Treatment Acceptability for Anorexia Nervosa: Effects of Treatment Type, Problem Severity and Treatment Outcome

Perceptions of the Use of Compulsory Detention in Treatment of People with Eating Disorders

To examine the perceived acceptability of compulsory detention in treatment of an individual with severe anorexia nervosa amongst a sample of members of the general population, 151 participants read vignettes describing the compulsory detention of a female patient with a Body Mass Index of 12.4. The vignettes systematically varied along three dimensions: patients' reaction, immediate outcome (psychological state), and long-term outcome (attendance at out-patient appointments). Acceptability was measured using the Treatment Evaluation Inventory. There were significant main effects of psychological outcome and the long-term treatment outcome. The main effect of the patients' reaction to the detention was not significant, but there was a significant interaction for psychological outcome and long-term outcome, such that good attendance at out-patient appointments increased ratings of acceptability more markedly when a good psychological outcome had been secured. The outcome of treatment exerts a strong influence on ratings of acceptability. Individuals who have no direct experience with eating disorders endorse treatments that are effective irrespective of the patients' feelings about the treatment.

Community recognition and beliefs about anorexia nervosa and its treatment

OBJECTIVE

Mental Health Literacy (MHL), namely recognition, and beliefs about treatment concerning Anorexia Nervosa (AN) were examined in a community sample of male and female (n = 983) aged 15-94 years.

METHOD

A vignette describing a women suffering from the symptoms of AN was presented, followed by a respondent-based structured interview concerning recognition of the problem and treatment beliefs.

RESULTS

The majority of participants could identify the problem as that of an eating disorder, although only 16.1% could specifically identify it as AN. Many also believed the problem was primarily one of low self-esteem (32.5%). General practitioners and psychiatrists or psychologists were considered the most helpful treatment providers, while obtaining information about the problem and available services, followed by family therapy, were considered the most helpful treatments. Less than one-third of participants believed complete recovery was possible. Better AN MHL was found in younger, higher educated, and metropolitan domiciled females.

DISCUSSION

This study offers encouraging results in regard to AN MHL. In particular, there was moderate regard for the use of mental health specialists in the treatment of the disorder. However, there appears to be a misconception that AN is largely the manifestation of low self-esteem and confusion concerning the distinction between AN and bulimia nervosa. AN MHL was poorer in males and those with higher social and health disadvantage.

Treatment Evaluation for Eating Disorders by Clients with Eating Disorders

A group of 54 clients with eating disorders who attended a college-based, group counselling service evaluated four treatments for eating disorders. Individual discussion of problems was uniformly rated as more acceptable than two behavioural treatments (systematic desensitization, and goals and relaxation) which were, in turn, rated as more acceptable than drug treatment. Methodological problems with this form of consumer evaluation and the need for further evaluation of behaviour therapy within a wider range of clinical populations are discussed.

Public perceptions of binge eating and its treatment

OBJECTIVE

Attitudes and beliefs concerning a binge eating problem were examined in a community sample of men and women (n = 1031) aged 15 to 94 years.

METHOD

A vignette describing a fictional 32-year-old female obese binge eater was presented, followed by a series of questions concerning the nature and treatment of the problem described.

RESULTS

Most participants believed that binge eating is primarily a problem of low self-esteem or depression. Behavioral weight loss treatment and self-help interventions were the treatments considered most helpful, whereas few participants believed that psychotherapy would be helpful. General practitioners and dieticians were the treatment providers considered most helpful. Most participants were ambivalent about prognosis given treatment and pessimistic about outcome in the absence of treatment.

CONCLUSION

The fact that binge eating is viewed primarily as a problem of negative affect, and that specific psychotherapy is not highly regarded as a treatment, may go some way to explaining why most individuals with binge eating-type disorders do not receive appropriate treatment. The benefits of specific psychotherapy in stabilizing eating behavior and improving quality of life for obese binge eaters need to be communicated to sufferers and to the health professionals they are likely to contact.

Internal consistency, factor structure, and concurrent validity of the treatment evaluation inventory

The Treatment Evaluation Inventory (TEI) is a commonly used 19-item measure of treatment acceptability. It yields a total score and Patient Progress and Acceptability subscales. The internal consistency and factor structure of the TEI were assessed in two samples, 218 members of the general public and 131 dental students. The total and both subscales had very high internal consistency (alpha for total scale = .96 and .94 in the two samples; alphas for Patient Progress .95 and .92; alphas for Acceptability .90 and .86). Factor analysis yielded a two-factor solution that accounted for 64.4% and 54.0% of the variance, but which did not correspond to the two existing subscales. A second analysis examined the distribution of TEI scores and correlations with two other measures of treatment acceptability (a thermometer rating scale and a 5-point Likert-type scale) in a sample of 222 undergraduate students. All measures were negatively skewed. There were large, significant correlations between the full scale TEI and the other measures, so the full TEI has concurrent validity. However, the TEI did not meet Anastasi's (1976) criterion for independent and useful subscales, therefore only the full scale score should be used.

