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Cripps S, Serpell L, Pugh M. Processes of change in family therapies for anorexia nervosa: a systematic review and meta-synthesis of qualitative data. J Eat Disord 2024; 12:104. [PMID: 39054560 PMCID: PMC11270895 DOI: 10.1186/s40337-024-01037-5] [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: 02/26/2024] [Accepted: 05/31/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE To synthesise young person and family member perspectives on processes of change in family therapy for anorexia nervosa (AN), including systemic family therapy and manualised family-based treatments, to obtain an understanding of what helps and hinders positive change. METHOD A systematic search of the literature was conducted to identify qualitative studies focussing on experiences of therapeutic change within family therapies for AN from the perspectives of young people and their families. Fifteen studies met inclusion criteria and underwent quality appraisal following which they were synthesised using a meta-synthesis approach. RESULTS Six overarching themes were generated: "A holistic focus on the young person's overall development"; "The therapeutic relationship as a vehicle for change"; "The therapist's confinement to a script and its impact on emotional attunement"; "A disempowering therapeutic context"; "Externalisation of the eating disorder (ED)"; and "The importance of family involvement". Positive change was helped by understanding and support given to the young person's overall development including their psychological, emotional, social and physical wellbeing, positive therapeutic relationships, relational containment within the family system and externalising conversations in which young people felt seen and heard. Positive change was hindered by inflexibility in the treatment approach, counter-effects of externalisation, negative experiences of the therapist, a narrow focus on food-intake and weight, as well as the neglect of family difficulties, emotional experiences, and psychological factors. CONCLUSIONS Positive change regarding the young person's eating-related difficulties ensued in the context of positive relational changes between the young person, their family members, the therapist and treatment team, highlighting the significance of secure and trusting relationships. The findings of this review can be utilised by ED services to consider how they may adapt to the needs of young people and their families in order to improve treatment satisfaction, treatment outcomes, and in turn reduce risk for chronicity in AN.
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Affiliation(s)
- Sophie Cripps
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Lucy Serpell
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Matthew Pugh
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
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Katsuki F, Watanabe N, Kondo M, Sawada H, Yamada A. Remote family education and support program for parents of patients with adolescent and early adulthood eating disorders based on interpersonal psychotherapy: study protocol for a pilot randomized controlled trial. J Eat Disord 2024; 12:61. [PMID: 38760800 PMCID: PMC11102252 DOI: 10.1186/s40337-024-01013-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In cases of adolescent and early adulthood eating disorders, despite the importance of the patients' relationship with their parents, conflict and confusion frequently occur among them. Interpersonal psychotherapy (IPT) is a present-focused psychotherapy that emphasizes the interpersonal context of symptoms. We developed a remote family education and support program exclusively for parents of patients with eating disorders, based on the principle of IPT. The use of IPT is expected to reduce conflicts in the patient-parent relationship. Consequently, parents will be better able to listen to patients, and patients will be better able to express their thoughts and desires. In this study, we describe the protocol for a randomized controlled trial designed to examine the effectiveness of this program in promoting effective communication in their home based on active listening skills of parents of patients with adolescent and early adulthood eating disorders. METHODS Participants will be parents of patients aged 12-29 years with adolescent and early adulthood eating disorders. Individually randomized, parallel-group trial design will be employed. Seventy participants will be allocated to one of two treatment conditions: (1) remote family education and support program (four, 150 min weekly group sessions) for parents plus treatment-as-usual for patients (consultation by physicians or no treatment), or (2) waiting for the control condition (parents will wait to start the program for 8 weeks) plus treatment-as-usual for patients. The primary outcome measure will be parents' active listening ability as measured by the Active Listening Attitude Scale at 8 weeks after randomization. Additionally, perception of social support (Social Provision Scale-10 item), loneliness (UCLA Loneliness Scale), mental health status (K6), family function (Family Assessment Device), and parent-evaluated eating disorder symptoms (Anorectic Behavior Observation Scale) will be assessed. Data from the intention-to-treat sample will be analyzed 8 weeks after randomization. DISCUSSION This is the first study to evaluate the effectiveness of a family education and support program for parents of patients with adolescent and early adulthood eating disorders based on IPT. If this type of intervention is effective, although indirect, it could be a new support method for this patient population. TRIAL REGISTRATION Clinical Trials. gov ID NCT05840614.
