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Erschens R, Fahse B, Festl-Wietek T, Herrmann-Werner A, Keifenheim KE, Zipfel S, Fallgatter AJ, Velten-Schurian K. Training medical students in motivational interviewing using a blended learning approach: a proof-of-concept study. Front Psychol 2023; 14:1204810. [PMID: 37546454 PMCID: PMC10400288 DOI: 10.3389/fpsyg.2023.1204810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Difficulties in implementing behavior change in patients with chronic diseases are common in clinical practice. Motivational interviewing (MI) helps clinicians to support patients in overcoming ambivalence while maintaining self-determination. The inclusion of MI in German medical training curricula is still rare. Furthermore, the effects of systematic teaching of MI, especially via blended learning, have hardly been investigated. Methods Medical students participated in three curricular events related to MI, consisting of instructional videos and theoretical and practical components in a blended learning format. The aim of the study was to investigate the effect of teaching MI in students' medical education. A controlled, non-randomized study was conducted with an intervention group and a control group. Both groups completed questionnaires on their experience and knowledge related to MI, completed a knowledge test and rated their satisfaction with the course. MI was taught in the 6th semester of medical coursework as part of a psychosomatic course, in the 8th semester during a psychiatry course and in the 9th semester during a weekly psychiatry clerkship. Results Data from the intervention group (n = 35) and control group (n = 14) were analyzed, with 65.7% of students participating in all three parts of the curriculum. Overall interest in learning MI was high, with M = 2.92 (SD = 1.00). The results indicate a greater increase in knowledge over time in the intervention group. The majority (62.86%) stated that the curriculum was relevant to their future career. Free-form text responses indicated a high level of satisfaction with practical relevance. Conclusion This study demonstrates the usefulness of an MI curriculum for medical students. The integration of MI into medical curricula is a promising curricular addition to improve doctor-patient communication. Future research should address patient perceptions of MI competencies and the persistence of acquired competencies.
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Affiliation(s)
- Rebecca Erschens
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | - Bettina Fahse
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
- Tübingen Institute for Medical Education (TIME), Faculty of Medicine, Tübingen, Germany
| | - Teresa Festl-Wietek
- Tübingen Institute for Medical Education (TIME), Faculty of Medicine, Tübingen, Germany
| | - Anne Herrmann-Werner
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
- Tübingen Institute for Medical Education (TIME), Faculty of Medicine, Tübingen, Germany
| | - Katharina E. Keifenheim
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | - Stephan Zipfel
- University Medical Hospital Tuebingen, Internal Medicine, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
- German Center for Mental Health (DZPG), Tuebingen, Germany
| | - Andreas J. Fallgatter
- German Center for Mental Health (DZPG), Tuebingen, Germany
- Tübingen Center for Mental Health, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Kerstin Velten-Schurian
- Tübingen Center for Mental Health, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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Mills JS, Poulin LE, Kirsh G. Comparison of MI-oriented versus CBT-oriented adjunctive treatments: impacts on therapeutic alliance and patient engagement during hospital treatment for an eating disorder. J Eat Disord 2023; 11:98. [PMID: 37340439 DOI: 10.1186/s40337-023-00818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Our aim was to compare MI-oriented versus CBT-oriented adjunctive treatments to test whether an MI approach is superior in terms of improving therapeutic alliance and engagement among individuals with an eating disorder. The current study was a pilot randomized controlled trial with random allocation to either MI-oriented or a CBT-oriented adjunctive treatment group completed concurrently with a hospital-based group program for adults. Both adjunctive treatment conditions consisted of three individual therapy sessions and a self-help manual. METHODS Sixty-five outpatients receiving hospital treatment for a diagnosed eating disorder were randomly assigned to a treatment group. Measures of working therapeutic alliance, engagement, treatment completion, and clinical impairment were completed at preadmission, mid-treatment, and at the end of treatment. RESULTS Working alliance increased equivalently in both conditions over time in treatment. Similarly, there were no differences between conditions in terms of engagement. Regardless of therapy orientation, greater use of the self-help manual predicted lowered eating disorder risk; stronger patient ratings of therapeutic alliance predicted decreased feelings of both ineffectiveness and interpersonal problems. CONCLUSION This pilot RCT provides further evidence that both alliance and engagement are important for treatment of an eating disorder; however, there was no clear advantage of MI over CBT as an adjunctive treatment approach to improving alliance or engagement. TRIAL REGISTRATION ClinicalTrials.gov ID #NCT03643445 (proactive registration).
