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Velkoff EA, Lusich R, Kaye WH, Wierenga CE, Brown TA. Early change in gastric-specific anxiety sensitivity as a predictor of eating disorder treatment outcome. EUROPEAN EATING DISORDERS REVIEW 2024; 32:905-916. [PMID: 38687750 DOI: 10.1002/erv.3099] [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: 10/18/2023] [Revised: 04/08/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
Eating disorders (EDs) are often accompanied by gastrointestinal (GI) distress. Anxiety sensitivity is the tendency to interpret sensations of anxiety as threatening or dangerous, and includes both broad physical symptoms (e.g., elevated heartrate) and GI-specific symptoms. Physical and GI-specific anxiety sensitivity may be important risk and maintaining factors in EDs. This study tested the hypothesis that greater reductions in both types of anxiety sensitivity during the first month of treatment would predict lower ED symptoms and trait anxiety at discharge and 6-month follow-up. Patients (n = 424) in ED treatment reported physical and GI-specific anxiety sensitivity, ED symptoms, and trait anxiety at treatment admission, 1-month into treatment, discharge, and 6-month follow-up. Analyses were conducted with hierarchical linear regression with imputation, controlling for relevant covariates. Results indicated that early reduction in GI-specific but not general physical anxiety sensitivity predicted both lower ED symptoms and lower trait anxiety at discharge and 6-month follow-up. These findings demonstrate the importance of GI-specific anxiety sensitivity as a potential maintaining factor in EDs. Developing and refining treatments to target GI-specific anxiety sensitivity may have promise in improving the treatment not only of EDs, but also of commonly co-morbid anxiety disorders.
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Affiliation(s)
| | | | - Walter H Kaye
- University of California, San Diego, California, USA
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2
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Thompson M, Radunz M, Wade TD, Balzan RP. Bridging the gap: Can single session interventions help enhance mental health treatment delivery for young people in Australia? Aust N Z J Psychiatry 2024:48674241271964. [PMID: 39152572 DOI: 10.1177/00048674241271964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Affiliation(s)
- Matthew Thompson
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
| | - Marcela Radunz
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Tracey D Wade
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Ryan P Balzan
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
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3
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Monteleone AM, Abbate-Daga G. Effectiveness and predictors of psychotherapy in eating disorders: state-of-the-art and future directions. Curr Opin Psychiatry 2024:00001504-990000000-00135. [PMID: 39146554 DOI: 10.1097/yco.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Psychotherapy is the cornerstone of the multidisciplinary treatment approach for eating disorders. This review examines recent evidence regarding effectiveness, predictors, and mechanisms of change of psychotherapy in eating disorders, providing a road map for clinicians and researchers. RECENT FINDINGS Family-based treatments (FBT) are effective in adolescents with anorexia nervosa and bulimia nervosa. Evidence-based psychotherapies for anorexia nervosa have no evidence of superiority compared with treatment as usual (TAU) in adults with anorexia nervosa. Cognitive-behavioural therapy (CBT) is the first-choice psychotherapy recommended for adults with bulimia nervosa and binge-eating disorder (BED). Self-help interventions have some evidence of effectiveness in nonunderweight individuals with eating disorders. Early symptom improvement and adolescent age predict more favourable outcomes. SUMMARY Evidence-based psychotherapies can be suggested for eating disorders, although follow-up data are needed. Beyond anorexia nervosa, bulimia nervosa, and BED, there is no evidence of psychotherapy effectiveness in other eating disorders. The effectiveness of novel (e.g. 'third-wave') psychotherapies, treatment delivery modality (e.g. internet-delivered), and adjunctive interventions (e.g. virtual reality) needs to be further explored. A broader definition of recovery is recommended, including behavioural, physical, and psychological criteria. Predictors and mechanisms of changes have not been studied enough: quantitative and qualitative studies are needed to promote more tailored and individualized psychotherapy interventions.
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Affiliation(s)
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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4
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Zhou Y, Pellizzer M, Keegan E, Wade TD. Factor Structure and Psychometric Properties of the ED-15 in People With an Eating Disorder. Int J Eat Disord 2024. [PMID: 39132900 DOI: 10.1002/eat.24271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE This study examines the factorial structure and psychometric properties of the Eating Disorder-15 questionnaire (ED-15) in a large clinical sample, as well as the instrument's sensitivity to early clinical change in therapy and ability to measure remission. METHOD Participants with eating disorders (N = 278) referred to the Flinders University Services for Eating Disorders in South Australia completed the ED-15 as well as other measures of eating disorder symptoms and co-occurring psychopathology, including depression, anxiety, and stress. RESULTS Confirmatory factor analysis (CFA) revealed a two-factor model for the ED-15. The ED-15 had good internal consistency. It showed satisfactory concurrent validity with moderate correlations with the EDE-Q global score and contribution of unique variance to that score. Correlations indicated good convergent validity with clinical impairment and good divergent validity from depression, anxiety, and stress. The ED-15 showed a significant medium effect size change within the first four sessions of therapy. Good discriminant validity was indicated by cut-off scores used for remission, with significantly different levels of ED psychopathology and other impairments between the two groups. DISCUSSION This study adds to the four previous psychometric studies of the ED-15, confirming robustness of the English version in a clinical sample. The brevity and psychometric robustness of the ED-15 makes it a preferable measure to the Eating Disorder Examination for sessional assessment of progress in treatment.
