorders Section, Department of Psychological Medicine, King's College London, London, UK
| | - James Shearer
- Department of Health Services and Population Research, King's College London, London, UK
| | - Mike Long
- Kent Surrey Sussex Academic Health Science Network, Crawley, UK
| | - Karina Allen
- Eating Disorders Section, Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Victoria A Mountford
- Eating Disorders Section, Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,Maudsley Health, Abu Dhabi, UAE
| | | | - Nina Grant
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Amy Brown
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | | | | | | | - Gabrielle Brady
- Central and North West London NHS Foundation Trust, London, UK
| | - Nicole Nunes
- Central and North West London NHS Foundation Trust, London, UK
| | - Frances Connan
- Central and North West London NHS Foundation Trust, London, UK
| | - Kate Mahony
- North East London NHS Foundation Trust, London, UK
| | - Lucy Serpell
- North East London NHS Foundation Trust, London, UK.,Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Ulrike Schmidt
- Eating Disorders Section, Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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18
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Thaler L, Booij L, Burnham N, Kenny S, Oliverio S, Israel M, Steiger H. Predictors of non-completion of a day treatment program for adults with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2021; 30:146-155. [PMID: 34971014 DOI: 10.1002/erv.2879] [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: 09/16/2021] [Revised: 11/16/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
Although treatment dropout is common among patients with eating disorders, very few studies have examined predictors of non-completion in day treatment. We investigated various potential predictors of dropout from adult day treatment. Participants were 295 adult patients with a diagnosis of Anorexia Nervosa (restricting or binge-eating/purging subtype), Bulimia Nervosa (BN), Other Specified Feeding or Eating Disorder, or Avoidant Restrictive Food Intake Disorder. Predictors included eating-disorder characteristics, motivation at the commencement of treatment, Body Mass Index (BMI), time spent in treatment and personality dimensions. Logistic regression analyses showed that for patients with a BMI of less than 20 at the start of treatment, low BMI was a significant predictor of staff-initiated termination due to not meeting weight gain goals. Furthermore, completing less than 6 weeks of treatment was associated with staff-initiated termination. For the whole sample, those with higher changes in weight over the course of treatment were less likely to terminate prematurely. None of the other predictor variables yielded significant results. Results of the current study highlight characteristics of patients who are more likely not to complete day treatment and can help identify patients who may be at risk for not succeeding in multi-diagnostic day treatment programs.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Department of Psychology, Concordia University, Montreal, Quebec, Canada.,Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Nuala Burnham
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Samantha Kenny
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada
| | - Stephanie Oliverio
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
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19
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Teramoto K, Kuwata S. Design and Evaluation of a Smartphone Medical Guidance App for Outpatients of Large-Scale Medical Institutions: A Retrospective Observational Study. JMIR Form Res 2021; 6:e32990. [PMID: 34818208 PMCID: PMC9037305 DOI: 10.2196/32990] [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: 08/17/2021] [Revised: 10/31/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The greatest stressor for outpatients is the waiting time before an examination. If the patient is able to use their smartphone to check in with the reception, the patient can wait for their examination at any location, and the burden of waiting can be reduced. OBJECTIVE This study aimed to report the system design and post-introductory outcomes of the Tori RinRin (TR2) system that was developed to reduce outpatient burden imposed by wait times before examination. METHODS The TR2 system was introduced at Tottori University Hospital, a large medical facility that accepts a daily average of 1,500 outpatients. The system, which links the hospital's electronic medical record database with patients' mobile devices, has the following two functions: 1) GPS-based examination check-in processing and 2) sending appointment notification messages via a cloud notification service. In order to evaluate the usefulness of the TR2 system, we surveyed the utilization rate of the TR2 system among outpatient, implemented a user questionnaire and polling the average time required for patients to respond to call notifications about their turn. RESULTS The 3 months average of TR2 users 9 months after the TR 2 system introduction was 17.9% (81,066 of 14,536 patients). In an investigation of 363 subjects, the mean examination call message response time using the TR2 system was 31 seconds (median 14 seconds). Among 166 subjects who responded to a user survey, 86.7% (144 of 166 patients) said that the system help reduce the burden of waiting time. CONCLUSIONS The app allowed 17.9% of outpatients at a large medical facility to check in remotely and wait for examinations anywhere. Hence, it is effective in preventing the spread of infection, especially during pandemics such as the coronavirus disease. The app reported in this study is beneficial for large medical facilities striving to reduce outpatient burden imposed by wait times. CLINICALTRIAL
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Affiliation(s)
- Kei Teramoto
- Tottori University Hospital, Nishi-cho36-1, Yonago, JP
| | - Shigeki Kuwata
- Department of Clinical Information Management, Nara City Hospital, Nara, JP
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20
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Can early change in eating disorder psychopathology predict outcome in guided self-help for binge eating? Eat Weight Disord 2021; 26:2143-2152. [PMID: 33145729 PMCID: PMC8437919 DOI: 10.1007/s40519-020-01059-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/16/2020] [Indexed: 11/02/2022] Open
Abstract
PURPOSE This study tests the value of a measure of eating disorder (ED) psychopathology in predicting outcome following guided self-help in a non-underweight sample with regular binge eating. It examines whether early reductions in ED psychopathology are associated with remission status at post-treatment. METHODS Seventy-two adults with bulimia nervosa, binge-eating disorder, or an atypical form of these illnesses received up to ten sessions of cognitive behaviour therapy-based guided self-help. Using a session-by-session measure of eating pathology and associated reliable change indices, response was analysed using receiver operating characteristic analysis to predict outcomes at post-treatment. RESULTS In this routine care setting, nearly one-quarter of the sample achieved remission following GSH, approximately two-thirds of whom showed early change in ED psychopathology. Early change prior to session 6 was accurate in predicting later remission. Individuals showing early change did not differ from others on baseline characteristics or rates of attrition. CONCLUSION Data suggest that a majority of those who respond to treatment will do so before the second half of treatment, information that could be used to ensure that evidence-based treatments are used as effectively as possible. LEVEL OF EVIDENCE Level III.