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Affiliation(s)
- Fujika Katsuki
- Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate School of Nursing, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, 101 Shimotoba, Hiroosa-machi, Fushimiku, Kyoto, Japan
| | - Masaki Kondo
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, Japan
| | - Hanayo Sawada
- Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate School of Nursing, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Atsurou Yamada
- Department of Neurodevelopmental Disorders, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
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Pedersen SH, Waage DA, Micali N, Bentz M. Families tackling adolescent anorexia nervosa: family wellbeing in family-based treatment or other interventions. A scoping review. Eat Weight Disord 2024; 29:20. [PMID: 38504003 PMCID: PMC10951015 DOI: 10.1007/s40519-024-01641-z] [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: 11/24/2023] [Accepted: 01/28/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE Family-based treatment (FBT) has contributed significantly to the treatment of anorexia nervosa (AN) in young people (YP). However, parents are concerned that FBT and the active role of parents in the task of refeeding may have a negative impact on family relations. The aim of the review is to assess whether families engaged in FBT for AN are more or less impacted in their family wellbeing and caregiver burden, compared to families with a YP diagnosed with AN, who are not undergoing treatment with FBT. METHOD Computerized searches across six databases complemented by a manual search resulted in 30 papers being included in the scoping review. RESULTS The review identified 19 longitudinal studies on change in family wellbeing in families in FBT-like treatments, and 11 longitudinal studies on change in family wellbeing in treatment where parents are not in charge of refeeding. Only three randomized controlled studies directly compare FBT to treatment without parent-led refeeding. CONCLUSION The available research suggests no difference between intervention types regarding impact on family wellbeing. Approximately half of the studies find improvements in family wellbeing in both treatment with and without parent-led refeeding, while the same proportion find neither improvement nor deterioration. As parents play a pivotal role in FBT, there is a need for good quality studies to elucidate the impact of FBT on family wellbeing. Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Signe Holm Pedersen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark.
| | - Dorthe Andersen Waage
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Denmark, Ballerup, Denmark
| | - Nadia Micali
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Denmark, Ballerup, Denmark
| | - Mette Bentz
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
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Liu X, Mo W, Takiue K, Kanaya R, Takeya Y, Koujiya E, Yamakawa M. Expressed Emotion in Families of People With Dementia: A Review of Scale-Based Measures. J Gerontol Nurs 2024; 50:17-25. [PMID: 38290096 DOI: 10.3928/00989134-20240110-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE Research on the concept of expressed emotion (EE) has expanded in recent years but its role in dementia still requires elucidation. Understanding the role of EE in the dementia context could help in the development of appropriate interventions. METHOD The current review synthesized relevant literature to investigate the prevalence and correlates of EE status in families of people with dementia. A comprehensive search of four databases from inception to 2022 produced 2,683 papers; 18 studies met inclusion criteria. RESULTS The use of EE criteria differed not only across cultural contexts, but even within the same cultural context. Overall, the prevalence of EE in families with dementia compared with other psychiatric conditions was not high. CONCLUSION Specific changes in EE over time remain to be explored, and findings emphasize the need to carefully discriminate High EE status based on the cultural background of family members with dementia. [Journal of Gerontological Nursing, 50(2), 17-25.].