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Affiliation(s)
- Yuan Zhou
- Flinders University Institute of Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Mia Pellizzer
- Flinders University Institute of Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Ella Keegan
- Flinders University Institute of Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Flinders University Institute of Mental Health and Wellbeing, Adelaide, South Australia, Australia
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Pennesi JL, Johnson C, Radünz M, Wade TD. Acute Augmentations to Psychological Therapies in Eating Disorders: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2024:10.1007/s11920-024-01519-y. [PMID: 39093534 DOI: 10.1007/s11920-024-01519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE OF REVIEW The purpose of this systematic review and meta-analysis was to examine the use and efficacy of acute augmentation therapies in eating disorders. RECENT FINDINGS A meta-analysis addressing this topic across psychological disorders found augmentation significantly improved therapy outcome with strongest findings for augmentations targeting biological mechanisms; however, only one study examined eating disorders. Our systematic review identified 29 studies examining people with eating disorders (N = 1831 participants, 93.7% female), of which 17 RCTs (n = 1162 participants) were included in the meta-analysis. Small subgroups of acute augmentations were identified. Adding acute augmentations to an intervention was effective in 72.4% of studies, with a significant effect on eating disorder outcomes (Hedges' g = 0.14, 95% CI: [0.02, 0.26]). Acute augmentation looks to be a promising approach regardless of weight status or whether it is added to treatment as usual or a single therapy approach.
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Affiliation(s)
- Jamie-Lee Pennesi
- Flinders University Institute for Mental Health and Wellbeing and Blackbird Initiative, Flinders University, Adelaide, SA, Australia.
| | - Catherine Johnson
- Flinders University Institute for Mental Health and Wellbeing and Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Marcela Radünz
- Flinders University Institute for Mental Health and Wellbeing and Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Tracey D Wade
- Flinders University Institute for Mental Health and Wellbeing and Blackbird Initiative, Flinders University, Adelaide, SA, Australia
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Waller G, Beard J. Recent Advances in Cognitive-Behavioural Therapy for Eating Disorders (CBT-ED). Curr Psychiatry Rep 2024; 26:351-358. [PMID: 38717658 PMCID: PMC11211111 DOI: 10.1007/s11920-024-01509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW Eating disorders require more effective therapies than are currently available. While cognitive behavioural therapy for eating disorders (CBT-ED) has the most evidence to support its effectiveness, it requires substantial improvement in order to enhance its reach and outcomes, and to reduce relapse rates. Recent years have seen a number of noteworthy developments in CBT-ED, which are summarised in this paper. RECENT FINDINGS The key advances identified here include: improvements in the efficiency and availability of CBT-ED; expansion of applicability to younger cases across durations of eating disorder; and new methodologies. There have been important recent advances in the field of CBT-ED. However, it is important to stress that there remain gaps in our evidence base and clinical skills, and suggestions are made for future research and clinical directions.
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Affiliation(s)
- Glenn Waller
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK.
| | - Jessica Beard
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
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Wade TD, Shafran R, Cooper Z. Developing a protocol to address co-occurring mental health conditions in the treatment of eating disorders. Int J Eat Disord 2024; 57:1291-1299. [PMID: 37278186 DOI: 10.1002/eat.24008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE While co-occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. METHOD The literature on managing mental health conditions that co-occur with eating disorders is outlined and reviewed. RESULTS In the absence of clear evidence to inform managing co-occurring mental health conditions, we advocate for use of an iterative, session-by-session measurement to guide practice and research. We identify three data-driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co-occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four-step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. DISCUSSION Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co-occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co-occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co-occurring conditions; (5) detailed specification on how to determine which adjuncts to add. PUBLIC SIGNIFICANCE Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence-based techniques. This paper outlines data-driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested.
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Affiliation(s)
- Tracey D Wade
- Blackbird Initiative, Flinders Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, South Australia, Australia
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Zafra Cooper
- Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Oxford University, Oxford, UK
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8
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Velkoff EA, Rubino LG, Liu J, Manasse SM, Juarascio AS. Early reduction in anxiety sensitivity predicts greater reduction in disordered eating and trait anxiety during treatment for bulimia nervosa. Int J Eat Disord 2024. [PMID: 38578224 DOI: 10.1002/eat.24207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Anxiety sensitivity (AS), the trait-like fear of symptoms of anxiety, has been associated with eating disorder (ED) pathology broadly, bulimia nervosa (BN) symptoms specifically, and the anxiety disorders that are commonly comorbid with BN. AS, especially for physical symptoms specifically, maybe a risk and maintenance factor for BN and comorbid anxiety. METHOD Adult participants with BN (n = 44) in a clinical trial comparing CBT to mindfulness and acceptance-based treatment (MABT) reported ED symptoms, trait anxiety, and AS through treatment and follow-up. We predicted that greater early reduction (i.e., within the first month of treatment) in AS would predict greater reductions in ED symptoms and trait anxiety at post-treatment and follow-up. RESULTS Early reductions in AS for physical concerns predicted lower ED symptoms and trait anxiety at post-treatment but not follow-up. Exploratory analyses indicated that treatment groups did not differ in either early or total change in AS, controlling for baseline AS. DISCUSSION Early reductions in AS may be an important treatment target for BN, and may additionally support reductions in anxiety. Future research should identify which components of CBT and MABT best target AS, to deliver these components early in treatment, when they can have maximum effect. PUBLIC SIGNIFICANCE Anxiety sensitivity, the fear of symptoms of anxiety, is associated with eating disorders (ED). In this study, participants in treatment for bulimia nervosa reported ED symptoms, trait anxiety, and anxiety sensitivity through treatment and follow-up. Greater early reductions in anxiety sensitivity predicted lower ED symptoms and trait anxiety at post-treatment. Future research should identify which elements of treatment best target anxiety sensitivity, to deliver them early in treatment.