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Affiliation(s)
- Jennifer S Mills
- Department of Psychology, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Lauren E Poulin
- Department of Psychology, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Gillian Kirsh
- Eating Disorders Program, North York General Hospital, 4001 Leslie St., North York, ON, M2K 1E1, Canada
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3
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Spivak-Lavi Z, Gewirtz-Meydan A. Why Do Women with Disordered Eating Engage in Sex? The Mediating Role of Sexual Motivations in the Association Between Disordered Eating Behaviors and Attitudes and Sexual Dysfunction. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1513-1524. [PMID: 36376742 DOI: 10.1007/s10508-022-02463-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Although there is growing evidence of an association between disordered eating and sexual dysfunction, the mechanism underlying this association is still unclear. In the current study, we sought to examine the mediating role of sexual motivation between disordered eating and sexual dysfunction. We used a multi-path mediation model to examine the mediating role of sexual motivation between disordered eating and sexual functioning among a sample of 341 non-clinical women in a steady relationship. Analysis revealed two significant mediation paths associating disordered eating with sexual functioning: (1) a high level of disordered eating was significantly linked with higher motivation for partner approval via sex and sexuality which, in turn, was associated with lower sexual functioning and (2) a high level of disordered eating was significantly linked with lower enhancement sexual motivation which, in turn, was associated with lower sexual functioning. This study extends the existing knowledge by offering an explanation for the relation between disordered eating and sexual dysfunction via sexual motives. Findings from the current study suggest women with disordered eating utilized sex for self-affirmation, for coping with negative emotions, for partner approval, and to increase intimacy. Also, these women were not likely to engage in sex for enhancement reasons.
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Affiliation(s)
- Zohar Spivak-Lavi
- Faculty of Social Work and Faculty of Education, Max Stern Yezreel Valley College, Emek Yezreel, Jezreel Valley, Israel
| | - Ateret Gewirtz-Meydan
- School of Social Work, University of Haifa, 199 Abba Khoushy Ave. Mount Carmel, 3498838, Haifa, Israel. Agewirtz-@univ.haifa.ac.il
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García-Anaya M, Caballero-Romo A, González-Macías L. Parent-Focused Psychotherapy for the Preventive Management of Chronicity in Anorexia Nervosa: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159522. [PMID: 35954879 PMCID: PMC9368715 DOI: 10.3390/ijerph19159522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023]
Abstract
Background: Anorexia nervosa (AN) is a complex eating disorder where involvement of family plays a central role in first line treatment in adolescents, but which is not so for adults where poor response to treatment is frequent. Given the reluctance of some patients to receive treatment, we set out to explore the hypothesis that certain family dynamics may be involved in the maintenance of the disorder. Methods: We aimed to understand what is underlying in the cases of patients who present clinical improvement with their parents, but not the ones who received a parent-focused psychotherapeutic intervention. We conducted a mixed methods study. On the one hand we performed a case series of 14 patients who dropped out of treatment while their parents actively attended the intervention, and on the other hand, we followed the evolution of the parents of those patients reluctant to continue treatment, through non-participant observation. Results: We present preliminary evidence where we found the parent-focused psychotherapeutic intervention was able to elicit a reflective function of the parents. We also observed that the intervention modified certain family dynamics that could be related to maintaining factors of the disorder. In patients, we found that in parallel to the assistance of their parents to psychotherapeutic treatment, and even when they were receiving no intervention, they showed significant clinical improvement of symptomatology and global functioning; we observed 9 of 14 of them who voluntarily decided to return to pharmacological treatment. Conclusions: This parent-focused intervention elicited changes in reflective functioning of participant parents; the intervention produced favorable changes in family dynamics, which we believe is probably related to improvement of global functioning, symptomatology, and insight of patients.
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Affiliation(s)
- María García-Anaya
- Clinical Research Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
- Correspondence: (M.G.-A.); (L.G.-M.)
| | - Alejandro Caballero-Romo
- Eating Disorders Clinic at Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico;
| | - Laura González-Macías
- Eating Disorders Clinic at Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico;
- Correspondence: (M.G.-A.); (L.G.-M.)
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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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Rababa M, Alhawatmeh H, Al Ali N, Kassab M. Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses' Ageism Toward Older Adults: A Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2020; 45:355-366. [PMID: 33100426 PMCID: PMC7573866 DOI: 10.1007/s10608-020-10167-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 02/06/2023]
Abstract
Background Although cognitive-behavioral therapy (CBT) techniques are well known for targeting psychological distresses, to date, no study has investigated their effectiveness in relieving death anxiety and ageism among nurses. Methods A parallel randomized controlled trial was conducted according to the CONSORT guidelines during October 2019 at the university hospital. A total of 110 nurses were selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered over five modules with the integration of different CBT exercises. The effect of CBT was assessed by measuring the differences in the students’ responses to a series of validated questionnaires of study variables pre-test (before the training sessions) and post-test (after the training sessions). Clinical registration was completed at ClinicalTrial.gov (ID: NCT04319393). Results Overall, using CBT techniques led to significant improvements in the study outcomes. At postintervention, the nurses who had received CBT training had significantly better self-esteem and interpersonal relationships, a greater sense of symbolic immortality, and less death anxiety and ageism than the nurses in the control group. Conclusions CBT is an effective evidence-based psychological intervention for relieving nurses’ ageism towards older adults. The psychological well-being of nurses caring for older adults is crucial, and new techniques should be adopted to relieve nurses’ accumulated stress and decrease their death anxiety. Future studies which investigate the effectiveness of CBT on other forms of discrimination, such as racism and sexism in healthcare settings, are recommended. Electronic supplementary material The online version of this article (10.1007/s10608-020-10167-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad Rababa