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Vashi N, Ibrahim A, Pouyandeh A, Weiss JA. Coherence of Parental Representations Following Therapy for Autistic Children. J Autism Dev Disord 2024:10.1007/s10803-024-06252-2. [PMID: 38281275 DOI: 10.1007/s10803-024-06252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
Autistic children experience high rates of mental health challenges, and links have been found between child mental health and the parent-child relationship. As parents of autistic children are often actively involved in their child's treatment, it is important to consider aspects of the parent-child relationship within this context. The present study investigated changes in a component of the parent-child relationship, the coherence of parental representations, following participation in a 10-week cognitive behavioural therapy intervention designed to address autistic children's mental health challenges. Relationships were examined between coherence and child characteristics (i.e., autism symptoms, mental health), and associations with child treatment outcomes (i.e., mental health). Participants included 81 children (89% boys) aged 8 to 13 years and their parents (85% mothers) aged 35 to 54 years. Baseline levels of coherence were related to children's mental health symptoms but not autism symptoms. Although there were no significant changes in overall coherence across therapy, subscale-level improvements (i.e., concern, acceptance) emerged. Changes in coherence across therapy were linked with children's post-intervention behavioural symptoms and were approaching significance for internalizing problems, but were not associated with externalizing problems. It is critical to investigate factors that shape the coherence of parents' representations of their children, as this may provide insight into potential targets for intervention. Ascertaining whether participation in therapy improves parental coherence, and consequently child treatment outcomes, can advocate for parent-involved therapy, which will ultimately benefit the well-being of autistic children.
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Affiliation(s)
- Nisha Vashi
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Alaa Ibrahim
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Ava Pouyandeh
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Jonathan A Weiss
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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Rienecke RD, Gorrell S, Johnson M, Duffy A, Mehler PS, Le Grange D. Expressed emotion and treatment outcome in higher levels of care for eating disorders. Int J Eat Disord 2023; 56:628-636. [PMID: 36584076 PMCID: PMC9992295 DOI: 10.1002/eat.23890] [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: 11/10/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Expressed emotion (EE) among caregivers toward the affected offspring is a negative prognostic indicator for adolescent patients with eating disorders (EDs) in outpatient treatment. Less research has examined its impact on adolescents in higher levels of care (HLOC). The current study examined differences in caregiver EE according to the subtype of anorexia nervosa (AN) (restricting [AN-R] versus binge/purge [AN-BP]), and level of care (LOC). We also examined the main effects of baseline caregiver EE (emotional overinvolvement [EOI] or criticism), AN subtype, and their interaction on eating pathology and depression at discharge. METHOD Adolescent patients (N = 203) receiving treatment at HLOCs completed measures of ED pathology (Eating Disorder Examination-Questionnaire) and depression (Patient Health Questionnaire-9) at baseline and discharge, and one caregiver of each patient completed a measure of EE (Family Questionnaire) at baseline. RESULTS No differences in caregiver EE were found between patients with AN-R versus AN-BP, or relative to LOC. Caregiver EE did not predict outcome for ED symptoms or depression at discharge. DISCUSSION The impact of high caregiver EE may be less substantial at HLOCs than outpatient care given that caregivers are less involved in treatment at HLOCs. Future research is needed to determine if high caregiver EOI leads to poor treatment outcome for adolescents as it does for adults, or whether it is an appropriate expression of care for patients who are ill enough to require HLOC treatment. PUBLIC SIGNIFICANCE STATEMENT High caregiver EE was not found to predict treatment outcome for adolescents with eating disorders in higher levels of care (HLOCs), possibly due to the limited involvement of caregivers in HLOCs. However, patients step down to outpatient treatment, where high caregiver EE can have a significant negative impact on outcome. HLOCs should incorporate efforts to reduce high caregiver EE in anticipation of step-down to outpatient treatment.