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Affiliation(s)
- Elizabeth A Velkoff
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Laura G Rubino
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jianyi Liu
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Stephanie M Manasse
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne S Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
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9
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Giles S, Hughes EK, Castle D, Jenkins Z, Phillipou A, Rossell S, Urbini G, Fuller-Tyszkiewicz M, Krug I. A new network analysis model in anorexia nervosa patients based on self-reported eating disorder symptoms, psychological distress, and cognitive flexibility. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:118-134. [PMID: 38071465 DOI: 10.1111/bjc.12451] [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: 04/28/2023] [Revised: 10/30/2023] [Accepted: 11/29/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Cognitive flexibility and psychological distress, such as depression and anxiety, have been implicated in the aetiology of Anorexia Nervosa (AN). Despite the known associations between eating disorder (ED) symptoms, depression, anxiety, and cognitive flexibility, the specific pathways that connect these constructs are unclear. We therefore used network analysis to examine the relationship between these symptoms in an AN sample. METHODS One hundred and ninety-three treatment-seeking individuals diagnosed with AN (95.6% female, M = 26.89 [SD = 9.45] years old) completed self-report measures assessing depression, anxiety, cognitive flexibility, and ED symptoms. To determine each symptom's influence in the network, we calculated the expected influence. RESULTS The two relationships with the greatest edges were those between (1) weight/shape concerns and eating/dietary restraint and (2) weight/shape concerns and psychological distress (a measure that combined depression and anxiety). Cognitive flexibility was not connected to weight/shape concerns but had negative partial associations with eating concerns/dietary restraint and psychological distress. There was also a slight, non-zero connection between eating concerns/dietary restraint and psychological distress. CONCLUSIONS The findings underscore the importance of weight/shape, eating/dietary concerns, and psychological distress in the AN network and suggest that addressing cognitive flexibility may be a useful target for eating concerns/dietary restraint and psychological distress. Future studies assessing the longitudinal course of psychopathology within the AN network structure may help in identifying whether specific symptoms function as risk factors or maintaining factors for this co-occurrence.
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Affiliation(s)
- Sarah Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth K Hughes
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David Castle
- Centre for Mental Health Service Innovation, University of Tasmania, Hobart, Tasmania, Australia
| | - Zoe Jenkins
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia
- Iverson Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea Phillipou
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Susan Rossell
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Gemma Urbini
- Body Image & Eating Disorders Treatment & Recovery Service, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Melbourne, Victoria, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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MacDonald DE, Trottier K, Cao L, Crosby RD, Wonderlich SA, Engel SG, Olmsted MP. Momentary skills use predicts decreased binge eating and purging early in day treatment: An ecological momentary assessment study. Int J Eat Disord 2024; 57:548-557. [PMID: 38189475 DOI: 10.1002/eat.24128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Emerging research indicates that skills acquisition may be important to behavior change in cognitive behavior therapy (CBT) for eating disorders. This study investigated whether skills use assessed in real time during the initial 4 weeks of CBT-based day treatment was associated with momentary eating disorder behavior change and rapid response to treatment. METHODS Participants with DSM-5 bulimia nervosa or purging disorder (N = 58) completed ecological momentary assessments (EMA) several times daily for the first 28 days of treatment. EMA assessed skills use, the occurrence of binge eating and/or purging, and state negative affect. Rapid response was defined as abstinence from binge eating and/or purging in the first 4 weeks of treatment. RESULTS Greater real-time skills use overall, and use of "planning ahead," "distraction," "social support," and "mechanical eating" skills in particular, were associated with a lower likelihood of engaging in binge eating or purging during the same period. After controlling for baseline group differences in overall difficulties with emotion regulation, rapid and non-rapid responders did not differ in overall skills use, or skills use at times of higher negative affect, during the EMA period. DISCUSSION Momentary use of skills appears to play an important role in preventing binge eating and purging, and certain skills appear to be particularly helpful. These findings contribute to the literature elucidating the processes by which CBT treatments for eating disorders work by providing empirical evidence that skills use helps to prevent binge eating and purging behaviors. PUBLIC SIGNIFICANCE Individuals with eating disorders learn new skills during treatment to help them improve their symptoms. This study shows that for people with eating disorders, using skills helps prevent eating disorder behaviors in the moment. Certain skills may be particularly helpful, including planning ahead, distracting activities, support from others, and focusing on eating meals and snacks regardless of how one is feeling. These findings help us better understand how treatments work.
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Affiliation(s)
- Danielle E MacDonald
- Centre for Mental Health, University Health Network, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Kathryn Trottier
- Centre for Mental Health, University Health Network, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Li Cao
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Ross D Crosby
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Stephen A Wonderlich
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Scott G Engel
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Marion P Olmsted
- Centre for Mental Health, University Health Network, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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11
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Öst LG, Brattmyr M, Finnes A, Ghaderi A, Havnen A, Hedman-Lagerlöf M, Parling T, Welch E, Wergeland GJ. Cognitive behavior therapy for adult eating disorders in routine clinical care: A systematic review and meta-analysis. Int J Eat Disord 2024; 57:249-264. [PMID: 38098336 DOI: 10.1002/eat.24104] [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: 07/27/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Cognitive behavior therapy (CBT) is a recommended treatment for eating disorders (ED) in adults given its evidence, mainly based on efficacy studies. However, little is known about how CBT works in routine clinical care. The goal of the present meta-analysis is to investigate how CBT works for various ED when carried out in routine clinical settings. METHOD Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until June 2023. The outcome of CBT, methodological quality, risk of bias (RoB), and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with efficacy studies for ED. Fifty studies comprising 4299 participants who received CBT were included. RESULTS Large within-group effect sizes (ES) were obtained for ED-psychopathology at post-treatment (1.12), and follow-up (1.22), on average 9.9 months post-treatment. Attrition rate was 25.5% and RoB was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies (1.20 at post-treatment and 1.28 at follow-up). CONCLUSION CBT for ED is an effective treatment when delivered in routine clinical care, with ESs comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution due to the RoB in a high proportion of studies. PUBLIC SIGNIFICANCE Eating disorders are common in the population and often lead to multiple negative consequences. CBT has been found effective for ED and is recommended in clinical guidelines. Since these recommendations are primarily based on university studies we wanted to investigate how CBT performs in routine clinical care. Our meta-analysis found that CBT worked as well in routine care as in university setting studies.