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21
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Jenkins PE, Luck A, Violato M, Robinson C, Fairburn CG. Clinical and cost-effectiveness of two ways of delivering guided self-help for people with an eating disorder: A multi-arm randomized controlled trial. Int J Eat Disord 2021; 54:1224-1237. [PMID: 33998020 DOI: 10.1002/eat.23554] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Increasing the availability and accessibility of evidence-based treatments for eating disorders is an important goal. This study investigated the effectiveness and cost-effectiveness of guided self-help via face-to-face meetings (fGSH) and a more scalable method, providing support via email (eGSH). METHOD A pragmatic, randomized controlled trial was conducted at three sites. Adults with binge-eating disorders were randomized to fGSH, eGSH, or a waiting list condition, each lasting 12 weeks. The primary outcome variable for clinical effectiveness was overall severity of eating psychopathology and, for cost-effectiveness, binge-free days, with explorative analyses using symptom abstinence. Costs were estimated from both a partial societal and healthcare provider perspective. RESULTS Sixty participants were included in each condition. Both forms of GSH were superior to the control condition in reducing eating psychopathology (IRR = -1.32 [95% CI -1.77, -0.87], p < .0001; IRR = -1.62 [95% CI -2.25, -1.00], p < .0001) and binge eating. Attrition was higher in eGSH. Probabilities that fGSH and eGSH were cost-effective compared with WL were 93% (99%) and 51% (79%), respectively, for a willingness to pay of £100 (£150) per additional binge-free day. DISCUSSION Both forms of GSH were associated with clinical improvement and were likely to be cost-effective compared with a waiting list condition. Provision of support via email is likely to be more convenient for many patients although the risk of non-completion is greater.
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Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Amy Luck
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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22
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Sima AP, Stromberg KA, Kreutzer JS. An adaptive method for assigning clinical trials wait-times for controls. Contemp Clin Trials Commun 2021; 21:100727. [PMID: 33604487 PMCID: PMC7872975 DOI: 10.1016/j.conctc.2021.100727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/16/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
Wait-list control clinical trials are popular among psychologists and rehabilitation specialists partly because all participants receive the intervention. In 2 arm wait-list control trials, individuals randomized to the treatment group receive immediate treatment whereas individuals randomized to the control group wait a fixed amount of time before intervention is initiated. For interventions that have varying durations, careful consideration must be given to the period that participants in the control group have a delay until treatment begins, as incongruent wait times compared to the intervention durations of the treatment group may introduce confounding into the evaluation of the treatment differences. To alleviate this issue, we propose to adaptively assign wait times to individuals randomized to the control group based on the intervention duration of those in the treatment group. Simulations demonstrate the that our method not only results in similar timing distributions between participants in the treatment and control groups, but also allows participants in the control group to initiate treatment earlier than the traditional design. The latter characteristic may reduce dropout and result in more efficient study enrollment.
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Affiliation(s)
- Adam P. Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jeffrey S. Kreutzer
- Departments of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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23
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Munasinghe S, Page A, Mannan H, Ferdousi S, Peek B. Determinants of treatment disengagement among those at risk of suicide referred to primary mental health care services in Western Sydney, Australia. Aust N Z J Psychiatry 2021; 55:277-288. [PMID: 33032444 DOI: 10.1177/0004867420963738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Continued engagement with primary mental health services has been associated with the prevention of subsequent suicidal behaviour; however, there are few studies that identify determinants of treatment disengagement among those at risk of suicide in primary care settings. This study investigated determinants of treatment disengagement of those at risk of suicide who were referred to primary mental health care services in Western Sydney, Australia. METHOD This study used routinely collected data of those referred for suicide prevention services provided through primary mental health care services between July 2012 and June 2018. Associations between sociodemographic, diagnostic, referral- and service-level factors and treatment non-attendance and early treatment cessation were investigated using a series of multivariable generalised estimation equations. RESULTS There were 1654 suicidal referrals for 1444 people during the study period. Those identified with a risk of suicide were less likely to never attend treatments (16.14% vs 19.77%), but were more likely to disengage earlier from subsequent service sessions (16.02% vs 12.41%), compared to those with no risk of suicide. A higher likelihood of non-attendance to any primary mental health care service sessions was associated with those aged 25-44, lower socioeconomic status, a presentation for substance use and a referral from acute care (either emergency department or hospital). Among those who attended an initial treatment session, younger age (18-24 years) and a longer waiting time for an initial follow-up appointment were associated with a higher likelihood of early treatment cessation from primary mental health care services. CONCLUSION These findings can inform potential strategies in routine primary mental health care practice to improve treatment engagement among those at risk of suicidal behaviour. Youth-specific interventions, behavioural engagement strategies and prompt access to services are policy and service priorities.