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Affiliation(s)
- Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Madelyn Johnson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Philip S. Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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García-Anaya M, Caballero-Romo A, González-Macías L. Maintaining Factors of Anorexia Nervosa Addressed from a Psychotherapeutic Group for Parents: Supplementary Report of a Patient's Therapeutic Success. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11396. [PMID: 36141668 PMCID: PMC9517022 DOI: 10.3390/ijerph191811396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Anorexia nervosa is an eating disorder (ED) where up to 30% of individuals remain unresponsive to treatments, whether they partially respond, or do respond and later relapse. It has been broadly reported how presenting maladaptive family functioning and communication style contributes to treatment drop-out, poor treatment compliance, and poor long-term outcomes. We studied the mother and father of a patient with AN, binge-purge subtype (according to DSM-IV TR) who achieved remission after her parents but not her attended an intervention through a psychotherapy group for parents (PGP). (2) Methods: We previously reported this patient's case report, and now, through an Interpretative Phenomenological Analysis (IPA) approach, we aimed to explore the understanding and meanings ascribed by the mother and father to their experience at the PGP and to their daughter's clinical and functional improvement. (3) Results: We identified two main stages along the process: one related to the presence of maintaining factors of their daughter's disorder, and the other related to the emergence of a reflective function and to the implementation of behavioral, emotional and cognitive changes. (4) Conclusions: The interview revealed both parents' experience at the PGP promoted a change process, where they were able to modify their previous style of communication and functioning, and to identify them as a contributors to maintain their daughter's disorder. Reflective function (RF) emerged in the mother and father throughout the psychotherapeutic process. Both parents also revealed some elements that were intergenerationally transmitted, that affected three generations and contributed to maintaining the ED. We observed the multilevel open-group structure of the PGP, enhancing the mother's and father's change process.
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Affiliation(s)
- María García-Anaya
- Clinical Research Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Alejandro Caballero-Romo
- Eating Disorders Clinic, Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Laura González-Macías
- Eating Disorders Clinic, Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
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Nestor B, Sutherland S, Kouros CD, Brunwasser SM, Weersing VR, Hollon SD, Gladstone TR, Clarke G, Beardslee W, Brent D, Garber J. Effects of an adolescent depression prevention program on maternal criticisms and positive remarks. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2020; 34:927-937. [PMID: 32658515 PMCID: PMC8022270 DOI: 10.1037/fam0000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study examined effects of an adolescent depression prevention program on maternal criticisms and positive remarks, whether the extent of adolescents' depression accounted for effects, and whether effects of the program on maternal criticisms and positive remarks differed by adolescents' gender. Participants were 298 adolescent (Mage = 14.79, SD = 1.36; 59% female) offspring of mothers with histories of depression; youth were randomized to either a cognitive-behavioral prevention (CBP) program or usual care (UC). At baseline and 9-month postintervention evaluations, mothers were administered the Five-Minute Speech Sample to measure number of criticisms and positive remarks made during an open-ended description of their child and their relationship. Adolescents' depression from pre- through postintervention was assessed with interviews. A hierarchical generalized linear model showed a significant condition-by-gender interaction, indicating that, controlling for baseline criticism, at postintervention mothers of girls in CBP made significantly more criticisms than did mothers of girls in UC, whereas mothers of boys in CBP made fewer criticisms than did mothers of boys in UC. The extent of adolescents' depression from pre- through postintervention partially mediated the relation between intervention condition and mothers' criticisms, for boys but not for girls. Second, controlling for preintervention positive remarks, at postintervention, mothers of youth in CBP made significantly more positive remarks about their child than did mothers of youth in UC, regardless of gender; this relation was not mediated by adolescent depression from pre- through postintervention. We suggest possible explanations for the observed effects of CBP on mothers' criticisms and positive remarks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Bridget Nestor
- Department of Psychology and Human Development and Department of Psychology, Vanderbilt University
| | - Susanna Sutherland
- Department of Psychology and Human Development and Department of Psychology, Vanderbilt University
| | | | | | - V. Robin Weersing
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego
| | - Steven D. Hollon
- Department of Psychology and Human Development and Department of Psychology, Vanderbilt University
| | | | - Greg Clarke
- Kaiser Permanente Center for Health Research
| | - William Beardslee
- Department of Psychiatry, Children’s Hospital Boston, and Judge Baker Children’s Center
| | - David Brent
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Judy Garber
- Department of Psychology and Human Development and Department of Psychology, Vanderbilt University
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Philipp J, Truttmann S, Zeiler M, Franta C, Wittek T, Schöfbeck G, Mitterer M, Mairhofer D, Zanko A, Imgart H, Auer-Welsbach E, Treasure J, Wagner G, Karwautz AFK. Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa-Caregivers' and Adolescents' Perspective. J Clin Med 2020; 9:jcm9072021. [PMID: 32605074 PMCID: PMC7409203 DOI: 10.3390/jcm9072021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
High expressed emotion (EE) is common in caregivers of patients with anorexia nervosa (AN) and associated with poorer outcome for patients. In this study, we examined the prevalence of high EE in caregivers of adolescents with AN and analyzed predictors for EE using multivariate linear regression models. We further analyzed whether EE is reduced by the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) intervention using general linear mixed models and whether a reduction of EE predicts patients’ outcomes. Caregivers were randomly allocated to the SUCCEAT workshop (N = 50) or online intervention (N = 50) and compared to a comparison group (N = 49). EE and patients’ outcomes were assessed at the baseline, post-intervention, and at the 12-month follow-up. Up to 47% of caregivers showed high EE. Lower caregiver skills, higher AN symptom impact, higher levels of depression and motivation to change in caregivers were significant predictors for high EE. EE significantly decreased in the SUCCEAT groups and the comparison group according to the caregivers’, but not the patients’ perspective. The level of reduction could partially predict subjective improvement and improvement in clinically assessed AN symptoms and body mass index of patients. Implementing interventions for caregivers addressing EE in the treatment of adolescents with AN is strongly recommended.
