Mechanisms of action in the process of change: helping eating disorder clients make meaningful shifts in their lives

Perception on family support and predictors' of satisfaction with the healthcare service among families of children and adolescents with serious mental illnesses who are in active psychiatric treatment

PROBLEM

Little is known about the factors related to satisfaction with healthcare services among families of children with serious mental illness who were in active psychiatry treatment.

METHODS

A cross-sectional study was conducted to explore perceived family support, illness beliefs, and families' satisfaction with healthcare services. Sixty-eight families of children with anxiety, depression, attention-deficit/hyperactivity disorder, eating disorders, and autism/Asperger's syndrome participated. Data were collected from March 2015 to December 2016.

FINDINGS

Illness beliefs and perceived family support explained 23% of the variance in family satisfaction with the healthcare service.

CONCLUSION

Family interventions need to specifically focus on the families' satisfaction with healthcare services and on utilizing the family support network, offering emotional support, and exploring illness beliefs.

Exercise and physical therapy help restore body and self in clients with severe anorexia nervosa

Exercise in the context of anorexia nervosa is a multifaceted endeavour surrounded by controversy and uncertainty. A broader comprehension of this poorly understood phenomenon is required. Informed by the findings of a body examination of six individuals with anorexia nervosa, as well as exercise science, phenomenology and neurocognition, the purpose of this article is to elaborate on the potential role of exercise and physical therapy in the treatment of anorexia nervosa. The findings of the body assessment include constriction of posture, muscles and pattern of breathing. These bodily restraints are not necessarily merely associated with high levels of exercise, they may also reflect psychological strain accompanying the illness. The restricted breathing in particular is assumed to be associated with difficult thoughts and suppressed feelings. Based on the results of the body examination, as well as medical and psychological considerations accompanying the illness, it is suggested that interventions should focus on improving postural stability and restoring related muscular function. Integral to engaging in these activities, the potential to integrate proprioceptive information in this process may generate a more coherent experience of the body, as well as of the self, in these clients. Accordingly, constrictions of the body may have a vital role in constraining the experience of the self. As such, addressing bodily restraints in these clients may facilitate the experience of being the subject causing and controlling the movements. This is in marked contrast to clients' previous exercise experiences, which were associated with compulsion, rigidity and the absence of coherence and control.

'Feelings stronger than reason': conflicting experiences of exercise in women with anorexia nervosa

BACKGROUND

Individuals with anorexia nervosa frequently feel ambivalent about treatment and weight restoration, and drop out and relapse rates in treatment are high. Increased insight into the function of the eating disorder is considered essential for achieving long-lasting, meaningful change. However, research investigating the functions of anorexia nervosa tends to focus on the role of the disease per se. Distinctions are rarely made across features. In particular, the subjective experience, understanding and sense making of the engagement in compulsive exercise in individuals with anorexia nervosa has received little attention. By using a qualitative methodological approach, this paper aims to expand on prior findings by examining how patients with anorexia nervosa understand and make sense of the experience of exercise in the context of their lives and treatment programme.

METHODS

Semi-structured interviews were conducted with six females, four of whom were former athletes. Transcripts were subjected to interpretative phenomenological analysis (IPA).

RESULTS

Two overarching themes emerged in the analysis of the larger study of which this paper is a part; 'paradoxical functions of exercise' and 'diverging experiences of exercise'. Diverging experiences of exercise is the focus of this paper. Firstly, in spite of being severely underweight and suffering from exhaustion, as well as having a clear awareness of the associated negative health effects, participants were engaged in a continuous cycle of rigorous and excessive exercise, which consumed extensive amounts of time and energy. Secondly, the results demonstrate how exercise routines negatively control and interfere with the participants' involvement in the social world. Thirdly, the manner in which participants speak about their exercise reveals their wording to be characterized by efforts to downplay the extent of their actual immersion in exercise. Issues of control and ambivalence about treatment and recovery can be considered potential triggers for the participants' engagement with exercise. Implicit meanings are elaborated upon and discussed in relation to existing literature.

CONCLUSIONS

The material provides increased insight into the multi-layered meanings of exercise for individuals with anorexia nervosa. It also suggests alternatives to current ways of understanding and approaching exercise that may enable this issue to be addressed in a more meaningful way in therapy. Qualitative approaches can make a valuable contribution to furthering such understanding.

From shame to shame resilience: narratives of counselor trainees with eating issues

Using narrative analysis, the experiences of 7 Canadian counselor trainees with eating issues were explored for meanings of shame and resilience. Shame was experienced as layers of discounting and disconnection from self and others, which served as barriers to help seeking and recovery. Trainees' attempts to overcome shame were characterized by a dialectic conflict of protecting shame vs. prioritizing recovery. Finding a culture of safety and belonging, invalidating perfection, and redefining ideals emerged as elements that fostered resilience from the layers of shame. Recommendations for future research include exploring the important features of social support and examining how safe disclosure contributes to overcoming shame. Potential implications for counselor education programs include introducing self-care initiatives, discussions about counselor wellness and ethical practice, and education on eating issues.