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Affiliation(s)
- Sithum Munasinghe
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Haider Mannan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Shahana Ferdousi
- Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Brendan Peek
- Royal Australasian College of Dental Surgeons, Sydney, NSW, Australia
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Lampard AM, Sharbanee JM. The Cognitive‐Behavioural Theory and Treatment of Bulimia Nervosa: An Examination of Treatment Mechanisms and Future Directions. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12078] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amy M Lampard
- School of Psychology and Speech Pathology, Curtin University,
- Department of Nutrition, Harvard School of Public Health,
| | - Jason M Sharbanee
- School of Psychology and Speech Pathology, Curtin University,
- Department of Psychology, York University,
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25
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Pellizzer ML, Waller G, Wade TD. Ten‐session cognitive behaviour therapy for eating disorders: Outcomes from a pragmatic pilot study of Australian non‐underweight clients. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mia L. Pellizzer
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, South Australia, Australia,
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK,
| | - Tracey D. Wade
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, South Australia, Australia,
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26
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Allen KL, Mountford V, Brown A, Richards K, Grant N, Austin A, Glennon D, Schmidt U. First episode rapid early intervention for eating disorders (FREED): From research to routine clinical practice. Early Interv Psychiatry 2020; 14:625-630. [PMID: 32064736 DOI: 10.1111/eip.12941] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/30/2019] [Accepted: 01/27/2020] [Indexed: 12/27/2022]
Abstract
AIMS Eating disorders are serious psychiatric disorders with high rates of morbidity and mortality. Early intervention can improve treatment outcomes and reduce disruption to psychosocial development. However, early intervention is not well established in the eating disorder field. First episode rapid early intervention for eating disorders (FREED) was developed to address barriers to early, effective eating disorder treatment in emerging adults aged 16 to 25 years. Since 2014, FREED has progressed from a single-site research project to an evidence-based care approach in nine eating disorder services. This paper aims to summarize key learning from the scaling of FREED to date, with attention to how this learning may generalizes to other models of care. METHODS We describe the development, scaling and implementation of FREED with reference to the RE-AIM (reach; effectiveness/efficacy; adoption; implementation; maintenance) framework. We also summarize challenges and learning in each of the RE-AIM domains. RESULTS FREED has demonstrated real-world validity across diverse clinical contexts, geographical regions and populations. Key outcomes are seen for each of the RE-AIM domains. CONCLUSIONS FREED provides an example of effective, non-commercial scaling of an early intervention eating disorder care pathway. This work is likely to be particularly relevant to others looking to scale-up early intervention models and for those working in secondary and tertiary mental health settings.
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Affiliation(s)
- Karina L Allen
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,School of Psychological Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Victoria Mountford
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Maudsley Health, Abu Dhabi, UAE
| | - Amy Brown
- Sussex Eating Disorder Service, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Katie Richards
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nina Grant
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Amelia Austin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Danielle Glennon
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Ulrike Schmidt
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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27
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Green SM, Donegan E, Frey BN, Fedorkow DM, Key BL, Streiner DL, McCabe RE. Cognitive behavior therapy for menopausal symptoms (CBT-Meno): a randomized controlled trial. Menopause 2019; 26:972-980. [PMID: 31453958 DOI: 10.1097/gme.0000000000001363] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of cognitive behavioral therapy for menopausal symptoms (CBT-Meno) compared with a waitlist condition (no active intervention). A randomized controlled trial was conducted with 71 perimenopausal or postmenopausal women who were seeking treatment for menopausal symptoms. METHODS Blind assessments were conducted at baseline, 12 weeks postbaseline, and 3 months post-treatment. An intention-to-treat analysis was conducted. CBT-Meno sessions included psychoeducation, and cognitive and behavioral strategies for vasomotor and depressive symptoms, anxiety, sleep difficulties, and sexual concerns. Primary outcomes were scores on the Hot Flash Related Daily Interference Scale (HFRDIS) and Beck Depression Inventory (BDI-II). Secondary outcomes were scores assessing vasomotor and sexual concerns on the Greene Climacteric Scale (GCS-vm, GCS-sex), the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI), and the Female Sexual Function Index (FSFI). RESULTS There were significantly greater improvements in CBT-Meno compared with waitlist in vasomotor symptom interference (HFRDIS; P < 0.001, ηP = 0.21) and "bothersomeness" (GCS-vm; P = 0.04, ηP = 0.06), depressive symptoms (BDI-II; P = 0.001, ηP = 0.15), sleep difficulties (PSQI; P = 0.001, ηP = 0.17), and sexual concerns (GCS-sex; P = 0.03, ηP = 0.07). These results were found even when controlling for menopausal staging and medication use. Gains were maintained at 3 months post-treatment. CONCLUSIONS CBT-Meno was particularly effective in improving self-reported vasomotor symptoms, depressive symptoms, sleep difficulties, and sexual concerns. Although future studies will be needed to confirm the impact of CBT-Meno on anxiety symptoms, these results suggest that this protocol is effective in targeting commonly reported menopausal symptoms. : Video Summary: Supplemental Digiatl Content 1, http://links.lww.com/MENO/A416.