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Affiliation(s)
- Julia Philipp
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Stefanie Truttmann
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Claudia Franta
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Tanja Wittek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Gabriele Schöfbeck
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Michaela Mitterer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Dunja Mairhofer
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Annika Zanko
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, 34537 Bad Wildungen, Germany; (A.Z.); (H.I.)
| | - Hartmut Imgart
- Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, 34537 Bad Wildungen, Germany; (A.Z.); (H.I.)
| | - Ellen Auer-Welsbach
- Department for Neurology and Child and Adolescent Psychiatry, 9020 Klagenfurt am Wörthersee, Austria;
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK;
| | - Gudrun Wagner
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
| | - Andreas F. K. Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (J.P.); (S.T.); (M.Z.); (C.F.); (T.W.); (G.S.); (M.M.); (D.M.); (G.W.)
- Correspondence: ; Tel.: +43-1-40400-30140
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10
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Nagamitsu S, Fukai Y, Uchida S, Matsuoka M, Iguchi T, Okada A, Sakuta R, Inoue T, Otani R, Kitayama S, Koyanagi K, Suzuki Y, Suzuki Y, Sumi Y, Takamiya S, Fujii C, Tsurumaru Y, Ishii R, Kakuma T, Yamashita Y. Validation of a childhood eating disorder outcome scale. Biopsychosoc Med 2019; 13:21. [PMID: 31528200 PMCID: PMC6737718 DOI: 10.1186/s13030-019-0162-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
We developed and validated a childhood eating disorder outcome scale based on outcomes associated with body mass index standard deviation score (BMI-SDS). This prospective observational study included 131 children with eating disorders (aged 5-15 years). Participants' outcomes scales were completed at the first visit and at 1, 3, 6, and 12 months. The scale evaluated 12 outcomes: body weight change (BW), eating attitude (EA), fear of being fat (FF), body image distortion (BD), menstruation (ME), perceived physical condition (PC), attending school (AS), disease recognition by school (RS), family function (FA), disease recognition by parent (RP), social adaptation (SA), and relationships with friends (RF). Responses to all items were on a four-point Likert scale. Exploratory factor analysis was used to determine the number of factors based on the 12 outcomes. The relation between outcome scale scores and BMI-SDS over the 12-month follow-up period was analyzed. Two types of factors were extracted: disease-specific factors (EA, FF, BD) and biopsychosocial factors (BW, PC, AS, FA, SA, RF). Three items (ME, RS, RP) were excluded because they showed no significant loading effect. There was a significant negative correlation between the outcome scale and BMI-SDS, and changes in outcome scale scores from baseline to 12 months were significantly associated with improvement in BMI-SDS. We developed a childhood eating disorder outcome scale characterized by disease-specific and biopsychosocial factors. Biopsychosocial management combined with a therapeutic approach for disease-specific symptoms may support body weight recovery for children with eating disorders.
