Jackie Wales

Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up

OBJECTIVE The aim of this study was to compare two cognitive-behavioral treatments for outpatients with eating disorders, one focusing solely on eating disorder features and the other a more complex treatment that also addresses mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties. METHOD A total of 154 patients who had a DSM-IV eating disorder but were not markedly underweight (body mass index over 17.5), were enrolled in a two-site randomized controlled trial involving 20 weeks of treatment and a 60-week closed period of follow-up. The control condition was an 8-week waiting list period preceding treatment. Outcomes were measured by independent assessors who were blind to treatment condition. RESULTS Patients in the waiting list control condition exhibited little change in symptom severity, whereas those in the two treatment conditions exhibited substantial and equivalent change, which was well maintained during follow-up. At the 60-week follow-up assessment, 51.3% of the sample had a level of eating disorder features less than one standard deviation above the community mean. Treatment outcome did not depend on eating disorder diagnosis. Patients with marked mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties appeared to respond better to the more complex treatment, with the reverse pattern evident among the remaining patients. CONCLUSIONS These two transdiagnostic treatments appear to be suitable for the majority of outpatients with an eating disorder. The simpler treatment may best be viewed as the default version, with the more complex treatment reserved for patients with marked additional psychopathology of the type targeted by the treatment.

Treatment outcome of patients with comorbid type 1 diabetes and eating disorders

BackgroundCo-morbidity between Type 1 Diabetes Mellitus (T1DM) and eating disorders (ED) has been previously described; however the effect of this illness on the outcomes for conventional ED treatments has not been previously investigated. This study aims to compare clinical, psychopathological and personality features between two samples of ED individuals: those with comorbid T1DM and those without (No-DM); and to identify differences in treatment outcomes between the groups.MethodsThis study compares treatment outcome, dropouts, ED psychopathology and personality characteristics for 20 individuals with ED and T1DM and 20 ED patients without diabetes, matched for diagnostic and treatment type.ResultsThe study found higher dropout rates from therapy in individuals with T1DM and worse treatment outcome in spite of having no significant differences in eating disorder psychopathology, although individuals with T1DM report misusing insulin.ConclusionsThe low levels of motivation to change, and insulin abuse in T1DM patients, may suggest that treatment for patients with ED and T1DM should consider the individual’s personality and role of insulin abuse when determining the appropriate intervention.

The Compulsive Exercise Test: confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders

BackgroundThis study aimed to determine the psychometric properties of the Compulsive Exercise Test (CET) among an adult sample of patients with eating disorders.MethodThree hundred and fifty six patients and 360 non-clinical control women completed the CET and the Eating Disorders Examination questionnaire (EDE-Q).ResultsA confirmatory factor analysis revealed that the clinical data showed a moderate fit to the previously published five factor model derived from a community sample (Taranis L, Touyz S, Meyer C, Eur Eat Disord Rev 19:256-268, 2011). The clinical group scored significantly higher than the non-clinical group on four of the five CET subscales, and logistic regression analysis revealed that the CET could successfully discriminate between the two groups. A Receiver Operating Curve analysis revealed that a cut-off score of 15 on the CET resulted in acceptable values of both sensitivity and specificity.ConclusionsThe CET appears to have a factor structure that is acceptable for use with an adult sample of patients with eating disorders. It can identify compulsive exercise among patients with eating disorders and a cut-off score of 15 is acceptable as indicating an appropriate cut-off point.

Changes in alcohol intake in response to transdiagnostic cognitive behaviour therapy for eating disorders

OBJECTIVE The aim of this study was to examine how alcohol intake changes during and after transdiagnostic cognitive behaviour therapy for eating disorders (CBT-E). Additionally, the paper considers the relationship between alcohol consumption, eating disorder diagnosis and current major depressive episode at the time of first assessment. METHOD One hundred and forty nine outpatients with an eating disorder (body mass index over 17.5) were divided into high or low alcohol intake groups (HIG and LIG) according to their intake at pre-treatment assessment. Their alcohol intake and eating disorder psychopathology were examined over the course of treatment and follow-up. RESULTS There was no difference between the groups on response of the eating disorder to treatment. The HIG significantly reduced their alcohol intake following treatment whilst the intake of the LIG remained stable over the course of treatment and follow-up. There were no group differences in major depression and overall severity of eating disorder at baseline. CONCLUSIONS The response to CBT-E was not influenced by baseline level of alcohol use. The mean alcohol intake of the heavy drinking subjects decreased without being specifically addressed by the treatment.