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Affiliation(s)
- Sheryl M Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Eleanor Donegan
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Donna M Fedorkow
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Brenda L Key
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
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28
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Pellizzer ML, Waller G, Wade TD. A pragmatic effectiveness study of 10‐session cognitive behavioural therapy (CBT‐T) for eating disorders: Targeting barriers to treatment provision. EUROPEAN EATING DISORDERS REVIEW 2019; 27:557-570. [DOI: 10.1002/erv.2684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Mia L. Pellizzer
- College of Education Psychology & Social WorkFlinders University Adelaide South Australia Australia
| | - Glenn Waller
- Department of PsychologyUniversity of Sheffield Sheffield United Kingdom
| | - Tracey D. Wade
- College of Education Psychology & Social WorkFlinders University Adelaide South Australia Australia
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29
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Fursland A, Erceg-Hurn DM, Byrne SM, McEvoy PM. A single session assessment and psychoeducational intervention for eating disorders: Impact on treatment waitlists and eating disorder symptoms. Int J Eat Disord 2018; 51:1373-1377. [PMID: 30584661 DOI: 10.1002/eat.22983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Long waitlists are common in eating disorder services and can have a detrimental impact on patients. We examined the effect on waitlist length, attendance, and eating disorder symptoms, of a 75-90 min single session intervention (SSI), attended a median of 16 days after referral to a specialist eating disorders clinic. METHOD Sequential referrals (N = 448) to a public outpatient eating disorders program were tracked from referral until a decision was made on patients entering treatment. One group ("SSI cohort") received a protocol incorporating assessment and psychoeducation about eating disorders before being placed on a waitlist, after which they received further assessment and entered treatment. Data on patient flow indices were collected from this cohort and compared to data from a "Pre-SSI" cohort who had not received the SSI. Symptom change was examined in the SSI cohort. RESULTS Waitlist length reduced and the proportion of referrals attending assessment and being allocated to treatment increased. Eating disorder symptoms and impairment decreased. Underweight patients (Body Mass Index [BMI] < 18.5 kg/m2 ) gained weight. DISCUSSION These findings suggest that a single session psychoeducational assessment may reduce waiting times, increase the likelihood of patients entering treatment, and facilitate early reductions in eating disorder symptoms. However, there may be other explanations for the changes observed.
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Affiliation(s)
- Anthea Fursland
- Centre for Clinical Interventions, North Metropolitan Health Service, Western Australia, Perth, Australia.,Western Australia Eating Disorders Outreach & Consultation Service, Western Australia, Perth, Australia
| | - David M Erceg-Hurn
- Centre for Clinical Interventions, North Metropolitan Health Service, Western Australia, Perth, Australia.,School of Psychology, Curtin University, Western Australia, Perth, Australia
| | - Susan M Byrne
- School of Psychology, The University of Western Australia, Perth, Australia
| | - Peter M McEvoy
- Centre for Clinical Interventions, North Metropolitan Health Service, Western Australia, Perth, Australia.,School of Psychology, Curtin University, Western Australia, Perth, Australia
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30
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Florer KJ, Prieto L. College Students’ Likelihood of “no-showing” for an Initial Hypothetical Counseling Appointment. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2018. [DOI: 10.1080/87568225.2017.1413321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Loreto Prieto
- Department of Psychology, Iowa State University, Ames, Iowa, USA
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31
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Brown A, McClelland J, Boysen E, Mountford V, Glennon D, Schmidt U. The FREED Project (first episode and rapid early intervention in eating disorders): service model, feasibility and acceptability. Early Interv Psychiatry 2018; 12:250-257. [PMID: 27619198 DOI: 10.1111/eip.12382] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/20/2016] [Accepted: 07/28/2016] [Indexed: 12/13/2022]
Abstract
AIM Eating disorders (EDs) are disabling disorders, predominantly affecting adolescents and young adults. Untreated symptoms have lasting effects on brain, body and behaviour. Care pathway-related barriers often prevent early detection and treatment of ED. The aim of this study was to assess the feasibility and acceptability of FREED (First Episode and Rapid Early Intervention for Eating Disorder), a novel service for young people (aged 18-25 years) with recent ED onset (≤3 years), embedded in a specialist adult National Health Service ED service. Specifically, we assessed the impact of FREED on duration of time until specialist service contact (DUSC), duration of untreated ED (DUED) and wait-times for assessment and treatment compared with patients seen earlier in our service. Acceptability of FREED was also assessed. METHODS Sixty individuals were recruited from September 2014 to August 2015. Fifty-one of these were compared with 89 patients seen earlier. RESULTS FREED patients, from areas with minimal National Health Service gatekeeping (14/51), had markedly shorter DUSC and DUED than controls (DUSC: 12.4 months vs. 16.2 months; DUED 13.0 months vs. 19.1 months), whereas those with complex gatekeeping (37/51) had shorter DUED (17.7 months), but longer DUSC (16.9 months) than controls. FREED patients waited significantly less time for both assessment and treatment than controls, had significantly better treatment uptake and were highly satisfied with the process of starting treatment. CONCLUSIONS FREED is a feasible and acceptable service which successfully reduced waiting times. Reductions in DUSC and DUED depend on gatekeeping arrangements. More research is required to establish clinical outcomes of FREED.
