Hannah Turner

Schema and parental bonding in overweight and nonoverweight female adolescents.

OBJECTIVE: To investigate whether family functioning and cognitions in a group of overweight female adolescents differ significantly from those in a group of normal weight female adolescents.DESIGN: Cross-sectional study.SUBJECTS: In all, 23 overweight female adolescents (mean age: 17.6 y, mean body mass index (BMI: 27.8 kg/m2), and 23 normal weight female adolescents (mean age: 17.7 y, mean BMI: 20.2 kg/m2).MEASUREMENTS: The following self-report measures were completed: the Parental Bonding Inventory,1 the Young Schema Questionnaire-short version,2 the Eating Attitudes Test,3 the Beck Depression Inventory4 and the Eating Disorder Belief Questionnaire.5RESULTS: Overweight female adolescents reported more negative self-beliefs and greater belief in schema relating to emotional deprivation, fears of abandonment, subjugation and insufficient self-control. They also perceived their fathers as being significantly more overprotective and significantly less caring. Within this group perceived level of maternal care correlated negatively with negative self-beliefs and schema.CONCLUSIONS: Overweight female adolescents show some of the cognitive features associated with the development of an eating disorder. However, positive parent–child relationships may serve to protect overweight adolescents from developing clinical eating disorders and from psychological distress later in life.

Underlying assumptions and core beliefs in anorexia nervosa and dieting

OBJECTIVE To investigate assumptions and beliefs in anorexia nervosa and dieting. DESIGN AND METHOD The Eating Disorder Belief Questionnaire (EDBQ), was administered to patients with anorexia nervosa, dieters and female controls. RESULTS The patients scored more highly than the other two groups on assumptions about weight and shape, assumptions about eating and negative self-beliefs. The dieters scored more highly than the female controls on assumptions about weight and shape. CONCLUSIONS The cognitive content of anorexia nervosa (both assumptions and negative self-beliefs) differs from that found in dieting. Assumptions about weight and shape may also distinguish dieters from female controls.

Cognitive-behavioural therapy for outpatients with eating disorders: effectiveness for a transdiagnostic group in a routine clinical setting.

Whilst there is a growing evidence to support the impact of cognitive-behavioural therapy (CBT) in the treatment of adults with eating disorders, much of this evidence comes from tightly controlled efficacy trials. This study aimed to add to the evidence regarding the effectiveness of CBT when delivered in a routine clinical setting. The participants were 203 adults presenting with a range of eating disorder diagnoses, who were offered CBT in an out-patient community eating disorders service in the UK. Patients completed measures of eating disorder pathology at the start of treatment, following the sixth session, and at the end of treatment. Symptoms of anxiety, depression, and psychosocial functioning were measured pre- and post-treatment. Approximately 55% of patients completed treatment, and there were no factors that predicted attrition. There were significant improvements in eating disorder psychopathology, anxiety, depression and general functioning, with particular changes in eating attitudes in the early part of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. These findings confirm that evidence-based forms of CBT can be delivered with strong outcomes in routine clinical settings. Clinicians should be encouraged to deliver evidence-based treatments when working in these settings.

A psychometric evaluation of an English version of the Utrecht Coping List

INTRODUCTION AND AIMS Although coping styles in individuals with eating disorders have received increased research interest in recent years, there remains a lack of brief, self-report measures that can reliably measure coping. This study developed an English version of the Utrecht Coping List (UCL) and evaluated its psychometric properties in a UK population. METHOD This was a cross-sectional study. Three hundred and fifteen participants completed the UCL and the Coping Orientation to Problems Experienced scale (Carver, Scheier & Weintraub, 1989). Of these, 124 completed the UCL again 6 weeks later. RESULTS The UCL demonstrated strong internal consistency. Five of the seven subscales had good test-retest reliability. With the exception of the expression of emotion subscale in men, concurrent validity with the Coping Orientation to Problems Experienced subscales was good. DISCUSSION Although its use with men requires further investigation, this translated version of the UCL represents a reliable and valid measure of coping in women.

Illness perception and its relationship to readiness to change in the eating disorders : A preliminary investigation

OBJECTIVE This study investigated the psychometric properties of a modified version of the Illness Perception Questionnaire - Revised (IPQ-R) in individuals with eating disorders. The relationship between illness representations and stage of change was then explored. Design and method. A cross-sectional design was employed and participants were asked to complete a set of questionnaires. A subset of participants completed the IPQ-R again after 2 weeks in order to assess test-retest reliability. The relationship between illness representations and stage of change was explored using hierarchical multiple regression analyses. RESULTS Sixty-nine participants with a clinical eating disorder took part in the study. With the exception of the causal subscales, the modified version of the IPQ-R had good internal validity and good test-retest reliability. Consequences, treatment control and personal control as well as cyclical timeline perceptions accounted for a significant and unique amount of variance in readiness to change stage scores. CONCLUSIONS Findings suggest that this modified version of the IPQ-R provides a reliable means of exploring illness representations in individuals with eating disorders. Given the significant relationships between illness representations and stage of change, it may be helpful to consider these aspects of illness representations when carrying out therapeutic work with this clinical population. Further research might usefully investigate the relationship between illness perceptions and clinical outcome, as well as examine what factors are important in the shift between stages of change in a longitudinal design.

Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track.