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Affiliation(s)
- Shinichiro Nagamitsu
- 1Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011 Japan
| | - Yoshimitsu Fukai
- 2Psychosomatic Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - So Uchida
- 3Department of Pediatrics, Tachikawa Hospital, Tachikawa, Japan
| | - Michiko Matsuoka
- 4Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Toshiyuki Iguchi
- Department of Pediatrics Hoshigaoka Maternity Hospital, Nagoya, Japan
| | - Ayumi Okada
- 6Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryoichi Sakuta
- 7Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Takeshi Inoue
- 7Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Ryoko Otani
- 7Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | | | - Kenshi Koyanagi
- Nagasaki Prefectural Center of Medicine and Welfare for Children, Nagasaki, Japan
| | - Yuichi Suzuki
- 10Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Suzuki
- Department of Pediatrics, National Hospital Organization Mie National Hospital, Mie, Japan
| | - Yoshino Sumi
- 12Department of Pediatrics, School of Medicine, Sapporo Medical University, Sapporo, Japan.,Mental and Developmental Clinic for Children "ELM TREE", Sapporo, Japan
| | - Shizuo Takamiya
- 14Psychiatry Department, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.,Takamiya Medical Clinic, Akashi, Japan
| | - Chikako Fujii
- 16Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Yasuko Tsurumaru
- 16Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Ryuta Ishii
- 1Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011 Japan
| | | | - Yushiro Yamashita
- 1Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011 Japan
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11
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Blondin S, Meilleur D, Taddeo D, Frappier JY. Caregiving experience and expressed emotion among parents of adolescents suffering from anorexia nervosa following illness onset. Eat Disord 2019; 27:453-470. [PMID: 30612513 DOI: 10.1080/10640266.2018.1553431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to better understand the relationship between parents' experience of caregiving and expressed emotion during the early stage of their child's eating disorder. Fifty mothers and 38 fathers of adolescents suffering from anorexia nervosa and hospitalized for the first time participated in this study. They completed the Experience of Caregiving Inventory, a measure of the negative and positive aspects of the caregiving experience, and the Family Questionnaire, which measured the different dimensions of expressed emotion, namely emotional over-involvement and critical comments. Results showed that caregiving experience is significantly and positively correlated to expressed emotion. Among the negative aspects of caregiving, sense of loss contributed most to emotional over-involvement, while difficult behaviours contributed most to critical comments. The results suggest that parents' perceptions of their child and child's future are strongly related to their tendency to be over-involved. The perception of disruptive behaviours in their child could be one of the principal triggers or exacerbating factors of parents' critical attitudes.
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Affiliation(s)
- Soline Blondin
- Department of Psychology, Adolescence and Eating Disorders Research Laboratory, Montreal University , Montreal , Quebec , Canada
| | - Dominique Meilleur
- Department of Psychology, Adolescence and Eating Disorders Research Laboratory, Montreal University , Montreal , Quebec , Canada
| | - Danielle Taddeo
- Division of Adolescent Medicine, Sainte-Justine Hospital Center , Montreal , Quebec , Canada
| | - Jean-Yves Frappier
- Division of Adolescent Medicine, Sainte-Justine Hospital Center , Montreal , Quebec , Canada
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12
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Dimitropoulos G, Landers AL, Freeman V, Novick J, Cullen O, Le Grange D. Family-based treatment for transition age youth: the role of expressed emotion and general family functioning. Eat Disord 2019; 27:419-435. [PMID: 30358513 DOI: 10.1080/10640266.2018.1529472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to investigate changes in family functioning and parental expressed emotion (EE) in parents and transition age youth (18 to 25 years old) with Anorexia Nervosa participating in Family-Based Treatment for Transition Age Youth (FBT-TAY). Further, we examined whether perceived family functioning and EE were associated with changes in eating disorder behaviour and weight in participants at end-of-treatment and three months post-treatment. Generalized estimating equations revealed that changes in family functioning significantly improved from baseline to end-of-treatment (p = .0001), and baseline to three months post-treatment (p = .0001) in parents; and from baseline to end-of-treatment (p = .011), and baseline to three months post-treatment (p = .0001) in transition age youth. The level of parental EE did not differ significantly from baseline to end-of-treatment (p = .379), or baseline to three months post-treatment (p = .185). A series of Ordinary Least Square regression models demonstrated that changes in perceived family functioning and EE were not significantly associated with changes in eating disorder behaviour and weight restoration of transition age youth at end-of-treatment and three months post-treatment. Overall, perceptions of family functioning improved during the course of FBT-TAY, but EE did not.