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Affiliation(s)
- Amy Brown
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jessica McClelland
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Elena Boysen
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Victoria Mountford
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Danielle Glennon
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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32
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Wade S, Byrne S, Allen K. Enhanced cognitive behavioral therapy for eating disorders adapted for a group setting. Int J Eat Disord 2017; 50:863-872. [PMID: 28489288 DOI: 10.1002/eat.22723] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/21/2017] [Accepted: 04/15/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This randomized control trial is an evaluation of the effectiveness of enhanced cognitive behavioral treatment (CBT-E) for eating disorders adapted for a group setting. The study aimed to examine the effects of group CBT-E on eating disorder psychopathology and additional maintaining pathology. METHOD A transdiagnostic sample of individuals with eating disorders with a BMI ≥ 18 kg/m2 (N = 40) were randomized to an immediate-start or delayed-start condition so as to compare therapeutic effects of group CBT-E with a waitlist control. Global Eating Disorder Examination Questionnaire (EDE-Q) scores, BMI, and measures of Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were measured across the 8-week control period, throughout the group treatment and at 3-months post-treatment. RESULTS Over 70% of those who entered the trial completed treatment. The first eight weeks of group CBT-E were more effective at reducing Global EDE-Q scores than no treatment (waitlist control). By post-treatment, good outcome (a Global EDE-Q within 1 SD of Australian community norms plus BMI ≥ 18.5) was achieved by 67.9% of treatment completers and 66.7% of the total sample. Symptom abstinence within the previous month was reported by 14.3% of treatment completers and 10.3% of the total sample. Significant reductions in Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were also observed. DISCUSSION This study demonstrated that a group version of CBT-E can be effective at reducing eating disorder psychopathology in a transdiagnostic sample of individuals with eating disorders. Group CBT-E could provide a means of increasing availability of evidence-based treatment for eating disorders.
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Affiliation(s)
- Stephanie Wade
- School of Psychology, University of Western Australia, Perth, Australia
| | - Sue Byrne
- School of Psychology, University of Western Australia, Perth, Australia
| | - Karina Allen
- School of Psychology, University of Western Australia, Perth, Australia.,Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.,The Eating Disorders Service, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, London, United Kingdom
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33
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Mathisen TF, Rosenvinge JH, Pettersen G, Friborg O, Vrabel K, Bratland-Sanda S, Svendsen M, Stensrud T, Bakland M, Wynn R, Sundgot-Borgen J. The PED-t trial protocol: The effect of physical exercise -and dietary therapy compared with cognitive behavior therapy in treatment of bulimia nervosa and binge eating disorder. BMC Psychiatry 2017; 17:180. [PMID: 28494809 PMCID: PMC5427572 DOI: 10.1186/s12888-017-1312-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sufferers from bulimia nervosa (BN) and binge eating disorder (BED) underestimate the severity risk of their illness and, therefore, postpone seeking professional help for years. Moreover, less than one in five actually seek professional help and only 50% respond to current treatments, such as cognitive behavioral therapy (CBT). The impetus for the present trial is to explore a novel combination treatment approach adapted from physical exercise- and dietary therapy (PED-t). The therapeutic underpinnings of these separate treatment components are well-known, but their combination to treat BN and BED have never been previously tested. The purpose of this paper is to provide the rationale for this new treatment approach and to outline the specific methods and procedures. METHODS The PED-t trial uses a prospective randomized controlled design. It allocates women between 18 and 40 years (BMI range 17.5-35.0) to groups consisting of 5-8 members who receive either CBT or PED-t for 16 weeks. Excess participants are allocated to a waiting list control group condition. All participants are assessed at baseline, post-treatment, 6, 12 and 24 months' post-follow-up, respectively, and monitored for changes in biological, psychological and therapy process variables. The primary outcome relates to the ED symptom severity, while secondary outcomes relates to treatment effects on physical health, treatment satisfaction, therapeutic alliance, and cost-effectiveness. We aim to disseminate the results in high-impact journals, preferable open access, and at international conferences. DISCUSSION We expect that the new treatment will perform equal to CBT in terms of behavioral and psychological symptoms, but better in terms of reducing somatic symptoms and complications. We also expect that the new treatment will improve physical fitness and thereby, quality of life. Hence, the new treatment will add to the portfolio of evidence-based therapies and thereby provide a good treatment alternative for females with BN and BED. TRIAL REGISTRATION Prospectively registered in REC the 16th of December 2013 with the identifier number 2013/1871 , and in Clinical Trials the 17th of February 2014 with the identifier number NCT02079935 .
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Affiliation(s)
| | - Jan H. Rosenvinge
- 0000000122595234grid.10919.30Department of Psychology, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9037 Tromsø, Norway
| | - Gunn Pettersen
- 0000000122595234grid.10919.30Department of Health and Caring Sciences, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9073 Tromsø, Norway
| | - Oddgeir Friborg
- 0000000122595234grid.10919.30Department of Psychology, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9037 Tromsø, Norway
| | - KariAnne Vrabel
- Research Institute of Modum Bad, Badeveien 287, 3370 Vikersund, Norway
| | - Solfrid Bratland-Sanda
- grid.463530.7University College of Southeast Norway, Bø Postboks 235, 3603 Kongsberg, Norway
| | - Mette Svendsen
- 0000 0004 0389 8485grid.55325.34Department of Preventive Medicine, Oslo University Hospital, Kirkeveien 166, 0407 Oslo, Norway
| | - Trine Stensrud
- 0000 0000 8567 2092grid.412285.8Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsvegen 220, 0806 Oslo, Norway
| | - Maria Bakland
- 0000000122595234grid.10919.30Department of Health and Caring Sciences, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9073 Tromsø, Norway
| | - Rolf Wynn
- 0000000122595234grid.10919.30Department of Clinical Medicine, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9037 Tromsø, Norway
| | - Jorunn Sundgot-Borgen
- 0000 0000 8567 2092grid.412285.8Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsvegen 220, 0806 Oslo, Norway
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34
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Danielsen YS, Årdal Rekkedal G, Frostad S, Kessler U. Effectiveness of enhanced cognitive behavioral therapy (CBT-E) in the treatment of anorexia nervosa: a prospective multidisciplinary study. BMC Psychiatry 2016; 16:342. [PMID: 27716162 PMCID: PMC5053175 DOI: 10.1186/s12888-016-1056-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/29/2016] [Indexed: 01/05/2023] Open
Abstract
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. .