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology/School of Nursing, P O Box 3030, Irbid, 22110 Jordan
| | - Hossam Alhawatmeh
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology/School of Nursing, P O Box 3030, Irbid, 22110 Jordan
| | - Nahla Al Ali
- Department of Community and Psychiatric Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Manal Kassab
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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7
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Reed P, Whittall CM, Osborne LA, Emery S. Impact of Strength and Nature of Patient Health Values on Compliance and Outcomes for Physiotherapy Treatment for Pelvic Floor Dysfunction. Urology 2020; 136:95-99. [DOI: 10.1016/j.urology.2019.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/27/2022]
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8
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Keifenheim KE, Velten-Schurian K, Fahse B, Erschens R, Loda T, Wiesner L, Zipfel S, Herrmann-Werner A. "A change would do you good": Training medical students in Motivational Interviewing using a blended-learning approach - A pilot evaluation. PATIENT EDUCATION AND COUNSELING 2019; 102:663-669. [PMID: 30448043 DOI: 10.1016/j.pec.2018.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 05/28/2023]
Abstract
Objectives This study aims to assess medical students' interest in a Motivational Interviewing (MI), the objective need for a special training, and students' satisfaction with and the effectiveness of such a course. Methods A mandatory MI course was implemented for sixth-semester medical students. Their interest in learning MI was evaluated, along with their satisfaction with the course, which was delivered in a blended-learning teaching approach. Participants' baseline MI skills and general communication skills were assessed. MI non-adherent behavior, like persuading and confronting patients, was noted. Successful learning was measured with a multiple-choice test administered before and after the course that assessed subjective knowledge and skills. Results Students were highly interested in learning MI. At baseline, they showed good communication skills but moderate MI skills. Satisfaction with the course was high. The course was effective, as subjective and objective knowledge and skills improved significantly. Conclusions This pilot study suggests that basic MI skills can be successfully taught in a blended-learning teaching approach. Further research should investigate sustainability and transfer to clinical practice. Practice implications Medical schools should consider providing students with special training in MI to help students counsel patients towards behavioral changes.
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Affiliation(s)
- K E Keifenheim
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Germany.
| | - K Velten-Schurian
- University Hospital for Psychiatry and Psychotherapy, Tuebingen, Germany
| | - B Fahse
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Germany
| | - R Erschens
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Germany
| | - T Loda
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Germany
| | - L Wiesner
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Germany
| | - S Zipfel
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Germany
| | - A Herrmann-Werner
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Germany
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9
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Hudson CC, Mac Neil BA. Ready or Not: Examining Self-Reported Readiness for Behavior Change at Intake Assessment for Adults With an Eating Disorder. Behav Modif 2018; 44:214-227. [PMID: 30339047 DOI: 10.1177/0145445518807129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We explored whether a single-item self-report measure (i.e., the Readiness Ruler) was an appropriate measure of treatment engagement in adult outpatients with eating disorders. In total, 108 women diagnosed with an eating disorder completed the Readiness Ruler and measures of symptom severity at intake to a hospital-based outpatient treatment program. Treatment engagement was operationalized as attendance to a minimum of one session of a cognitive-behavioral therapy (CBT) treatment group, the number of CBT group sessions attended, and whether the participants dropped out of the CBT group prematurely. Results suggest that the Readiness Ruler was not associated with attending the CBT group. Among the participants who attended the program, the Readiness Ruler was not associated with the number of CBT group sessions attended or CBT group dropout. Higher Readiness Ruler score was associated with more severe symptomatology. In conclusion, the Readiness Ruler may not be a good predictor of CBT group treatment engagement for individuals with eating disorders and may instead be a proxy for symptom severity.
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Affiliation(s)
- Chloe C Hudson
- Kingston Health Sciences Centre (KHSC), Hotel Dieu Hospital Site, Kingston, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Brad A Mac Neil
- Kingston Health Sciences Centre (KHSC), Hotel Dieu Hospital Site, Kingston, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada.,George Mason University, Fairfax, VA, USA
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10
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Ziser K, Giel KE, Resmark G, Nikendei C, Friederich HC, Herpertz S, Rose M, de Zwaan M, von Wietersheim J, Zeeck A, Dinkel A, Burgmer M, Löwe B, Sprute C, Zipfel S, Junne F. Contingency Contracts for Weight Gain of Patients with Anorexia Nervosa in Inpatient Therapy: Practice Styles of Specialized Centers. J Clin Med 2018; 7:jcm7080215. [PMID: 30110917 PMCID: PMC6111747 DOI: 10.3390/jcm7080215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022] Open
Abstract
The treatment of patients with anorexia nervosa (AN) is often challenging, due to a high degree of ambivalence towards recovery and weight gain these patients often express. One part of the multimodal treatment is the utilization of treatment contracts (i.e., contingency contracts) that aim to motivate patients to gain weight by applying positive and negative consequences for the (non-)achievement of weight goals. The main aim of this study is to assess and analyze current standards of contingency contracts’ utilization in German eating disorder centers. n = 76 mental health professionals of twelve specialized university centers in Germany that are currently or were formerly treating patients with AN in an inpatient setting participated. Most experts use contingency contracts in their clinic with weekly weight goals ranging between 500 and 700 g. Overall effectiveness and significance of contingency contracts for the inpatient treatment of patients with AN was rated high. Typical characteristics of a contingency contract in specialized German university hospital centers, such as the most frequent consequences, are described. The survey results assist the planning of further studies aiming to improve the multimodal treatment of patients with AN. For clinical practice, using external motivators such as contingency contracts as well as targeting internal motivation (e.g., by using motivational interviewing) is proposed.