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Affiliation(s)
- Lars-Göran Öst
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Finnes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Center, Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway
| | - Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Elisabeth Welch
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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12
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Baudinet J, Eisler I, Konstantellou A, Simic M, Schmidt U. How young people perceive change to occur in family therapy for anorexia nervosa: a qualitative study. J Eat Disord 2024; 12:11. [PMID: 38254187 PMCID: PMC10804743 DOI: 10.1186/s40337-024-00971-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Family therapy for anorexia nervosa (FT-AN) is the first line recommended treatment for child and adolescent anorexia nervosa. Despite evidence of its efficacy, little is understood about the treatment mechanisms. This study aimed to understand how young people who have received FT-AN perceive change to occur across treatment. METHOD Fifteen adolescents (age 12-18 years) completed individual semi-structured interviews online. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS Four inter-connected themes describing the process of change during treatment were generated; (1) relationships as the vehicle for change, (2) an awakening, (3) through, not around - no way out, (4) the life beyond. CONCLUSIONS Current data match relatively closely with theoretical models of FT-AN and emphasise the importance of building trust with all family members, including the young person. Additionally, supporting the family to create a trusting context in which there is a sense that the only way out of the illness is by going through it (rather than avoiding it) is critical. Empirical investigation of each of the described mechanisms is needed.
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Affiliation(s)
- Julian Baudinet
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK.
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| | - Ivan Eisler
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK
- Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
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13
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Röhrig B, Witthöft M, Herpertz S, Petrak F. "The early bird catches the worm"-Prediction of early response and its importance for treatment outcome in a naturalistic setting of cognitive behaviour therapy. Clin Psychol Psychother 2024; 31:e2956. [PMID: 38363023 DOI: 10.1002/cpp.2956] [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: 09/11/2022] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Knowledge about predictors of early response (ER) remains limited. This study examined patient, process, and therapist variables to predict ER in a naturalistic setting. RESEARCH DESIGN AND METHODS Data from 493 psychotherapy outpatients were analysed. ER was defined by a ≥25% reduction in general psychological distress (ER percent) and by the reliable change index (ER RCI) within the first 10 sessions measured by the Brief Symptom Inventory-18. ER prediction was determined using logistic regression. General psychological distress (GSI) throughout treatment in patients with and without ER was modelled using a multilevel linear model. This model aimed to predict GSI over treatment using repeated measurements, considering group affiliation (ER percent vs. no ER percent), controlled for other predictors. RESULTS The prevalence of ER percent and ER RCI were 63.6% and 47.5%, respectively. GSI and therapeutic relationship significantly predicted ER (ER percent: χ2 (6) 70.32, p < .001, Nagelkerkes R2 = .19; ER RCI: χ2 (6) 134.71, p < .001, Nagelkerkes R2 = .35). Patients who rated the therapeutic relationship more positively were more likely to achieve ER (OR = 1.10). Difference in outcomes between patients with and without ER during treatment was influenced by factors such as therapeutic relationship, GSI, therapist experience, and mental comorbidities. Including these variables improved the predictive model from AIC = 17,042.98 to AIC = 16,730.24. CONCLUSION The therapeutic relationship is a crucial predictor of ER. Patients achieving ER tend to have better outcome than those without ER. The early phase of therapy warrants particular attention to enhance psychotherapy outcomes.
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Affiliation(s)
- Bonnie Röhrig
- Center for Psychotherapy Wiesbaden MVZ GmbH, Wiesbaden, Germany
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Frank Petrak
- Center for Psychotherapy Wiesbaden MVZ GmbH, Wiesbaden, Germany
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
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14
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Kussman A, Choo HJ. Mental Health and Disordered Eating in Athletes. Clin Sports Med 2024; 43:71-91. [PMID: 37949515 DOI: 10.1016/j.csm.2023.07.001] [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] [Indexed: 11/12/2023]
Abstract
Disordered eating (DE) and eating disorders (EDs) are more prevalent in athletes than non-athletes, and can cause devastating health and performance consequences. Although they can affect any athlete, DE/EDs are more common among women and athletes in lean sports, where there is a perceived competitive advantage to being lean. The sports medicine provider plays a crucial role in screening, diagnosis, and treatment of DE/ED. Treatment should involve a multidisciplinary team with a physician, dietitian, and mental health provider. Preventative efforts should seek to educate athletes and their coaches/support staff and should foster a healthy environment, which deemphasizes weight or body image.