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Affiliation(s)
- Yngvild S. Danielsen
- Department of Clinical Psychology, University of Bergen, Christiesgt.12, Po.box. 7800, 5021 Bergen, Norway
| | - Guro Årdal Rekkedal
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
| | - Stein Frostad
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
| | - Ute Kessler
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
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35
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Peterson CB, Becker CB, Treasure J, Shafran R, Bryant-Waugh R. The three-legged stool of evidence-based practice in eating disorder treatment: research, clinical, and patient perspectives. BMC Med 2016; 14:69. [PMID: 27081002 PMCID: PMC4832531 DOI: 10.1186/s12916-016-0615-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/08/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Evidence-based practice in eating disorders incorporates three essential components: research evidence, clinical expertise, and patient values, preferences, and characteristics. Conceptualized as a 'three-legged stool' by Sackett et al. in 1996 (BMJ), all of these components of evidence-based practice are considered essential for providing optimal care in the treatment of eating disorders. However, the extent to which these individual aspects of evidence-based practice are valued among clinicians and researchers is variable, with each of these stool 'legs' being neglected at times. As a result, empirical support and patient preferences for treatment are not consistently considered in the selection and implementation of eating disorder treatment. In addition, clinicians may not have access to training to provide treatments supported by research and preferred by patients. Despite these challenges, integrating these three components of evidence-based practice is critical for the effective treatment of eating disorders. DISCUSSION Current research supports the use of several types of psychotherapies, including cognitive-behavioral, interpersonal, and family-based therapies, as well as certain types of medications for the treatment of eating disorders. However, limitations in current research, including sample heterogeneity, inconsistent efficacy, a paucity of data, the need for tailored approaches, and the use of staging models highlight the need for clinical expertise. Although preliminary data also support the importance of patient preferences, values, and perspectives for optimizing treatment, enhancing treatment outcome, and minimizing attrition among patients with eating disorders, the extent to which patient preference is consistently predictive of outcome is less clear and requires further investigation. All three components of evidence-based practice are integral for the optimal treatment of eating disorders. Integrating clinical expertise and patient perspective may also facilitate the dissemination of empirically-supported and emerging treatments as well as prevention programs. Further research is imperative to identify ways in which this three-legged approach to eating disorder treatment could be most effectively implemented.
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Affiliation(s)
- Carol B. Peterson
- />Department of Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue South, Minneapolis, MN 55454 USA
- />The Emily Program, St. Paul, MN USA
| | | | - Janet Treasure
- />Department of Psychological Medicine, IOPPN, King’s College, London, UK
| | - Roz Shafran
- />Institute of Child Health, University College, London, UK
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36
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Schmidt U, Brown A, McClelland J, Glennon D, Mountford VA. Will a comprehensive, person-centered, team-based early intervention approach to first episode illness improve outcomes in eating disorders? Int J Eat Disord 2016; 49:374-7. [PMID: 27084796 DOI: 10.1002/eat.22519] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Ulrike Schmidt
- Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Amy Brown
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jessica McClelland
- Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Danielle Glennon
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Victoria A Mountford
- Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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37
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Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2015; 48:946-71. [PMID: 26171853 DOI: 10.1002/eat.22411] [Citation(s) in RCA: 309] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Understanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out. METHOD A literature search was conducted to identify research investigating predictors of outcome in individuals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor. RESULTS The most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge/purge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge/purge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type. DISCUSSION To ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.
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Affiliation(s)
- Eva Vall
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Davis M, Sheidow AJ, McCart MR. Reducing recidivism and symptoms in emerging adults with serious mental health conditions and justice system involvement. J Behav Health Serv Res 2015; 42:172-90. [PMID: 25023764 PMCID: PMC4294988 DOI: 10.1007/s11414-014-9425-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The peak years of offending in the general population and among those with serious mental health conditions (SMHC) are during emerging adulthood. There currently are no evidence-based interventions for reducing offending behavior among 18-21 year olds, with or without SMHC. This open trial examined outcomes from an adaptation of Multisystemic Therapy (MST), an effective juvenile recidivism reduction intervention, modified for use with emerging adults with SMHC and recent justice system involvement. MST for emerging adults (MST-EA) targets MH symptoms, recidivism, problem substance use, and young adult functional capacities. All study participants (n = 41) were aged 17-20 and had a MH diagnosis and recent arrest or incarceration. Implementation outcomes indicated that MST-EA was delivered with strong fidelity, client satisfaction was high, and the majority of participants successfully completed the intervention. Research retention rates also were high. Pre-post-analyses revealed significant reductions in participants' MH symptoms, justice system involvement, and associations with antisocial peers.