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Affiliation(s)
- Gina Dimitropoulos
- Toronto General Hospital Eating Disorder Program, University Health Network , Toronto , Ontario , Canada
| | - Ashley L Landers
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University , Falls Church , Virginia , USA
| | - Victoria Freeman
- Toronto General Hospital, University Health Network , Toronto Ontario , Canada
| | - Jason Novick
- Department of Sociology, Mount Royal University , Calgary Alberta , Canada
| | - Olivia Cullen
- Faculty of Social Work, University of Calgary , Calgary Alberta , Canada
| | - Daniel Le Grange
- Department of Psychiatry, University of California , San Francisco CA , USA
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13
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Toubøl A, Koch-Christensen H, Bruun P, Nielsen DS. Parenting skills after participation in skills-based training inspired by the New Maudsley Method: a qualitative study in an outpatient eating disorder setting. Scand J Caring Sci 2019; 33:959-968. [PMID: 31058339 DOI: 10.1111/scs.12694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/17/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eating disorders affect the whole family and it is recommended that parents play an important role in their adolescents' recovery. Being a parent to an adolescent with an eating disorder is often linked to feelings of guilt and hopelessness and at the same time parents often feel left alone with unmet needs when it comes to handling symptoms in family life. Little is known about parents' perspectives to skills-based training in adolescent eating disorder treatment. This knowledge is urgently required, since previous research has focused mainly on adult patients showing positive effects of skills-based training as a promising adjunct in eating disorder treatment. OBJECTIVE To examine parents' perception of their new skills after having participated in skills-based training inspired by the New Maudsley Method. METHODOLOGY A qualitative study using deductive dominant content analysis. METHODS In total, 21 parents participated in focus groups. FINDINGS Three categories were identified (i) Standing outside oneself and realise that one has become entangled in the illness, (ii) Understanding the daughter's inner life with the illness offers new opportunities in the relationship, (iii) Courage to find new ways of parenting. The parents experienced themselves more calm and confident in their ability to recognise and confront the eating disorder symptoms. They expressed increased communication skills, which improved their relationship with their child and gave access to her inner life. CONCLUSION Skills-based training serves as an important intervention and it may improve parental skills, reduce high expressed emotions and reduce anxiety, guilt and stress. Skills-based training may contribute to reinforcing parents to regain parenting authority and enable parents and adolescents to 'be on the same side' in the beating the eating disorder.
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Affiliation(s)
- Annemarie Toubøl
- Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Helle Koch-Christensen
- Child and Adolescent Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Poul Bruun
- Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Dorthe S Nielsen
- Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
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14
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Abstract
BACKGROUND Expressed emotion (EE) is detrimental to patients with schizophrenia, mood disorders, eating disorders and many other psychiatric and neurological disorders. However, majority of the EE literature is generated from the west, and the results of those studies may have limited application in Indian setting. Hence, we conducted this review with the main aim of understanding EE research in India and its potential role in the course and outcome of psychiatric disorders and other chronic illnesses. METHODS Using keywords, we performed searches of electronic databases (PubMed, IndMed, PsychInfo, Science-Direct and Google Scholar) and internet sources and a manual search in the bibliography of the retrieved articles to identify potential original research articles on EE in India. RESULTS As per the selection criteria, 19 reports of 16 studies were included and reviewed. The sample size of the EE studies ranged from 20 to 200, and majority of the studies were conducted in psychosis/schizophrenia, followed by obsessive compulsive disorder and epilepsy. Although high EE was found in most of the studies, the impact of EE on illness outcome is not well explored and only two studies examined the relationship between EE and relapse. DISCUSSION AND CONCLUSION There is a dearth of studies on EE, especially its relationship with relapse or clinical outcomes in the Indian context. We recommend more studies in these areas which may be helpful for clinical decisions and advancement of context knowledge in EE.