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Affiliation(s)
- Andrea Kussman
- Department of Family Medicine, University of Washington.
| | - Hyunwoo June Choo
- Division of Physical Medicine and Rehabilitation, Stanford University Department of Orthopaedics, 450 Broadway, MC 6342, Redwood City, CA 94063, USA
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15
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de Boer K, Johnson C, Wade TD, Radunz M, Fernando AN, Babb J, Stafrace S, Sharp G. A systematic review and meta-analysis of intensive treatment options for adults with eating disorders. Clin Psychol Rev 2023; 106:102354. [PMID: 37926059 DOI: 10.1016/j.cpr.2023.102354] [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: 06/30/2023] [Revised: 09/22/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
Eating disorders (EDs) are complex conditions with one of the highest mortality rates among psychiatric illnesses. While outpatient evidence-based treatments for EDs in adults exist, there is often utilisation of more intensive interventions as part of treatment. However, a comprehensive analysis of the impacts of intensive treatment (inpatient, residential and day program) on physical and psychosocial outcomes is lacking. Thus, the current systematic review and meta-analysis aimed to investigate the effectiveness of intensive treatments in adults with EDs for the outcomes of body mass index (BMI), disordered eating, depression, and quality of life, as well as a moderation analysis investigating a range of clinical characteristics. Overall, 62 studies were included in the meta-analysis. The results revealed that intensive treatment in adults yielded significant improvements in BMI (for underweight patients), disordered eating, depression, and quality of life. Treatment setting, length of stay and geographical region of the study all served as moderators for disordered eating and depression. Nevertheless, given the high heterogeneity in the meta- and moderation analyses, these results should be interpreted with caution. Future high-quality research is needed to determine the most beneficial elements of intensive treatment (compared to outpatient) in adults with EDs.
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Affiliation(s)
- Kathleen de Boer
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Catherine Johnson
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Marcela Radunz
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | | | - Jennifer Babb
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Simon Stafrace
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia; Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia.
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16
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Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:175. [PMID: 37794513 PMCID: PMC10548609 DOI: 10.1186/s40337-023-00886-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.
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Affiliation(s)
- Haley Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
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17
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Rom S, Miskovic-Wheatley J, Barakat S, Aouad P, Kim M, Fuller-Tyszkiewicz M, Maguire S. The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder. Front Psychiatry 2023; 14:1229261. [PMID: 37860164 PMCID: PMC10584326 DOI: 10.3389/fpsyt.2023.1229261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Studies in transdiagnostic eating disorder (ED) samples suggest supported online self-help programs (eTherapies) are effective and may improve access to treatment; however, their evaluation in those with binge-eating disorder (BED) is limited. Given BED's high prevalence and low levels of treatment uptake, further eTherapy evaluation is needed to broaden access to effective, evidence-based treatment options. The aim of this study was to investigate the acceptability, feasibility, and preliminary efficacy of a supported eTherapy for those with BED or subthreshold BED, and to examine symptom change across the duration of therapy. Method Nineteen women with BED completed a supported, 10-session Cognitive Behavioural Therapy-based eTherapy in an uncontrolled, pre-post, and 3 months follow up intervention study. Key outcomes were assessed by the Eating Disorder Examination Questionnaire (EDE-Q): objective binge episode (OBE) frequency and ED psychopathology. Feasibility was evaluated via program adherence and dropout, whilst acceptability was assessed through participant feedback post-treatment. Weekly symptom change (ED psychopathology) during treatment was assessed by the Eating Disorder Examination - Questionnaire Short (EDE-QS). Results Generalised estimating equations showed statistically and clinically significant reductions in OBEs and ED psychopathology (large effects) post-treatment, with these decreases maintained at follow up. Across weekly assessment, a marked slowing in the rate of change in ED psychopathology was observed after four sessions of the program. Program feasibility was high (i.e., 84% of content completed), as was program acceptability (i.e., 93% of participants expressed high levels of satisfaction). Discussion These results support the acceptability, feasibility, and preliminary efficacy of a supported eTherapy program for those with BED and suggest the variability of symptom change across the duration of therapy. Future research should further investigate findings in an adequately powered randomised controlled trial.
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Affiliation(s)
- Sean Rom
- Faculty of Health, School of Psychology, Deakin University, Geelong, VIC, Australia
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Barakat
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | | | | | - Sarah Maguire
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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18
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Davey E, Allen K, Bennett SD, Bryant‐Waugh R, Clarke T, Cooper Z, Dixon‐Ward K, Dudley J, Eisler I, Griffiths J, Hill AJ, Micali N, Murphy R, Picek I, Rea R, Schmidt U, Simic M, Tchanturia K, Traviss‐Turner G, Treasure J, Turner H, Wade T, Waller G, Shafran R. Improving programme-led and focused interventions for eating disorders: An experts' consensus statement-A UK perspective. EUROPEAN EATING DISORDERS REVIEW 2023; 31:577-595. [PMID: 37218053 PMCID: PMC10947440 DOI: 10.1002/erv.2981] [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: 12/15/2022] [Revised: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Greater use of programme-led and focused interventions that are less resource-intensive might be part of the solution to this demand-capacity mismatch. METHOD In October 2022, a group of predominantly UK-based clinical and academic researchers, charity representatives and people with lived experience convened to consider ways to improve access to, and efficacy of, programme-led and focused interventions for eating disorders in an attempt to bridge the demand-capacity gap. RESULTS Several key recommendations were made across areas of research, policy, and practice. Of particular importance is the view that programme-led and focused interventions are suitable for a range of different eating disorder presentations across all ages, providing medical and psychiatric risk are closely monitored. The terminology used for these interventions should be carefully considered, so as not to imply that the treatment is suboptimal. CONCLUSIONS Programme-led and focused interventions are a viable option to close the demand-capacity gap for eating disorder treatment and are particularly needed for children and young people. Work is urgently needed across sectors to evaluate and implement such interventions as a clinical and research priority.