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Affiliation(s)
- Maryann Davis
- Center for Learning and Working During the Transition to Adulthood, Systems and Psychosocial Advances Research Center, Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA, 01655, USA,
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Abstract
BACKGROUND Recent quantitative studies provide support for an "enhanced" transdiagnostic approach of Cognitive Behaviour Therapy (CBT-E) for eating disorders; however it is not yet known how recipients of CBT-E experience therapy. AIMS The current study used a qualitative approach to explore service users' experiences of CBT-E. METHOD Individuals with a diagnosis of bulimia nervosa and who had completed CBT-E from one service in Wales were invited to participate. Semi-structured interviews were completed with eight individuals and analysed using Interpretative Phenomenological Analysis (IPA). RESULTS Participants valued both specific and non-specific elements of CBT-E. Therapist specialism in eating disorders was considered to enhance therapist empathy. The most helpful aspects specific to CBT-E were gaining insight into maintenance cycles and experiential learning. The most challenging aspects of CBT-E were changing behaviours and cognitions "in the moment" and in the longer-term. CONCLUSIONS The implication of therapist specialism and empathy is further discussed, as well as the difficulty for CBT-E in changing service users' long-standing core beliefs.
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Elmquist J, Shorey RC, Anderson S, Stuart GL. Eating Disorder Symptoms and Length of Stay in Residential Treatment for Substance Use: A Brief Report. J Dual Diagn 2015; 11:233-7. [PMID: 26457661 PMCID: PMC4724169 DOI: 10.1080/15504263.2015.1104480] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Treatment dropout is common both among people in treatment for eating disorders and for substance use disorders. Because of the high rates of co-occurrence and mortality associated with these disorders, the purpose of the current study was to examine the relationship among eating disorder symptoms, length of stay, and decisions to leave against medical advice among individuals in substance use treatment. METHODS We analyzed de-identified medical record data for 122 adult women enrolled in residential treatment for substance use disorders over a 12-month period. Routine treatment intake included standardized assessments of eating disorders, depression, and substance use. RESULTS Participants averaged 43.1 years of age (SD = 10.7) and were primarily non-Hispanic Caucasian (n = 118, 96.7%). Approximately 8 (6.6%) patients met criteria for a probable eating disorder and 79 (64.8%) for a probable alcohol use disorder. Mean length of stay was 28.1 days (SD = 6.6) and 21 (17%) patients left against medical advice. Logistic regression analysis showed that eating disorder symptoms were significantly associated with decisions to leave treatment against medical advice after controlling for age, years of education, depression symptoms, alcohol problems, and drug problems: χ(2) = 14.88, df = 6, p =.02. This model accounted for 19.1% (Nagelkerke R(2)) of the variance in discharge type. Eating disorder symptoms were not associated with length of treatment. CONCLUSIONS Our findings suggest the importance of assessing and monitoring eating disorder symptoms among individuals in treatment for substance use disorders.
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Affiliation(s)
- JoAnna Elmquist
- a University of Tennessee-Knoxville , Knoxville , Tennessee , USA
| | - Ryan C Shorey
- b Department of Psychology , Ohio University , Athens , Ohio , USA
| | - Scott Anderson
- c Cornerstone of Recovery , Louisville , Tennessee , USA
| | - Gregory L Stuart
- a University of Tennessee-Knoxville , Knoxville , Tennessee , USA
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Legenbauer TM, Meule A. Challenges in the Treatment of Adolescent Anorexia Nervosa - Is Enhanced Cognitive Behavior Therapy The Answer? Front Psychiatry 2015; 6:148. [PMID: 26528192 PMCID: PMC4604253 DOI: 10.3389/fpsyt.2015.00148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/02/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tanja M Legenbauer
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum , Hamm , Germany
| | - Adrian Meule
- Department of Psychology, Center for Cognitive Neuroscience, University of Salzburg , Salzburg , Austria
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Beck A, Burdett M, Lewis H. The association between waiting for psychological therapy and therapy outcomes as measured by the CORE-OM. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 54:233-48. [DOI: 10.1111/bjc.12072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 09/19/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Alison Beck
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust; London UK
| | - Mark Burdett
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust; London UK
| | - Helen Lewis
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust; London UK
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Cognitive Behaviour Therapy for Bulimia Nervosa and Eating Disorders Not Otherwise Specified: Translation from Randomized Controlled Trial to a Clinical Setting. Behav Cogn Psychother 2014; 43:641-54. [PMID: 25331090 DOI: 10.1017/s1352465814000393] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Enhanced Cognitive Behaviour Therapy (CBT-E) (Fairburn, Cooper and Shafran, 2003) was developed as a treatment approach for eating disorders focusing on both core psychopathology and additional maintenance mechanisms. AIMS To evaluate treatment outcomes associated with CBT-E in a NHS Eating Disorders Service for adults with bulimia and atypical eating disorders and to make comparisons with a previously published randomized controlled trial (Fairburn et al., 2009) and "real world" evaluation (Byrne, Fursland, Allen and Watson, 2011). METHOD Participants were referred to the eating disorder service between 2002 and 2011. They were aged between 18-65 years, registered with a General Practitioner within the catchment area, and had experienced symptoms fulfilling criteria for BN or EDNOS for a minimum of 6 months. RESULTS CBT-E was commenced by 272 patients, with 135 completing treatment. Overall, treatment was associated with significant improvements in eating disorder and associated psychopathology, for both treatment completers and the intention to treat sample. CONCLUSIONS Findings support dissemination of CBT-E in this context, with significant improvements in eating disorder psychopathology. Improvements to global EDE-Q scores were higher for treatment completers and lower for the intention to treat sample, compared to previous studies (Fairburn et al., 2009; Byrne et al., 2011). Level of attrition was found at 40.8% and non-completion of treatment was associated with higher levels of anxiety. Potential explanations for these findings are discussed.