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Affiliation(s)
- Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
| | - Christoph Nikendei
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Baden-Wuerttemberg, Germany.
| | - Hans-Christoph Friederich
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Nordrhein-Westfalen, Germany.
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr. 1-3, 44791 Bochum, Nordrhein-Westfalen, Germany.
| | - Matthias Rose
- Division of Psychosomatic Medicine, Charité University Hospital Berlin, Hindenburgdamm 30, 12200 Berlin, Berlin, Germany.
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Niedersachsen, Germany.
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Baden-Wuerttemberg, Germany.
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Hauptstr. 8, 79104 Freiburg, Baden-Wuerttemberg, Germany.
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Langerstr. 3, 81675 Munich, Bayern, Germany.
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Domagkstr. 22, 48149 Muenster, Nordrhein-Westfalen, Germany.
| | - Bernd Löwe
- Institute and Outpatient Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg-Eppendorf, Hamburg, Germany.
| | - Carina Sprute
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University Duisburg-Essen, Virchowstr. 174, 45147 Essen, Nordrhein-Westfalen, Germany.
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Osianderstr. 5, 72076 Tuebingen, Baden-Wuerttemberg, Germany.
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Biddiscombe RJ, Scanlan JN, Ross J, Horsfield S, Aradas J, Hart S. Exploring the perceived usefulness of practical food groups in day treatment for individuals with eating disorders. Aust Occup Ther J 2017; 65:98-106. [PMID: 29270987 DOI: 10.1111/1440-1630.12442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM Recovery from eating disorders is a challenging process. Emerging literature suggests that occupational therapists may provide a useful contribution in delivering purposeful eating-related interventions as a potential treatment to support sustained cognitive and behavioural changes for individuals with eating disorders. This study aimed to evaluate participants' perceptions of the contribution of occupational therapy practical food groups (food based outings and cooking groups) in supporting their functional recovery. METHODS Individuals attended practical food groups as part of standard treatment at an outpatient eating disorders day program. Ninety-nine participants completed questionnaires at discharge and up to three follow-up points (6, 12 and 24 months). Questions related to practical food groups were analysed, exploring participants' experiences and perceived usefulness of groups using rating-scale and open-ended questions. Open-ended responses were analysed using thematic analysis. Descriptive statistics were calculated for responses to rating-scale questions. RESULTS At discharge, participants rated the importance and usefulness of practical food groups as high (4.73 and 4.43 on 5-point scales, respectively), but tended to rate their enjoyment of the groups lower (3.50 on a 5-point scale). Some skill transfer was typically reported by participants at discharge (3.92 on a 5-point scale). One core theme, 'success through participation', emerged from qualitative comments. Six subthemes were also identified: helpful components of practical food groups; perceived benefit of exposure; impact of applying cognitive and behavioural skills; challenges affecting participation; facilitating adaptation; and influence of eating disorders on challenging feared foods. CONCLUSION This study highlights that participation in practical food groups was perceived as useful in assisting individuals to improve eating behaviours and, in some circumstances, transfer these skills into their lives outside of day program. Results suggest that occupational therapists may have an important contribution in delivering these interventions to support recovery and facilitate application of adaptive coping strategies.
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Affiliation(s)
- Rachel J Biddiscombe
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Justin Newton Scanlan
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jessica Ross
- Peter Beumont Day Program, Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sarah Horsfield
- Peter Beumont Day Program, Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jessica Aradas
- Peter Beumont Day Program, Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Susan Hart
- Peter Beumont Day Program, Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
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12
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Affiliation(s)
- Howard Steiger
- a Eating Disorders Continuum , Douglas University Institute, Montreal West Island Integrated University Health and Social Service Centre , Verdun , Quebec , Canada.,b Psychiatry Department , McGill University , Montreal , Quebec , Canada
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13
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Kolnes LJ. 'Feelings stronger than reason': conflicting experiences of exercise in women with anorexia nervosa. J Eat Disord 2016; 4:6. [PMID: 26962455 PMCID: PMC4784414 DOI: 10.1186/s40337-016-0100-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/02/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Individuals with anorexia nervosa frequently feel ambivalent about treatment and weight restoration, and drop out and relapse rates in treatment are high. Increased insight into the function of the eating disorder is considered essential for achieving long-lasting, meaningful change. However, research investigating the functions of anorexia nervosa tends to focus on the role of the disease per se. Distinctions are rarely made across features. In particular, the subjective experience, understanding and sense making of the engagement in compulsive exercise in individuals with anorexia nervosa has received little attention. By using a qualitative methodological approach, this paper aims to expand on prior findings by examining how patients with anorexia nervosa understand and make sense of the experience of exercise in the context of their lives and treatment programme. METHODS Semi-structured interviews were conducted with six females, four of whom were former athletes. Transcripts were subjected to interpretative phenomenological analysis (IPA). RESULTS Two overarching themes emerged in the analysis of the larger study of which this paper is a part; 'paradoxical functions of exercise' and 'diverging experiences of exercise'. Diverging experiences of exercise is the focus of this paper. Firstly, in spite of being severely underweight and suffering from exhaustion, as well as having a clear awareness of the associated negative health effects, participants were engaged in a continuous cycle of rigorous and excessive exercise, which consumed extensive amounts of time and energy. Secondly, the results demonstrate how exercise routines negatively control and interfere with the participants' involvement in the social world. Thirdly, the manner in which participants speak about their exercise reveals their wording to be characterized by efforts to downplay the extent of their actual immersion in exercise. Issues of control and ambivalence about treatment and recovery can be considered potential triggers for the participants' engagement with exercise. Implicit meanings are elaborated upon and discussed in relation to existing literature. CONCLUSIONS The material provides increased insight into the multi-layered meanings of exercise for individuals with anorexia nervosa. It also suggests alternatives to current ways of understanding and approaching exercise that may enable this issue to be addressed in a more meaningful way in therapy. Qualitative approaches can make a valuable contribution to furthering such understanding.
