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Albano G, Salerno L, Cardi V, Brockmeyer T, Ambwani S, Treasure J, Lo Coco G. Patient and mentor language style matching as a predictor of working alliance, engagement with treatment as usual, and eating disorders symptoms over the course of an online guided self-help intervention for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023; 31:135-146. [PMID: 35983983 PMCID: PMC10087304 DOI: 10.1002/erv.2948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/29/2022] [Accepted: 08/07/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine the processes involved in a guided self-help (GSH) pre-treatment intervention (RecoveryMANTRA) for patients with anorexia nervosa (AN), by measuring the levels of patient/mentor Language Style Matching (LSM). RecoveryMANTRA was supported by student mentors or peer mentors (recovered individuals) over six weekly chat-based sessions. We examined whether LSM during RecoveryMANTRA predicted patients'working alliance with the clinic therapist, motivation, eating disorder (ED) and general psychopathology. A further aim was to examine differences in LSM between student mentors and peer mentors. METHOD 87 AN adults received RecoveryMANTRA plus treatment as usual. The LSM algorithm was used to calculate verbal attunement between patient and mentor. Participants were assessed at baseline and at the end of the intervention. RESULTS Both early (1st session) and late (6th session) LSM predicted higher working alliance with the clinic therapist. Moreover, late LSM predicted lower EDs symptoms at the end of the RecoveryMANTRA intervention. Patient/peer mentor dyads showed higher late verbal attunement than patient/student mentor dyads. CONCLUSIONS These findings suggests that in the early phase of treatment relational aspects can impact on engagement with treatment. Verbal attunement in a GSH for AN is associated with working alliance and better clinical outcome.
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Affiliation(s)
- Gaia Albano
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Laura Salerno
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Valentina Cardi
- Department of Psychological Medicine, King's College London, London, UK.,Department of General Psychology, University of Padova, Padova, Italy
| | - Timo Brockmeyer
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, Pennsylvania, USA
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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Hodsoll J, Rhind C, Micali N, Hibbs R, Goddard E, Nazar BP, Schmidt U, Gowers S, Macdonald P, Todd G, Landau S, Treasure J. A Pilot, Multicentre Pragmatic Randomised Trial to Explore the Impact of Carer Skills Training on Carer and Patient Behaviours: Testing the Cognitive Interpersonal Model in Adolescent Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2017; 25:551-561. [PMID: 28948663 DOI: 10.1002/erv.2540] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/14/2017] [Indexed: 12/11/2022]
Abstract
AIM The aim of the study is to establish the acceptability, feasibility and approximate size of the effect of adding a carer intervention [Experienced Caregivers Helping Others (ECHO)] to treatment as usual (TAU) for adolescents with anorexia nervosa. METHODS The study is a pilot randomised trial comparing TAU (n = 50) alone or TAU plus ECHO with (n = 50) or without (n = 49) telephone guidance. Effect sizes (ESs) were regression coefficients standardised by baseline standard deviations of measure. RESULTS Although engagement with ECHO was poor (only 36% of carers in the ECHO group read over 50% of the book), there were markers of intervention fidelity, in that caregivers in the ECHO group showed a moderate increase in carer skills (ES = 0.4) at 12 months and a reduction in accommodating and enabling behaviour at 6 months (ES = 0.17). In terms of efficacy, in the ECHO group, carers spent less time care giving (ES = 0.40, p = 0.04) at 1 year, and patients had a minor advantage in body mass index (ES = 0.17), fewer admissions, decreased peer problems (ES = -0.36) and more pro-social behaviours (ES = 0.53). The addition of telephone guidance to ECHO produced little additional benefit. CONCLUSIONS The provision of self-management materials for carers to standard treatment for adolescent anorexia nervosa shows benefits for both carers and patients. This could be integrated as a form of early intervention in primary care. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- John Hodsoll
- Department of Biostatistics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Charlotte Rhind
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, University College London, Institute of Child Health, London, UK.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rebecca Hibbs
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Elizabeth Goddard
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Bruno Palazzo Nazar
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, Brazil
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Simon Gowers
- Adolescent Psychiatry, University of Liverpool, Chester, UK
| | - Pamela Macdonald
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Gillian Todd
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sabine Landau
- Department of Biostatistics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Abstract
The aim of this study is to evaluate the recent literature on carers/parenting interventions for people with eating disorders. Interesting and important new findings are highlighted as well as the implications that this may have for treatment. We have reviewed and critically analysed the recent literature. Close others often play an important role in recognising the early signs of eating disorders and accessing and implementing treatment. Their role in helping with recovery is to give support and hold a united front themselves and with the professional team to avoid those common interpersonal reactions that adversely impact on outcome such as accommodating to the illness and reacting with high expressed emotion (overprotection and hostility). Managing this role is difficult, and coping resources are often strained. Carers ask for and are now getting expert training in skills to manage this role. There is an overlap between carer/parenting interventions and family therapies. The interface with close others is critical both for early recognition and access and implementation of treatment. Interventions which equip families and close others with the skills to manage eating disorder behaviours are showing potential at improving outcomes.