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Raykos BC, McEvoy PM, Erceg-Hurn D, Byrne SM, Fursland A, Nathan P. Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: Probably necessary but definitely insufficient. Behav Res Ther 2014; 57:65-71. [DOI: 10.1016/j.brat.2014.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 04/09/2014] [Accepted: 04/16/2014] [Indexed: 01/13/2023]
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Jenkins PE, Luck A, Burrows A, Boughton N. Comparison of face-to-face versus email guided self-help for binge eating: study protocol for a randomised controlled trial. Trials 2014; 15:181. [PMID: 24886555 PMCID: PMC4035724 DOI: 10.1186/1745-6215-15-181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 05/08/2014] [Indexed: 01/18/2023] Open
Abstract
Background Guided self-help is a recommended first-step treatment for bulimia nervosa, binge eating disorder and atypical variants of these disorders. Further research is needed to compare guided self-help that is delivered face-to-face versus via email. Methods/Design This clinical trial uses a randomised, controlled design to investigate the effectiveness of providing guided self-help either face-to-face or via e-mail, also using a delayed treatment control condition. At least 17 individuals are required per group, giving a minimum N of 51. Discussion Symptom outcomes will be assessed and estimates of cost-effectiveness made. Results are proposed to be disseminated locally and internationally (through submission to conferences and peer-reviewed journals), and will hopefully inform local service provision. The trial has been approved by an ethics review board and was registered with ClinicalTrials.gov NCT01832792 on 9 April 2013.
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Affiliation(s)
- Paul E Jenkins
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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Waller G, Gray E, Hinrichsen H, Mountford V, Lawson R, Patient E. Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: effectiveness in clinical settings. Int J Eat Disord 2014; 47:13-7. [PMID: 23996224 DOI: 10.1002/eat.22181] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 07/25/2013] [Accepted: 07/27/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The efficacy of cognitive-behavioral therapy (CBT) for bulimic disorders has been established in research trials. This study examined whether that efficacy can be translated into effectiveness in routine clinical practice. METHOD Seventy-eight adult women with bulimic disorders (bulimia nervosa and atypical bulimia nervosa) undertook individual CBT, with few exclusion criteria and a treatment protocol based on evidence-based approaches, utilizing individualized formulations. Patients completed measures of eating behaviors, eating attitudes, and depression pre- and post-treatment. Eight patients dropped out. The mean number of sessions attended was 19.2. RESULTS No pretreatment features predicted drop-out. Treatment outcome was similar whether using treatment completer or intent to treat analyses. Approximately 50% of patients were in remission by the end of treatment. There were significant improvements in mood, eating attitudes, and eating behaviors. Reductions in bingeing and vomiting were comparable to efficacy trials. DISCUSSION The improvements in this "real-world" trial of CBT for adults with bulimic disorders mirrored those from large, funded research trials, though the conclusions that can be reached are inevitably limited by the nature of the trial (e.g., lack of control group and therapy validation).
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Affiliation(s)
- Glenn Waller
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, Sheffield, England, United Kingdom
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Jenkins PE, Turner H, Morton L. Active waiting list management: potential usefulness in a community eating disorders service. Eat Disord 2014; 22:72-81. [PMID: 24365529 DOI: 10.1080/10640266.2014.857523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We explored the usefulness of an initiative for managing a treatment waiting list in a community eating disorders service. We sent 108 patients awaiting treatment an opt-in letter and, if necessary, a reminder 3 weeks later. Those who opted in were compared with those who did not. Of those receiving the letter, 67.6% opted in and did not differ significantly from those who opted out on measures of eating disorder pathology and general functioning. However, they had waited less time. Opt-in letters may help to identify those who no longer want to access services, thereby allowing resources to be directed towards those who still want treatment.
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Affiliation(s)
- Paul E Jenkins
- a Eating Disorders Service , Southern Health NHS Foundation Trust , Southampton , UK
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Abstract
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.
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Affiliation(s)
- Andrea E. Kass
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel P. Kolko
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa. Behav Res Ther 2013; 51:216-20. [PMID: 23435122 DOI: 10.1016/j.brat.2013.01.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/20/2013] [Accepted: 01/25/2013] [Indexed: 12/28/2022]
Abstract
This study examined the relationship between therapeutic alliance and primary symptom change (weight gain) during CBT for anorexia nervosa. The aims were threefold: (1) to establish the strength of the therapeutic alliance across the treatment, (2) to determine whether early therapeutic alliance is associated with the completion of CBT for this client group, and (3) to determine the direction of the relationship between therapeutic alliance and weight gain. Adult outpatients (N=65) with a diagnosis of anorexia nervosa (or atypical anorexia nervosa) completed a measure of alliance at session six and at the end of treatment. Weight was recorded at the start of treatment, session six and at the end of treatment. The strength of the alliance was consistently high in the sample. However, early therapeutic alliance was not associated with either the likelihood of completing treatment or subsequent weight gain. In contrast, both early and later weight gain were associated with the strength of subsequent alliance. These findings indicate that it might be advisable to focus on techniques to drive weight gain rather than rely on the therapeutic alliance to bring about therapeutic change.
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