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Affiliation(s)
- Emily Davey
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Karina Allen
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Sophie D. Bennett
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Rachel Bryant‐Waugh
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Tim Clarke
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Norfolk and Suffolk NHS Foundation TrustNorwichUK
| | - Zafra Cooper
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | | | - Jake Dudley
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Ivan Eisler
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Jess Griffiths
- NHS England Adult Eating Disorders Co‐Chair Parliamentary Health Service Ombudsman's Delivery GroupRedditchUK
| | - Andrew J. Hill
- Leeds Institute of Health SciencesSchool of MedicineUniversity of LeedsLeedsUK
| | - Nadia Micali
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Department of PsychiatryFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Mental Health Services of the Capital Region of DenmarkEating Disorders Research UnitBallerup Psychiatric CentreCopenhagenDenmark
| | | | - Ivana Picek
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Ulrike Schmidt
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Kate Tchanturia
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Janet Treasure
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Hannah Turner
- Eating Disorders ServiceSouthern Health NHS Foundation TrustSouthamptonUK
| | - Tracey Wade
- Blackbird InitiativeFlinders Research Institute for Mental Health and WellbeingFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Glenn Waller
- Clinical and Applied Psychology UnitDepartment of PsychologyUniversity of SheffieldSheffieldUK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
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19
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Miskovic-Wheatley J, Bryant E, Ong SH, Vatter S, Le A, Touyz S, Maguire S. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disord 2023; 11:85. [PMID: 37254202 DOI: 10.1186/s40337-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality. METHODS This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review. RESULTS Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates. CONCLUSION Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.
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Affiliation(s)
- Jane Miskovic-Wheatley
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Emma Bryant
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Shu Hwa Ong
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sabina Vatter
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Stephen Touyz
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
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20
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Yurkow S, Ivezaj V, Grilo CM. Predictors and significance of rapid response to behaviorally based treatment of binge eating disorder. Obesity (Silver Spring) 2023; 31:390-398. [PMID: 36623872 PMCID: PMC9877118 DOI: 10.1002/oby.23648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study examined baseline predictors of rapid response and its prognostic significance in a clinical trial of behaviorally based weight loss treatment (BBWLT) for binge eating disorder in patients with obesity. METHODS One hundred ninety-one participants receiving BBWLT were assessed at baseline, throughout treatment, and at posttreatment (6 months) by independent assessors. Rapid response was defined as ≥ 65% reduction in binge eating by the fourth treatment week. Patients with versus without rapid response were compared on demographic features, a broad range of current/past clinical and psychiatric variables, and treatment attitudes. Rapid response was used to prospectively predict posttreatment outcomes. RESULTS Rapid response, which characterized 63% (N = 120) of participants, was not associated significantly with any demographic features or with any current/past clinical and psychiatric variables. Higher ratings (at week one) regarding the logic of BBWLT and greater confidence that treatment would help with binge eating and weight loss were associated significantly with rapid response (at week four). Rapid response was prospectively associated with significantly better binge eating and weight loss outcomes. CONCLUSIONS These findings indicate that rapid response to BBWLT for binge eating disorder prospectively predicts superior clinical outcomes in both binge eating and weight loss. Treatment attitudes, rather than patient demographic or clinical severity variables, are prospectively associated with rapid response.
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Affiliation(s)
- Sydney Yurkow
- Yale School of Medicine, Department of Psychiatry, New Haven, CT. USA
| | - Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT. USA
| | - Carlos M. Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT. USA
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21
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de Vos JA, Radstaak M, Bohlmeijer ET, Westerhof GJ. Modelling trajectories of change in psychopathology and well-being during eating disorder outpatient treatment. Psychother Res 2022; 33:415-427. [PMID: 36330764 DOI: 10.1080/10503307.2022.2139647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: There are considerable differences in how eating disorder (ED) patients respond to treatment. This study aimed to identify change trajectories of mental health during treatment. Method: Longitudinal data of 442 patients was used with five time points during a year of outpatient treatment. ED psychopathology and well-being were used as primary measures. A series of latent growth mixture models were applied to model trajectories of change. Results: Three latent classes were found for ED psychopathology and well-being. For ED psychopathology, a high baseline severity and slow recovery class (55.9% of the patients), a high baseline severity followed by a substantial recovery class (19.9%) and a moderate baseline severity and no significant recovery class (24.2%) were found. For well-being, a low baseline followed by a slow growth class (44.6%), a low baseline and substantial growth class (9.5%) and a moderate and stable well-being class (45.9%) was found. General psychopathology, early symptom change, hope for recovery, intrinsic motivation and the ED type were predictive of class membership in either ED psychopathology or well-being. Conclusions: This study shows variability in ED psychopathology and well-being change trajectories, modelled in meaningful latent recovery classes. These results may have clinical implications, such as adjusting patients' treatment based on change trajectories.