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Affiliation(s)
- Liv-Jorunn Kolnes
- Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, 0806 Oslo, Norway
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Brachel RV, Windgassen A, Hötzel K, Hirschfeld G, Vocks S. Was passiert nach dem letzten Klick? ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2016. [DOI: 10.1026/1616-3443/a000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Bisherige Studien zeigen, dass internetbasierte Interventionen kurzfristig die Veränderungsmotivation bei Essstörungen verbessern können. Zur Stabilität dieser Effekte ist jedoch wenig bekannt. Fragestellung: Wie entwickeln sich die Veränderungsmotivation, die Essstörungspsychopathologie und das Selbstwertgefühl 8 Wochen nach Abschluss eines internetbasierten Motivationsprogramms? Methode: Neunzig Frauen bearbeiteten den Stages of Change Questionnaire for Eating Disorders, den Eating Disorder Examination-Questionnaire und die Rosenberg Self-Esteem-Scale unmittelbar (Post) sowie 8 Wochen nach Abschluss der Intervention (Katamnese). Ergebnisse: Es zeigten sich stabile Effekte in der Veränderungsmotivation sowie im Selbstwertgefühl. Zusätzlich zeigten sich in der Essstörungspsychopathologie signifikante Verbesserungen. Schlussfolgerungen: Die Studie belegt die längerfristige Wirksamkeit eines internetbasierten Motivationsprogramms für Frauen mit Essstörungen.
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Affiliation(s)
- Ruth von Brachel
- Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | - Anja Windgassen
- Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Katrin Hötzel
- Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | | | - Silja Vocks
- Klinische Psychologie und Psychotherapie, Universität Osnabrück
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Green J, Melvin GA, Newman L, Jones M, Taffe J, Gordon M. Day program for young people with anorexia nervosa. Australas Psychiatry 2015; 23:249-53. [PMID: 25948510 DOI: 10.1177/1039856215584513] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study examined changes in body mass index (BMI), anorectic cognitions, and psychological distress following day program treatment. METHODS Participants were 42 female patients from the Monash Health Butterfly eating disorder day program, with anorexia nervosa (AN) restricting type (n = 35) or AN binge-eating/purging type (n = 7), ranging from 12 to 24 years. RESULTS Participants' BMI increased significantly over time. Higher motivation at intake predicted a greater increase in BMI over time, compared to those with lower motivation at intake. There were also significant reductions in drive for thinness, body dissatisfaction, anxiety, and depression scores, and improved motivation following two, four and six months of treatment. CONCLUSIONS These findings provide further evidence that day programs can assist in weight restoration and improvements in psychological aspects of AN in adolescents and young adults.
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Affiliation(s)
- Jessica Green
- Director of Psychology (Clinical) Candidate, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Glenn A Melvin
- Senior Lecturer and Clinical Psychologist, Centre for Developmental Psychiatry & Psychology, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Louise Newman
- Director, Centre for Developmental Psychiatry & Psychology, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Meaghan Jones
- Clinical Psychologist, Monash Health Early in Life Mental Health Service, Monash Health Victoria, Clayton, VIC, Australia
| | - John Taffe
- Biostatistician, Centre for Developmental Psychiatry & Psychology, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Michael Gordon
- Unit Head, Child and Adolescent Stream, Early in Life Mental Health Service, Monash Health Victoria, Clayton, VIC, Australia
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Romano M, Peters L. Evaluating the mechanisms of change in motivational interviewing in the treatment of mental health problems: A review and meta-analysis. Clin Psychol Rev 2015; 38:1-12. [DOI: 10.1016/j.cpr.2015.02.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/19/2014] [Accepted: 02/24/2015] [Indexed: 11/29/2022]
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Wittchen HU, Härtling S, Hoyer J. Psychotherapy and Mental Health as a Psychological Science Discipline. VERHALTENSTHERAPIE 2015. [DOI: 10.1159/000430772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Vella-Zarb RA, Mills JS, Westra HA, Carter JC, Keating L. A Randomized controlled trial of motivational interviewing + self-help versus psychoeducation + self-help for binge eating. Int J Eat Disord 2015; 48:328-32. [PMID: 24753120 DOI: 10.1002/eat.22242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 11/24/2013] [Accepted: 12/22/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Motivational Interviewing (MI) is a collaborative therapy that focuses on strengthening a person's internal motivation to change. Research suggests that MI may be helpful for treating binge eating; however, findings are limited and little is known about how MI for binge eating compares to active therapy controls. The present study aimed to build on current research by comparing MI as a prelude to self-help treatment for binge eating with psychoeducation as a prelude to self-help treatment for binge eating. METHOD Participants with full or subthreshold DSM-IV Binge Eating Disorder or nonpurging Bulimia Nervosa were randomly assigned to receive either 60 minutes of MI followed by a self-help manual (n = 24) or 60 minutes of psychoeducation followed by a self-help manual (n = 21). Questionnaires were completed pre- and postsession, and at 1 and 4 months postsession. RESULTS MI significantly increased readiness to change and confidence in ability to control binge eating, whereas psychoeducation did not. No group differences were found when changes in eating disorder attitudes and behaviors were examined. DISCUSSION MI offers benefits for increasing motivation and self-efficacy. However, it may not be a uniquely effective treatment approach for reducing binge eating.