Resistance to treatment and change in anorexia nervosa [corrected]: a clinical overview

BACKGROUND

Current literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN). This lack of successful guidelines may play a role in making these disorders even more resistant. In fact, many individuals do not respond to the available treatments and develop an enduring and disabling illness. With this overview we aimed to highlight and discuss treatment resistance in AN--with an in-depth investigation of resistance-related psychological factors.A literature search was conducted on PubMed and PsychINFO; English-language articles published between 1990 and 2013 investigating the phenomenon of resistance to treatment in AN have been considered.

DISCUSSION

The selected papers have been then grouped into four main thematic areas: denial of illness; motivation to change; maintaining factors and treatment outcome; and therapeutic relationship. Eating symptomatology was found to only partially explain resistance to treatment. The role of duration of illness has been questioned whilst some maintaining factors seemed promising in providing a useful framework for this phenomenon. Emotive and relational aspects have been investigated on their role in resistance as well as therapists' countertransference.

SUMMARY

Remarkably there has been little research done on resistance to treatment in the ED field, in spite of its clinical relevance. Motivation, insight and subjective meaning of the illness can be useful tools to manage the resistance phenomenon when coupled with a wider approach. The latter enables the therapists to be aware of their role in the therapeutic alliance through countertransference aspects and to consider the EDs as disorders of the development of both personality and self, entailing severe impairments as regards identity and relationships.

Leadership qualities when providing therapy for women who suffer from eating difficulties

AIM

The aim of this study was to reflect on aspects of mental health nursing leadership qualities with special focus on the therapeutic process for women who suffer from eating difficulties (ED).

BACKGROUND

Therapy for patients with ED involves motivating them to make meaningful changes. Leadership qualities in MHN should focus on the relationship with the patient and positive empowerment processes.

METHODS

In-depth interviews were conducted with six women suffering from ED who had participated in art therapy. The interviews were analysed by means of an interpretative hermeneutic approach.

RESULTS

A main theme 'The mental health nurse as a formative and mindful leader in a group therapeutic relationship' and two themes 'Leading sensitively towards awakening the patients' awareness of their pre-understanding' and 'Leading dialectically towards solving patients' existential dilemmas' were developed and comprised two aspects of leadership.

CONCLUSION

The nurse-patient relationship is influenced by the patients' pre-understanding and existential dilemmas. Leadership qualities associated with being formative and mindful represent important aspects of this relationship and should be investigated and thematically described in greater detail in future research.

IMPLICATIONS FOR NURSING MANAGEMENT

The nurse-patient relationship should focus on clinical supervision, in order to strengthen the nurses' leadership qualities in terms of being aware and dialectical.

Balancing between mental vulnerability and strength in daily life when suffering from eating difficulties

The aim of this study was to explore the daily life experiences of women who suffer from eating difficulties (ED). The research question was: what mental challenges related to daily life are experienced by women who suffer from ED? ED challenge the daily lives of individuals and their families. The problem is often concealed, and the individuals concerned frequently experience guilt and shame. An explorative design was used. Five women participated in a group programme focusing on experiences of ED, guilt and shame, being a mother and self-expression. Data were collected using focus group interviews and analysed by means of qualitative content analysis. The main theme Balancing between mental vulnerability and strength comprised three themes: (1) Struggling with emotional ambivalence; (2) Being cognitively aware of limitations; and (3) Experiencing an existential sense of being lost and frozen. The mental challenges were strong and affected the participants' lives. One clinical implication for psychiatric nurses is to acknowledge the strength of emotional, cognitive and existential challenges and make it possible for patients to articulate their exhaustion in spite of their outward appearance of strength.

The feeling of being trapped in and ashamed of one's own body: A qualitative study of women who suffer from eating difficulties

The aim of this study was to explore women's bodily experiences of suffering from eating difficulties (ED). The research question was: How do women who suffer from ED experience the bodily aspects related to their condition? Women suffering from ED experience problems in both the physical and emotional areas. Few qualitative studies have specifically addressed sufferers' bodily experiences related to ED. An explorative design was used. The data were collected by means of focus group interviews on the subject of ED-related problems, guilt and shame, and being a mother. The interpretation of the qualitative data was inspired by hermeneutic content analysis. The main theme, 'Powerful feelings of being trapped in and ashamed of one's own body', comprised two themes: 'The feeling of being trapped by overwhelming physical sensations' and 'The feeling of being ashamed of one's own body'. Bodily experiences were reported as strong. One clinical implication for nurses is to acknowledge this fact and make it possible for these women to articulate their difficulties, especially those connected to the feelings of being trapped and ashamed. Support groups focusing on these themes could be one way of assisting women and easing some of the negative feelings associated with ED.

Chronic anorexia nervosa: a Delphi study to explore practitioners' views

OBJECTIVE

Anorexia nervosa (AN) can be an enduring condition. Increasing interest in the treatment of long-term cases has occurred over the recent years. This study explored healthcare practitioners' views of what constitutes a case of chronic AN and their opinions of its treatment.

METHOD

A Delphi study was conducted, involving members of specialist groups for professionals with an interest in eating disorders and delegates from a conference about enduring AN.

RESULTS

Participants reached agreement and consensus on factors relating to weight, behaviors, and cognitions in cases of chronic AN, but did not for the importance of duration and number of treatment attempts. Adopting a supportive, co-ordinated, and eclectic approach was considered important in the care of these patients.

CONCLUSION

Results suggest that chronic AN is not an easy term to define and that a rehabilitative model for working with this patient group may be required.