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Affiliation(s)
- Anvar Sadath
- Department of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India
| | - Ram Kumar
- Department of Psychiatry, Government Medical College, Kollam, Kerala, India
| | - Magnus Karlsson
- Department of Social Work, Linneaus University, Vaxjo, Sweden
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15
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Duclos J, Dorard G, Cook-Darzens S, Curt F, Faucher S, Berthoz S, Falissard B, Godart N. Predictive factors for outcome in adolescents with anorexia nervosa: To what extent does parental Expressed Emotion play a role? PLoS One 2018; 13:e0196820. [PMID: 30063706 PMCID: PMC6067718 DOI: 10.1371/journal.pone.0196820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/20/2018] [Indexed: 11/18/2022] Open
Abstract
In studies on family therapy in Anorexia Nervosa, family relationships, as assessed by Expressed Emotion, have been associated with outcome. Our aim was to explore the contribution of Expressed Emotion as a predictor of 18-month outcome, above and beyond the usual predictive factors. Sixty adolescent girls suffering from Anorexia Nervosa and their parents were assessed at baseline and 18 months later. Levels of Expressed Emotion were evaluated in both parents with the Five-Minute Speech Sample. After controlling for treatment group and initial clinical status, high maternal Emotional Over-Involvement at baseline was significantly associated with better clinical state. More precisely, high maternal Emotional Over-Involvement was associated with higher nutritional status, lower eating disorder severity and fewer re-hospitalizations 18 months later. No associations were found with paternal levels of Expressed Emotion. Therefore, our study confirmed the importance of taking into account both maternal and paternal Expressed Emotion. Our results also underlined that high maternal Emotional Over-Involvement plays a positive role in the outcome of Anorexia Nervosa and needs to be explored further.
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Affiliation(s)
- Jeanne Duclos
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
- * E-mail:
| | - Géraldine Dorard
- Laboratoire de Psychopathologie et Processus de santé (LPPS), University Paris Descartes, Boulogne, France
| | - Solange Cook-Darzens
- Service de psychopathologie de l’enfant et de l’adolescent, Hôpital Robert Debré, Paris, France
| | - Florence Curt
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Sophie Faucher
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Sylvie Berthoz
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
| | - Bruno Falissard
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
| | - Nathalie Godart
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, Université Paris-Saclay, Paris, France
- Fondation de Santé des Etudiants de France, Paris, France
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16
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Allan E, Le Grange D, Sawyer SM, McLean LA, Hughes EK. Parental Expressed Emotion During Two Forms of Family-Based Treatment for Adolescent Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2017; 26:46-52. [PMID: 29105211 DOI: 10.1002/erv.2564] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/04/2017] [Accepted: 10/11/2017] [Indexed: 11/09/2022]
Abstract
High parental expressed emotion (EE), reflected by criticism or emotional over-involvement, has been related to poorer outcome in family-based treatment (FBT) for adolescent anorexia nervosa. This study assessed EE in 89 mothers and 64 fathers at baseline and end of treatment in a randomised trial comparing conjoint FBT to parent-focused FBT (PFT). Compared with conjoint FBT, PFT was associated with a decrease in maternal criticism, regardless of adolescent remission. Furthermore, an increase in maternal criticism was more likely to be observed in conjoint FBT (80%) than PFT (20%, p = 0.001). Adolescents of mothers who demonstrated an increase in EE, or remained high in EE, were less likely to remit compared with adolescents for whom EE decreased or remained low (33% and 0% vs. 43% and 50%, p = 0.03). There were no significant effects for paternal EE. The results highlight the importance of considering EE when implementing FBT for adolescents with anorexia nervosa. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Erica Allan
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Faculty of Education, Monash University, VIC, Australia
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, CA, USA.,Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, USA (Emeritus)
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
| | | | - Elizabeth K Hughes
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,School of Psychological Sciences, Monash University, VIC, Australia
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