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Magill N, Rhind C, Hibbs R, Goddard E, Macdonald P, Arcelus J, Morgan J, Beecham J, Schmidt U, Landau S, Treasure J. Two-year Follow-up of a Pragmatic Randomised Controlled Trial Examining the Effect of Adding a Carer's Skill Training Intervention in Inpatients with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2015; 24:122-30. [PMID: 26695507 DOI: 10.1002/erv.2422] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 10/30/2015] [Accepted: 11/06/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Active family engagement improves outcomes from adolescent inpatient care, but the impact on adult anorexia nervosa is uncertain. AIM The aim of this study was to describe the 2-year outcome following a pragmatic randomised controlled trial in which a skill training intervention (Experienced Caregivers Helping Others) for carers was added to inpatient care. METHOD Patient, caregiver and service outcomes were measured for 2 years following discharge from the index inpatient admission. RESULTS There were small-sized/moderate-sized effects and consistent improvements in all outcomes from both patients and carers in the Experienced Caregivers Helping Others group over 2 years. The marked change in body mass index and carers' time caregiving following inpatient care was sustained. Approximately 20% of cases had further periods of inpatient care. CONCLUSION In this predominately adult anorexia nervosa sample, enabling carers to provide active support and management skills may improve the benefits in all symptom domains that gradually follow from a period of inpatient care.
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Affiliation(s)
| | - Charlotte Rhind
- Department of Psychological Medicine, King's College, IoPPN, London, UK
| | - Rebecca Hibbs
- Department of Psychological Medicine, King's College, IoPPN, London, UK
| | - Elizabeth Goddard
- Department of Psychological Medicine, King's College, IoPPN, London, UK
| | - Pamela Macdonald
- Department of Psychological Medicine, King's College, IoPPN, London, UK
| | - Jon Arcelus
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - John Morgan
- Yorkshire Centre for Eating Disorders, Leeds Partnerships NHS Foundation Trust, Leeds, UK
| | | | - Ulrike Schmidt
- Department of Psychological Medicine, King's College, IoPPN, London, UK
| | | | - Janet Treasure
- Department of Psychological Medicine, King's College, IoPPN, London, UK
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Hibbs R, Magill N, Goddard E, Rhind C, Raenker S, Macdonald P, Todd G, Arcelus J, Morgan J, Beecham J, Schmidt U, Landau S, Treasure J. Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial. BJPsych Open 2015; 1:56-66. [PMID: 27703724 PMCID: PMC4998946 DOI: 10.1192/bjpo.bp.115.000273] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/27/2015] [Accepted: 07/14/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Families express a need for information to support people with severe anorexia nervosa. AIMS To examine the impact of the addition of a skills training intervention for caregivers (Experienced Caregivers Helping Others, ECHO) to standard care. METHOD Patients over the age of 12 (mean age 26 years, duration 72 months illness) with a primary diagnosis of anorexia nervosa and their caregivers were recruited from 15 in-patient services in the UK. Families were randomised to ECHO (a book, DVDs and five coaching sessions per caregiver) or treatment as usual. Patient (n=178) and caregiver (n=268) outcomes were measured at discharge and 6 and 12 months after discharge. RESULTS Patients with caregivers in the ECHO group had reduced eating disorder psychopathology (EDE-Q) and improved quality of life (WHO-Quol; both effects small) and reduced in-patient bed days (7-12 months post-discharge). Caregivers in the ECHO group had reduced burden (Eating Disorder Symptom Impact Scale, EDSIS), expressed emotion (Family Questionnaire, FQ) and time spent caregiving at 6 months but these effects were diminished at 12 months. CONCLUSIONS Small but sustained improvements in symptoms and bed use are seen in the intervention group. Moreover, caregivers were less burdened and spent less time providing care. Caregivers had most benefit at 6 months suggesting that booster sessions, perhaps jointly with the patients, may be needed to maintain the effect. Sharing skills and information with caregivers may be an effective way to improve outcomes. This randomised controlled trial (RCT) was registered with Current Controlled Trials ISRCTN06149665. DECLARATION OF INTEREST J.T. is a co-author of the book used in the ECHO intervention and receives royalties. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Rebecca Hibbs