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Carter JC, Kelly AC. Autonomous and controlled motivation for eating disorders treatment: baseline predictors and relationship to treatment outcome. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 54:76-90. [PMID: 25045794 DOI: 10.1111/bjc.12062] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 05/27/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to identify baseline predictors of autonomous and controlled motivation for treatment (ACMT) in a transdiagnostic eating disorder sample, and to examine whether ACMT at baseline predicted change in eating disorder psychopathology during treatment. METHOD Participants were 97 individuals who met DSM-IV-TR criteria for an eating disorder and were admitted to a specialized intensive treatment programme. Self-report measures of eating disorder psychopathology, ACMT, and various psychosocial variables were completed at the start of treatment. A subset of these measures was completed again after 3, 6, 9, and 12 weeks of treatment. RESULTS Multiple regression analyses showed that baseline autonomous motivation was higher among patients who reported more self-compassion and more received social support, whereas the only baseline predictor of controlled motivation was shame. Multilevel modelling revealed that higher baseline autonomous motivation predicted faster decreases in global eating disorder psychopathology, whereas the level of controlled motivation at baseline did not. CONCLUSION The current findings suggest that developing interventions designed to foster autonomous motivation specifically and employing autonomy supportive strategies may be important to improving eating disorders treatment outcome. PRACTITIONER POINTS The findings of this study suggest that developing motivational interventions that focus specifically on enhancing autonomous motivation for change may be important for promoting eating disorder recovery. Our results lend support for the use of autonomy supportive strategies to strengthen personally meaningful reasons to achieve freely chosen change goals in order to enhance treatment for eating disorders. One study limitation is that there were no follow-up assessments beyond the 12-week study and we therefore do not know whether the relationships that we observed persisted after treatment. Another limitation is that this was a correlational study and it is therefore important to be cautious about making causal conclusions when interpreting the results.
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Affiliation(s)
- Jacqueline C Carter
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Hötzel K, von Brachel R, Schmidt U, Rieger E, Kosfelder J, Hechler T, Schulte D, Vocks S. An Internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial. Psychol Med 2014; 44:1947-1963. [PMID: 24128818 DOI: 10.1017/s0033291713002481] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Previous research has demonstrated an association between low motivation to change and an unfavorable treatment outcome in patients with an eating disorder. Consequently, various studies have examined the effects of motivational enhancement therapy (MET) on motivation to change and treatment outcome in eating disorders. In each of these studies, MET was administered in a face-to-face setting. However, because of its anonymity and ease of access, the internet provides several advantages as the format for such an intervention. Therefore, the current study investigated the effects of an internet-based program ('ESS-KIMO') to enhance motivation to change in eating disorders. METHOD In total, 212 females were accepted for participation and assigned randomly to the intervention condition (n = 103) or waiting-list control condition (n = 109). The intervention consisted of six online MET sessions. Before and after the intervention or waiting period respectively, participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED), the Pros and Cons of Eating Disorders Scale (P-CED), the Self-Efficacy Scale (SES), and the Rosenberg Self-Esteem Scale (RSES). A total of 125 participants completed the assessment post-treatment. Completer analyses and intent-to-treat analyses were performed. RESULTS Significant time × group interactions were found, indicating a stronger increase in motivational aspects and self-esteem, in addition to a stronger symptom reduction on some measures from pre- to post-treatment in the intervention group compared to the control group. CONCLUSIONS Internet-based approaches can be considered as useful for enhancing motivation to change in eating disorders and for yielding initial symptomatic improvement.