Therapist drift occurs when clinicians fail to deliver the optimum evidence-based treatment despite having the necessary tools, and is an important factor in why those therapies are commonly less effective than they should be in routine clinical practice. The research into this phenomenon has increased substantially over the past five years. This review considers the growing evidence of therapist drift. The reasons that we fail to implement evidence-based psychotherapies are considered, including our personalities, knowledge, emotions, beliefs, behaviours and social milieus. Finally, ideas are offered regarding how therapist drift might be halted, including a cognitive-behavioural approach for therapists that addresses the cognitions, emotions and behaviours that drive and maintain our avoidance of evidence-based treatments.

The clinical features of EDNOS: Relationship to mood, health status and general functioning

STUDY PURPOSE Eating disorder not otherwise specified (EDNOS) remains poorly evaluated in terms of eating disorder features and relationship to mood, health status and general functioning. This study investigated the clinical profiles of a sample of EDNOS patients, and how they compared to patients with anorexia nervosa (AN) and bulimia nervosa (BN). METHOD The sample consisted of 178 patients. All completed the Eating Disorder Examination, Beck Depression Inventory, Work and Social Adjustment Scale and Sf-36. ANOVAs were conducted to explore group differences. RESULTS No differences were found for depression. No differences were found between BN and EDNOS on measures of health status and general functioning. AN patients reported greater role limitations due to physical health and experienced greater physical pain compared with BN or EDNOS patients, and reported poorer social functioning, lower vitality and higher functional impairment compared with EDNOS patients. CONCLUSION EDNOS patients are generally no less clinically impaired than those with BN. However AN patients may be more impaired in some aspects of general functioning compared with BN or EDNOS patients.

An approach to sub‐grouping the eating disorder population: Adding attachment and coping style

OBJECTIVE To investigate whether clinically meaningful sub-groups of patients can be identified by clustering eating disorder features, attachment and coping styles. METHOD 165 patients completed the Eating Disorder Examination (EDE), Attachment Style Questionnaire (ASQ) and Utrecht Coping List (UCL). Cluster analysis was used to identify sub-groups across the sample. RESULTS Four clusters were identified. Cluster one had low levels of eating disorder behaviours and the most severe attachment and coping difficulties. Cluster two had high levels of dietary restriction and exercise, and a fearful/avoidant attachment style. Cluster three had high levels of binge eating and vomiting, and few attachment and coping difficulties. Cluster four had low levels of eating disorder features and positive attachment and coping styles. CONCLUSIONS Clustering participants on the basis of eating disorder features, attachment and coping yields four sub-groups appearing to have clinical face validity.

The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders

The present study explored the impact of early symptom change (cognitive and behavioural) and the early therapeutic alliance on treatment outcome in cognitive-behavioural therapy (CBT) for the eating disorders. Participants were 94 adults with diagnosed eating disorders who completed a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment, following the 6th session and at the end of treatment. They also completed a measure of therapeutic alliance following the 6th session. Greater early reduction in dietary restraint and eating concerns, and smaller levels of change in shape concern, significantly predicted later reduction in global eating pathology. The early therapeutic alliance was strong across the three domains of tasks, goals and bond. Early symptom reduction was a stronger predictor of later reduction in eating pathology than early therapeutic alliance. The early therapeutic alliance did not mediate the relationship between early symptom reduction and later reduction in global eating pathology. Instead, greater early symptom reduction predicted a strong early therapeutic alliance. Early clinical change was the strongest predictor of treatment outcome and this also facilitated the development of a strong early alliance. Clinicians should be encouraged to deliver all aspects of evidence-based CBT, including behavioural change. The findings suggest that this will have a positive impact on both the early therapeutic alliance and later change in eating pathology.

Development, psychometric properties and preliminary clinical validation of a brief, session-by-session measure of eating disorder cognitions and behaviors: The ED-15.

OBJECTIVE In the treatment research literature on other psychological disorders, there is a move towards session-by-session symptom measurement. The necessary measures need to be brief, focused on core features since the last session, and readily available to clinicians. There is no measure in the eating disorders that meets those criteria. This research reports the development and validation of such a self-report questionnaire. METHOD The authors generated and refined a brief set of attitudinal and behavioral items. The resulting questionnaire (the ED-15) and an existing measure (Eating Disorders Examination-Questionnaire; EDE-Q) were completed by a large nonclinical adult sample (N = 531), a group of self-reported eating disorder sufferers (N = 63), and a group of women (N = 33) diagnosed with bulimia nervosa or atypical bulimia nervosa and undertaking cognitive-behavioral therapy. RESULTS Factor analysis identified two scales (Weight and Shape Concerns; Eating Concerns), with strong internal consistency and test-retest reliability. Correlations with the EDE-Q (r = 0.889) indicates that the ED-15 and EDE-Q measure near-identical constructs. The ED-15 differentiated self-reported eating-disordered and nonclinical groups to the same degree as the longer EDE-Q. Session-by-session analysis of the CBT treatment group demonstrated that the different ED-15 scales changed in different patterns across therapy. DISCUSSION The ED-15 is not proposed as an alternative to existing measures, but as a complementary tool, used to measure session-by-session change for clinical and research purposes. Future research will track changes in ED-15 scores across therapy, to determine the importance of very early response to therapy and sudden changes.