Predictors of attitudes towards treatments for bulimia nervosa

OBJECTIVE

The aim of this study was to examine, using Mental Health Literacy, acceptability and correlates of acceptability of three treatment interventions for bulimia nervosa; medication, psychological therapy and self-change/lifestyle therapies.

METHOD

A self-report questionnaire to ascertain correlates of attitudes towards the three interventions was used. Respondents (n = 177) were females aged 18-53 years.

RESULTS

Psychological therapy was rated the most acceptable treatment to participants as well as the most acceptable to others, and to have most advantages and fewest disadvantages, followed by self-change/lifestyle therapies, and then medication. Social Pressures to be Thin was the most strongly endorsed cause of bulimia, followed by Low Self-Esteem, Eating Behaviour, Relationship and Family Environment, and lastly, Biology. Correlates with acceptability of different treatment approaches were identified.

CONCLUSIONS

Although no causal link can be assumed from this design, findings suggest that women appear to have a mixed understanding of the different mechanisms that each treatment intervention adopts to treat the causes and symptoms of bulimia, particularly self-change/lifestyle therapies. This may help to explain poor adherence to interventions.

Beliefs of the public concerning the helpfulness of interventions for bulimia nervosa

OBJECTIVE

To examine the beliefs of women concerning the helpfulness of various possible interventions for bulimia nervosa.

METHOD

Face-to-face interviews were conducted with a community sample of 208 women aged 18-45 years. Respondents were presented with a vignette describing a fictional person meeting diagnostic criteria for bulimia nervosa and were asked to indicate whether various persons, treatments, medications, and self-help activities would be helpful, harmful, or neither helpful nor harmful for the person described.

RESULTS

Respondents indicated that seeing a general practitioner (GP), counselor, or dietitian was more likely to be helpful than seeing either a psychologist or a psychiatrist. GPs were perceived as the individuals likely to be most helpful for the problem described, and most likely to be approached first, whereas counseling was regarded as the most helpful treatment. Self-help interventions, including the use of vitamins and minerals, were also highly regarded, while a minority of participants believed that anti-depressant medication would be helpful.

CONCLUSIONS

Information concerning treatments that are effective for eating disorders should be included in prevention programs. Collaborations between mental health specialists and primary health providers are vital to ensure the optimal treatment of eating-disordered behavior.

Development of a short form of the Treatment Evaluation Inventory for acceptability of psychological interventions

The Treatment Evaluation Inventory of Kazdin, French, and Sherick is a 19-item measure of the perceived acceptability of behavioural treatments. Development of two brief forms was based on data from two sources. For Study 1, data from 218 completed questionnaires were used to develop internally consistent brief scales. In Study 2 internal consistency and the validity of the brief forms were estimated for a set of 131 questionnaires. Item reduction was achieved by analysis of item-total minus item correlations. Brief forms with 3, 6, 9, and 12 items were proposed. Their internal consistency (Cronbach alpha) and construct validity were based on correlations of scores on each short form with the full scale scores and on comparing means of different forms. Discriminant validity was based on the difference between two groups (estimated effect size 0.7). Scores for all forms showed high internal consistency and correlated highly with total scale scores. Only the 12-item brief scale yielded mean scores similar to the full scale. The 3-item form could be used as a quick screen, and the 12-item form for more intensive purposes as it is most similar to the full-scale.

The acceptability of the use of sedation in the management of dental anxiety in children: views of dental students

The aim of the present study was to determine the views of dental students concerning the acceptability of the use of sedation in the management of dentally anxious children. Dental students in Trinidad (n = 100) were asked to rate the acceptability of vignettes describing the management of a young teenager with dental anxiety. The vignettes varied systematically along two dimensions: nature of intervention for anxiety (sedation vs. the use of relaxation training and rewards) and outcome of the intervention (good vs. poor). Ratings of acceptability were made using a standardized questionnaire measure. The data were analysed using analysis of variance (ANOVA). There were significant main effects of nature of intervention (F = 5.54; P < 0.05) and outcome of intervention (F = 298.01; P < 0.001), though the students' year of study did not influence ratings. None of the interaction terms were significant. Sedation was viewed as a less acceptable intervention than relaxation and rewards. Interventions associated with good outcomes were seen as more acceptable than interventions associated with poor outcomes. It is concluded that dental students' perceptions of the acceptability of interventions for use with dentally anxious patients are related to the effectiveness of the intervention. Sedation, regardless of the outcome, is seen as less acceptable than the use of rewards and relaxation.

Involving the 'consumer' in the evaluation of dental care: a philosophy in search of data

Recent initiatives by the government of the United Kingdom have led to an increasing interest in patient and public participation in the evaluation and design of healthcare. (1,2) To date this has largely concentrated on the identification of the views of service users of both the treatment they have received, and of what could be called the structural dimensions of service provision, for example ease of access, waiting times, availability of treatment facilities, priorities in care and so on. (3,4) In this article I shall explore three broad questions: Who counts as a 'consumer' and what do we want to know from them? How do we go about ascertaining their views? How do we use information on the views of consumers in planning services and providing care?