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Affiliation(s)
- K Hötzel
- Department of Psychology, Clinical Psychology and Psychotherapy,Osnabrück University,Germany
| | - R von Brachel
- Department of Psychology, Clinical Psychology and Psychotherapy,Osnabrück University,Germany
| | - U Schmidt
- Section of Eating Disorders, Institute of Psychiatry,King's College London,UK
| | - E Rieger
- Research School of Psychology,Australian National University,Australia
| | - J Kosfelder
- Department of Social Sciences and Cultural Studies,University of Applied Sciences Düsseldorf,Germany
| | - T Hechler
- German Pediatric Pain Center, Children's and Adolescents' Hospital,Witten/Herdecke University,Datteln,Germany
| | - D Schulte
- Department of Psychology, Clinical Psychology and Psychotherapy,Ruhr-University Bochum,Germany
| | - S Vocks
- Department of Psychology, Clinical Psychology and Psychotherapy,Osnabrück University,Germany
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Emmelkamp PM, David D, Beckers T, Muris P, Cuijpers P, Lutz W, Andersson G, Araya R, Banos Rivera RM, Barkham M, Berking M, Berger T, Botella C, Carlbring P, Colom F, Essau C, Hermans D, Hofmann SG, Knappe S, Ollendick TH, Raes F, Rief W, Riper H, Van Der Oord S, Vervliet B. Advancing psychotherapy and evidence-based psychological interventions. Int J Methods Psychiatr Res 2014; 23 Suppl 1:58-91. [PMID: 24375536 PMCID: PMC6878277 DOI: 10.1002/mpr.1411] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, "component analyses" aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support "real time" clinical decision-making to prevent treatment failure or relapse) might be one promising way forward.
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Affiliation(s)
- Paul M.G. Emmelkamp
- Department of Clinical PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- King Abdulaziz UniversityJeddahSaudi Arabia
| | - Daniel David
- Department of Clinical Psychology and PsychotherapyBabes‐Bolyai UniversityCluj‐NapocaRomania
- Mount Sinai School of Medicine, Department of Oncological SciencesNew YorkUSA
| | - Tom Beckers
- KU Leuven, LeuvenBelgium and University of AmsterdamAmsterdamThe Netherlands
| | - Peter Muris
- Maastricht UniversityMaastrichtThe Netherlands
| | - Pim Cuijpers
- Department of Clinical PsychologyVU University AmsterdamAmsterdamThe Netherlands
- EMGO Institute for Health and Care ResearchVU University and VU University Medical CentreAmsterdamThe Netherlands
- Leuphana UniversityLüneburgGermany
| | - Wolfgang Lutz
- Department of PsychologyUniversity of TrierTrierGermany
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability ResearchLinköping UniversityLinköpingSweden
- Department of Clinical Neuroscience, Psychiatry SectionKarolinska InstitutetStockholmSweden
| | - Ricardo Araya
- Academic Unit of Psychiatry, School of Social and Community MedicineUniversity of BristolBristolUK
| | | | - Michael Barkham
- Centre for Psychological Services Research, Department of PsychologyUniversity of SheffieldSheffieldUK
| | - Matthias Berking
- Leuphana UniversityLüneburgGermany
- Institute of Clinical Psychology and PsychotherapyUniversity of Marburg, Marburg and Philipps‐University MarburgMarburgGermany
| | - Thomas Berger
- Department of Clinical Psychology and PsychotherapyUniversity of BernBernSwitzerland
| | | | - Per Carlbring
- Department of PsychologyStockholm UniversityStockholmSweden
| | - Francesc Colom
- Psychoeducation and Psychological Treatments Area, Barcelona Bipolar Disorders Unit, IDIBAPS‐CIBERSAMInstitute of Neurosciences, Hospital ClinicBarcelonaSpain
| | | | | | | | - Susanne Knappe
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | | | | | - Winfried Rief
- Institute of Clinical Psychology and PsychotherapyUniversity of Marburg, Marburg and Philipps‐University MarburgMarburgGermany
| | - Heleen Riper
- Department of Clinical PsychologyVU University AmsterdamAmsterdamThe Netherlands
- EMGO Institute for Health and Care ResearchVU University and VU University Medical CentreAmsterdamThe Netherlands
- Department of PsychiatryVU University Medical CentreAmsterdamThe Netherlands
| | - Saskia Van Der Oord
- KU Leuven, LeuvenBelgium and University of AmsterdamAmsterdamThe Netherlands
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Merwin RM, Zucker NL, Timko CA. A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa. COGNITIVE AND BEHAVIORAL PRACTICE 2013; 20:485-500. [PMID: 27307691 PMCID: PMC4905735 DOI: 10.1016/j.cbpra.2012.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of adolescent anorexia nervosa (AN) has improved significantly with the increased emphasis on family-based intervention. Yet despite advances, a substantial number of adolescents do not respond optimally to existing treatment models and thus there is a need for treatment alternatives that address barriers to recovery. We developed and piloted an acceptance-based separated family treatment (ASFT) with 6 adolescents with AN or subthreshold AN (eating disorder not otherwise specified, with the primary symptoms of restriction and severe weight loss). Treatment acceptability was adequate. Overall, parents rated the treatment as credible and expected improvement in their child's condition. Five of the 6 adolescents treated with ASFT restored weight to their ideal body mass index as indicated by age, height, and sex and determined by individual growth charts. Many demonstrated improved psychological health and adaptive functioning. There was evidence of broad effects, with parents reporting decreased anxiety and caregiver burden. ASFT holds promise as a treatment option for AN. The efficacy of this therapeutic approach should be tested in larger trials and compared to current family-based interventions to determine unique effects.