- Rebecca Hibbs, MSc, PhD, Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Nicholas Magill
- Nicholas Magill, MSc, Biostatistics Department, King’s College London, IoPPN, London, UK
| | - Elizabeth Goddard
- Elizabeth Goddard, PhD, Department of Psychological Medicine, Section of Eating Disorders, King’s College London, IoPPN, London, UK
| | - Charlotte Rhind
- Charlotte Rhind, MSc, Department of Psychological Medicine, Section of Eating Disorders, King’s College London, IoPPN, London, UK
| | - Simone Raenker
- Simone Raenker, PhD, Department of Psychological Medicine, Section of Eating Disorders, King’s College London, IoPPN, London, UK
| | - Pamela Macdonald
- Pamela Macdonald, PhD, Department of Psychological Medicine, Section of Eating Disorders, King’s College London, IoPPN, London, UK
| | - Gill Todd
- Gill Todd, RMN, MSc, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jon Arcelus
- Jon Arcelus, MD, PhD, Eating Disorders Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - John Morgan
- John Morgan, MD, PhD, Yorkshire Centre for Eating Disorders, Leeds, UK
| | - Jennifer Beecham
- Jennifer Beecham, PhD, Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science, London, UK
| | - Ulrike Schmidt
- Ulrike Schmidt, MD, PhD, Department of Psychological Medicine, Section of Eating Disorders, King’s College London, IoPPN, London, UK
| | - Sabine Landau
- Sabine Landau, PhD, Biostatistics Department, King’s College London, IoPPN, London, UK
| | - Janet Treasure
- Janet Treasure, MD, PhD, Department of Psychological Medicine, Section of Eating Disorders, King’s College London, IoPPN, London, UK
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Cardi V, Ambwani S, Crosby R, Macdonald P, Todd G, Park J, Moss S, Schmidt U, Treasure J. Self-Help And Recovery guide for Eating Disorders (SHARED): study protocol for a randomized controlled trial. Trials 2015; 16:165. [PMID: 25885697 PMCID: PMC4435653 DOI: 10.1186/s13063-015-0701-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/01/2015] [Indexed: 02/07/2023] Open
Abstract
Background We describe the theoretical rationale and protocol for Self-Help And Recovery guide for Eating Disorders (SHARED), a trial investigating whether a guided self-care intervention (Recovery MANTRA) is a useful addition to treatment as usual for individuals with anorexia nervosa. Recovery MANTRA, a 6-week self-care intervention supplemented by peer mentorship, is a module extension of the Maudsley Model of Treatment for Adults with Anorexia Nervosa and targets the maintenance factors identified by the cognitive-interpersonal model of the illness. Methods Patients accessing outpatient services for anorexia nervosa are randomized to either treatment as usual or treatment as usual plus Recovery MANTRA. Outcome variables include change in body weight at the end of the intervention (primary) and changes in body weight and eating disorder symptoms at immediate and extended follow-up (6-months; secondary). Change is also assessed for the domains identified by the theoretical model, including motivation, hope, confidence to change, positive mood, cognitive flexibility, therapeutic alliance and social adjustment. Feedback from peer mentors is gathered to understand the impact on their own well-being of providing guidance. Discussion Results from this exploratory investigation will determine whether a larger clinical trial is justifiable and feasible for this affordable intervention, which has potential for high reach and scalability. Trial registration ClinicalTrials.gov NCT02336841.
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Affiliation(s)
- Valentina Cardi
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Suman Ambwani
- Department of Psychology, Dickinson College, P.O. Box 1773, Carlisle, PA, 17013, USA.
| | - Ross Crosby
- Neuropsychiatric Research Institute, 700 First Ave. South, Fargo, ND, 58103, USA.
| | - Pamela Macdonald
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Gill Todd
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Jinhong Park
- Department of Psychology, Carleton College, 1 N. College St., Northfield, MN, 55057, USA.
| | - Sara Moss
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Janet Treasure
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
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