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Affiliation(s)
- Jan Alexander de Vos
- Centre for eHealth and well-being research, University of Twente, Psychology, Health, & Technology, Enschede, The Netherlands
- Human Concern, Centrum voor eetstoornissen, Amsterdam, The Netherlands
| | - Mirjam Radstaak
- Centre for eHealth and well-being research, University of Twente, Psychology, Health, & Technology, Enschede, The Netherlands
| | - Ernst T. Bohlmeijer
- Centre for eHealth and well-being research, University of Twente, Psychology, Health, & Technology, Enschede, The Netherlands
| | - Gerben J. Westerhof
- Centre for eHealth and well-being research, University of Twente, Psychology, Health, & Technology, Enschede, The Netherlands
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22
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Rom S, Miskovic‐Wheatley J, Barakat S, Aouad P, Fuller‐Tyszkiewicz M, Maguire S. Evaluating the feasibility and potential efficacy of a brief eTherapy for binge-eating disorder: A pilot study. Int J Eat Disord 2022; 55:1614-1620. [PMID: 35986579 PMCID: PMC9804415 DOI: 10.1002/eat.23803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE For those with binge-eating disorder (BED), access to evidence-based, face-to-face treatment is often constrained by clinician availability and high treatment costs. Emerging evidence suggests online therapy (eTherapy) may navigate these barriers and reduce binge-eating symptomatology; however, less evaluation has been done in those with BED, particularly with briefer programs targeting early change. This study investigated the feasibility and potential efficacy of a brief, supported eTherapy in those with BED or subthreshold BED. METHOD Participants were 19 women with BED who completed a four-session eTherapy. This was a single-arm, pre-post intervention study, with participants completing weekly content and attending telehealth sessions. Key outcomes were assessed by the Eating Disorder Examination Questionnaire-Short (EDE-QS): objective binge episode days, loss of control over eating days, and eating disorder (ED) psychopathology via a total EDE-QS score. RESULTS Generalized and linear mixed models showed significantly reduced loss of control over eating days and ED psychopathology. Program feasibility was high, with strong program adherence and a below average attrition rate. DISCUSSION Pilot results support the feasibility and potential efficacy of a brief, behavioral-focused eTherapy program in reducing ED pathology in those with BED. Future research should further investigate findings in an adequately powered randomized controlled trial. PUBLIC SIGNIFICANCE This study suggests that a brief, behavioral-focused online therapy, guided by non-expert clinicians, can be successfully administered to those with binge-eating disorder (BED) and may be efficacious at reducing eating disorder and other related symptomatology. Brief eTherapies that are effective, accessible, and rapidly available may facilitate earlier intervention in illness and improve treatment outcomes for individuals who experience this common and distressing disorder.
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Affiliation(s)
- Sean Rom
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Jane Miskovic‐Wheatley
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Sarah Barakat
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia,School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | | | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia,Sydney Local Health DistrictSydneyNew South WalesAustralia
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23
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Jarman HK, McLean SA, Rodgers R, Fuller-Tyszkiewicz M, Paxton S, O'Gorman B, Harris E, Shatte A, Bishop K, Baumann T, Mahoney D, Daugelat MC, Yager Z. Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches. JMIR Form Res 2022; 6:e38387. [PMID: 36315225 PMCID: PMC9664336 DOI: 10.2196/38387] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. OBJECTIVE To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. METHODS In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. RESULTS Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. CONCLUSIONS Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population.
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Affiliation(s)
- Hannah K Jarman
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Melbourne, Australia
| | - Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Rachel Rodgers
- Applied Psychology Program for Eating and Appearance Research, Department of Applied Psychology, Northeastern University, Boston, MA, United States
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Centre Hospitalier Regional Universitaire Montpellier, Montpellier, France
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Melbourne, Australia
| | - Susan Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Beth O'Gorman
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Emily Harris
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Adrian Shatte
- Department of Planning, Performance & Analytics, James Cook University, Townsville, Australia
| | - Katie Bishop
- School of Psychology, Deakin University, Geelong, Australia
| | - Tahlia Baumann
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Danielle Mahoney
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Melissa-Claire Daugelat
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders, University of Tübingen, Tübingen, Germany
| | - Zali Yager
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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24
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Keegan E, Waller G, Wade TD. A systematic review and meta-analysis of a 10-session cognitive behavioural therapy for non-underweight eating disorders. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2075257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Tracey D. Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
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25
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Affiliation(s)
- Evelyn Attia
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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26
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Abstract
Outcome measurement in the field of psychotherapy has developed considerably in the last decade. This review discusses key issues related to outcome measurement, modeling, and implementation of data-informed and measurement-based psychological therapy. First, an overview is provided, covering the rationale of outcome measurement by acknowledging some of the limitations of clinical judgment. Second, different models of outcome measurement are discussed, including pre-post, session-by-session, and higher-resolution intensive outcome assessments. Third, important concepts related to modeling patterns of change are addressed, including early response, dose-response, and nonlinear change. Furthermore, rational and empirical decision tools are discussed as the foundation for measurement-based therapy. Fourth, examples of clinical applications are presented, which show great promise to support the personalization of therapy and to prevent treatment failure. Finally, we build on continuous outcome measurement as the basis for a broader understanding of clinical concepts and data-driven clinical practice in the future. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany;
| | - Brian Schwartz
- Department of Psychology, University of Trier, Trier, Germany;
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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27
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Abstract
PURPOSE OF REVIEW This review summarizes recent developments in cognitive-behavioural therapy for eating disorders (CBT-ED). More specifically, the past five years were covered, with the latest UK and Dutch guidelines for eating disorders as a starting benchmark, and with special consideration of the past 18 months. RECENT FINDINGS The new research can be divided into findings that have: (1) reinforced our existing understanding of CBT-ED's models and impact; (2) advanced our understanding and the utility of CBT-ED, including its application for the 'new' disorder Avoidant/Restrictive Food Intake Disorder (ARFID); (3) suggested new directions, which require further exploration in clinical and research terms. These include learning from the circumstances of the COVID-19 pandemic. SUMMARY CBT-ED has developed substantially in the past 5 years, with consolidation of its existing evidence base, further support for real-life implementation, extension of methods used, and the development of new approaches for working with younger people - particularly in the form of treatments for ARFID. Over the past 18 months, even more promising changes in delivery occurred in response to the COVID19 pandemic, showing that we can adapt our methods in order to work effectively via remote means. Challenges remain regarding poor outcomes for anorexia nervosa.