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Abstract
Few treatments for eating disorders have established a base of empirical support, and those that have are still limited by high dropout rates and low abstinence rates. Thus, there is a critical need for innovative eating disorder treatments to fill this gap. The past decade has seen a surge in the development of novel treatments that address eating pathology. This review provides an overview of the emerging psychological treatments for eating disorders, including descriptions of the therapeutic rationales, treatment techniques, and research support. The review will cover face-to-face interventions that are provided in the context of individual or group psychotherapy. Treatments included in this review were organized into the following six categories based on their underlying therapeutic rationales: (1) cognition-focused approaches, (2) emotion regulation approaches, (3) exposure-based approaches, (4) motivational enhancement, (5) integrative approaches, and (6) family- and couple-based interventions.
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Affiliation(s)
- Kelly C Berg
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA,
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Roedelof AJM, Bongers IL, van Nieuwenhuizen C. Treatment engagement in adolescents with severe psychiatric problems: a latent class analysis. Eur Child Adolesc Psychiatry 2013; 22:491-500. [PMID: 23455601 DOI: 10.1007/s00787-013-0385-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/29/2013] [Indexed: 12/31/2022]
Abstract
Motivation is considered a pivotal factor in treatment, but a better understanding of this topic is needed. Drieschner et al. (Clin Psychol Rev 23:1115-1137, 2004) proposed to distinguish treatment motivation and treatment engagement. This study aimed to discover whether it is possible to identify classes of adolescents with severe psychiatric problems having comparable profiles of treatment engagement. To this end, professionals filled out the Treatment Engagement Rating Scale 5 times for 49 adolescents (mean age 18.3 years; SD = 1.6) during the first year of case management treatment. Using a longitudinal latent class analysis, the number of profiles of treatment engagement was investigated and described. Results identified three profiles: high (19 clients, 39%), medium (20 clients, 41%) and low (10 clients, 20%). Adolescents with a high engagement profile were at first equally, and later on more engaged in treatment than clients with a medium engagement profile. Adolescents with a low engagement profile made the least effort to engage, except after 30 weeks. Adolescents with a low engagement profile were often substance-dependent males with the lowest scores on the Global Assessment of Functioning Scale after a year. Only adolescents with a high engagement profile improved on global functioning. In conclusion, it is possible to identify different treatment engagement profiles by asking one question about level of global treatment engagement. Frequent assessment of engagement of the individual client as well as including a behavioural component into assessment and treatment may help to improve case management treatment for adolescents with medium and low engagement profiles.
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Affiliation(s)
- A J M Roedelof
- GGzE Centre for Child and Adolescent Psychiatry, PO Box 909, 5600 AX, Eindhoven, The Netherlands.
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Abstract
This article describes the utilization of forgiveness therapy with a 26-year-old female recovering anorexic. She presents for treatment highly distressed over her commission of self-injurious behaviors and ensuing harm to her person. The process model is used to facilitate self-forgiveness. Emotion provides the main analytical context for the case study. The inability to manage negative affective states is seen as a significant factor contributing to the etiology of eating disorders (EDs). In the aftermath of eating disordered behaviors, negative feelings about the self may impede full recovery. In the therapeutic process described, it is the emotional changes attempted by the client that stand out as central in her eventual attainment of self-forgiveness. The implications of the case study for practitioners considering the use of forgiveness therapy with clients recovering from EDs, as well as the gamut of self-injurious behaviors, are considered. The important role of attachment processes in the utilization of this innovative therapeutic modality is underscored.
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Westra HA, Aviram A, Doell FK. Extending motivational interviewing to the treatment of major mental health problems: current directions and evidence. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:643-50. [PMID: 22114918 DOI: 10.1177/070674371105601102] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Motivational interviewing (MI) was originally developed for the treatment of substance abuse but is rapidly expanding to other major mental health populations beyond addictions. This brief review considers the use of MI and related motivational enhancement therapies (METs) in the treatment of anxiety, depression, and eating disorders, and concurrent psychosis and substance use disorders. MI-MET has been added and (or) integrated into treatment for these problems in a wide variety of ways, most commonly as a pretreatment to other therapies (psychosocial treatments and pharmacotherapy) or integrated into standard assessment procedures. In each problem domain, the bulk of the current evidence supports the value of adding MI to existing therapies in increasing engagement with treatment and in improving clinical outcomes. This is particularly encouraging in that many of the populations included in these investigations represent severe and treatment-recalcitrant populations. However, research on the application of MI to other major mental health problems beyond addictions is in the early stages, with existing studies having numerous limitations (for example, small uncontrolled studies or lack of adequate control groups, and failure to establish both MI treatment integrity and the unique contribution of MI in integrated treatments). In short, the substantial body of promising preliminary findings strongly support the continued investigation of MI and related methods for these populations in well-designed clinical trials that examine not only the additive value of MI but also mechanisms underlying these effects and individual differences (moderators) indicating the need for MI.
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Affiliation(s)
- Henny A Westra
- Associate Professor, Department of Psychology, York University, Toronto, Ontario.
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Driessen E, Hollon SD. Motivational Interviewing From a Cognitive Behavioral Perspective. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2010.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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