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Affiliation(s)
- Sandra Mulkens
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine, and Life Sciences, School for Mental Health and Neuroscience
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Glenn Waller
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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28
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Fernandez-Aranda F. New challenges in the field of eating disorders. EUROPEAN EATING DISORDERS REVIEW 2021; 29:823-825. [PMID: 34655130 DOI: 10.1002/erv.2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fernando Fernandez-Aranda
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL) and CIBERobn, ISCIII, Barcelona, Spain.,Eating Disorders Program, Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
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29
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Austin A, Flynn M, Richards KL, Sharpe H, Allen KL, Mountford VA, Glennon D, Grant N, Brown A, Mahoney K, Serpell L, Brady G, Nunes N, Connan F, Franklin-Smith M, Schelhase M, Jones WR, Breen G, Schmidt U. Early weight gain trajectories in first episode anorexia: predictors of outcome for emerging adults in outpatient treatment. J Eat Disord 2021; 9:112. [PMID: 34521470 PMCID: PMC8439063 DOI: 10.1186/s40337-021-00448-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early response to treatment has been shown to be a predictor of later clinical outcomes in eating disorders (EDs). Specifically, early weight gain trajectories in anorexia nervosa (AN) have been shown to predict higher rates of later remission in inpatient treatment. However, no study has, as of yet, examined this phenomenon within outpatient treatment of first episode cases of AN or in emerging adults. METHODS One hundred seven patients with AN, all between the ages of 16 and 25 and with an illness duration of < 3 years, received treatment via the first episode rapid early intervention in eating disorders (FREED) service pathway. Weight was recorded routinely across early treatment sessions and recovery outcomes (BMI > 18.5 kg/m2 and eating psychopathology) were assessed up to 1 year later. Early weight gain across the first 12 treatment sessions was investigated using latent growth mixture modelling to determine distinct classes of change. Follow-up clinical outcomes and remission rates were compared between classes, and individual and clinical characteristics at baseline (treatment start) were tested as potential predictors. RESULTS Four classes of early treatment trajectory were identified. Three of these classes (n = 95), though differing in their early change trajectories, showed substantial improvement in clinical outcomes at final follow-up. One smaller class (n = 12), characterised by a 'higher' start BMI (> 17) and no early weight gain, showed negligible improvement 1 year later. Of the three treatment responding groups, levels of purging, depression, and patient reported carer expressed emotion (in the form of high expectations and low tolerance of the patient) determined class membership, although these findings were not significant after correcting for multiple testing. A higher BMI at treatment start was not sufficient to predict optimal clinical outcomes. CONCLUSION First episode cases of AN treated via FREED fit into four distinct early response trajectory classes. These may represent subtypes of first episode AN patients. Three of these four trajectories included patients with substantial improvements 1 year later. For those in the non-response trajectory class, treatment adjustments or augmentations could be considered earlier, i.e., at treatment session 12.
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Affiliation(s)
- A Austin
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK.
| | - M Flynn
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
| | - K L Richards
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
| | - H Sharpe
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - K L Allen
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - V A Mountford
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Maudsley Health, Abu Dhabi, UAE
| | - D Glennon
- South London and Maudsley NHS Foundation Trust, London, UK
| | - N Grant
- South London and Maudsley NHS Foundation Trust, London, UK
| | - A Brown
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - K Mahoney
- North East London NHS Foundation Trust, London, UK
| | - L Serpell
- North East London NHS Foundation Trust, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
| | - G Brady
- Central and North West London NHS Foundation Trust, London, UK
| | - N Nunes
- Central and North West London NHS Foundation Trust, London, UK
| | - F Connan
- Central and North West London NHS Foundation Trust, London, UK
| | | | - M Schelhase
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - W R Jones
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - G Breen
- Department of Social, Genetic & Developmental Psychiatry, King's College London, London, UK
| | - U Schmidt
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 16 De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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30
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Rose C, Bakopoulou I, Novak T. A case series of CBT-T in routine clinical practice. Int J Eat Disord 2021; 54:1549-1554. [PMID: 34137051 DOI: 10.1002/eat.23566] [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] [Received: 02/18/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE CBT-T is a relatively new, brief cognitive behavioral therapy eating disorder treatment for non-underweight patients. This study evaluates CBT-T independently from the team that developed the protocol, and examines the relationship between eating disorder duration and CBT-T effectiveness. METHOD A case series design was used, comprising N = 40 adults with bulimia or atypical anorexia type eating disorders. CBT-T was delivered by CBT therapists in a specialist outpatient service. Mixed model analysis examined the interactions between eating disorder duration and change to eating disorder psychopathology and secondary impairment from pre-post treatment. Abstinence, good outcome, and remission rates were also provided. RESULTS Intervention effect sizes were large. Treatment completers reported abstinence from binge eating and purging over the final 28-days, and 7-days of treatment at 30.1%, and 73.1%, respectively; 76.9% reported good outcome; and 23.1% reported remission. No relationship between eating disorder duration and treatment effectiveness was found. DISCUSSION These findings build on existing evidence supporting provision of CBT-T in routine clinical practice, for patients with eating disorders of any duration. Replication, extension, and RCT will strengthen comparability with other evidence-based approaches.
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Affiliation(s)
- Charlotte Rose
- First Step Primary Care Eating Disorder Service, Avon and Wiltshire Partnership NHS Trust, Bristol, UK
| | | | - Tamas Novak
- School of Education, University of Bristol, Bristol, UK
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