Predictors of Positive Treatment Outcome in People With Anorexia Nervosa Treated in a Specialized Inpatient Unit: The Role of Early Response to Treatment

OBJECTIVE To investigate factors which predict positive treatment outcome in inpatients with anorexia nervosa (AN), particularly the role of early treatment response. METHOD 102 patients entering specialist inpatient treatment were assessed for eating disorder history, psychopathology, and motivation to change. Predictive factors assessed were: early treatment response defined as weight increase of at least 0.5-1 kg/week during the first 6 weeks of treatment (n=87), admission body mass index (BMI), onset age, chronicity, motivation to change, diagnosis, and previous hospitalization for AN. Positive treatment outcome was defined as achieving a BMI of 17.5 kg/m(2) within an individual time frame. RESULTS Logistic regression indicated that patients were 18 times more likely to reach positive treatment outcome if they met the National Institute for Health and Care Excellence weight guidelines within the first 6 weeks of hospitalization. Higher admission BMI was also found to predict positive treatment outcome. DISCUSSION Higher entry BMI and early weight gain predict positive treatment outcome in individuals receiving specialist AN inpatient treatment. Copyright

Evaluation of a Motivation and Psycho-Educational Guided Self-Help Intervention for People with Eating Disorders (MOPED).

High dropout rates and poor levels of engagement are well documented for patients with eating disorders. Utilising motivational techniques and providing psycho-education have been suggested as ways to reduce treatment disengagement. This study aimed to evaluate the effect of a newly developed motivational and psycho-educational (MOPED) guided self-help intervention for people with eating disorders on engagement and retention in therapy. Patients who received MOPED pre-treatment (n = 79) were compared with a diagnosis-matched group of patients receiving treatment as usual (TAU; n = 79). The study found that patients receiving MOPED had a higher engagement rate than those within the TAU group. Specifically, patients in the anorexic spectrum were found to present with both higher rates of engagement and completion of therapy when issued with MOPED in comparison with TAU. Self-help packages using motivational style could be a valuable and cost-effective intervention for patients with eating disorders.

Anorexia Nervosa and Low Weight EDNOS: A 10-year Study of Service Consumption and Outcome in a Local Specialised Service for Adults

A 10-year retrospective case note study of adults with eating disorders at low weight examined levels of service consumption and the outcome in terms of body mass index. Records of 202 such patients, referred to a specialist secondary service, were studied. Just over one quarter of the patients failed to engage in treatment, attending five or fewer appointments. Of those who did engage, most were treated as out-patients and had an average contact with the service of almost 2.5 years and 46 sessions. Only about one in six patients was admitted as an in-patient at any time. These results suggest that most adults with eating disorder at low weight can be managed as out-patients. However, service providers should expect prolonged contact and high service consumption.

Can treatment trial samples be representative

A catchment area-based sample of patients recruited for an eating disorder treatment trial was compared with patients from the same geographical area seen in the 12 months before and after the trial. The three samples were very similar. The research sample was representative of the usual clinic sample from which it had been selected and thus the results could be extrapolated with some confidence to other similar clinical settings. It is concluded that whilst treatment trials, by their very nature, have explicit and implicit inclusion and exclusion criteria with appropriate designs they can be usefully representative.

A randomised controlled trial of the compuLsive Exercise Activity TheraPy (LEAP): a new approach to compulsive exercise in anorexia nervosa

OBJECTIVE To compare the efficacy of the compuLsive Exercise Activity theraPy (LEAP) programme integrated with manualized cognitive behavioral therapy for anorexia nervosa (CBT-AN) compared to CBT-AN alone. METHOD Seventy-eight adults were randomized to CBT-AN, delivered with or without eight embedded sessions of LEAP, for a total of 34 individual outpatient sessions. Participants were assessed at baseline, the end of the first phase of CBT-AN (which included LEAP), mid-therapy, end of therapy, and at 3 and 6 months follow-up. Linear mixed effects modelling was used for comparing trajectories over time by group in primary outcomes of pathological exercise cognitions and secondary outcomes of exercise frequency, BMI, eating disorder (ED) symptoms, AN stage of change, anxiety/depression, and health related quality of life. RESULTS There were significant improvements over time in all outcomes. There were no significant differences between treatment groups in primary outcome measures. Fidelity and end-of-treatment participant satisfaction were satisfactory across both conditions. DISCUSSION CBT-AN and LEAP added to CBT-AN resulted in improved attitudes and beliefs toward exercise and general improvements in BMI and ED psychopathology in people with AN.

Exploring Barriers to South Asian Help-Seeking for Eating Disorders

Purpose Referrals to specialist eating disorder (ED) services from the South Asian (SA) community are under-represented, despite research suggesting that disordered eating attitudes and behaviours of SA people are similar to the population in general. The purpose of this paper is to identify the reasons for this and sought to inform ways to encourage help-seeking. Design/methodology/approach A qualitative methodology was used to investigate barriers to help-seeking for EDs among the SA community. A key informant focus group was conducted with clinicians working within the local specialist ED service (participants n=16, 12 female, 4 male). Six focus groups were conducted with members of the SA community in Leicester, UK (participants n=28, 23 female, 5 male), recruited from a local university, two charities and Children, Young People and Family Centres. Findings A number of themes emerged as possible factors for delaying early access to help: lack of knowledge about EDs and their potential seriousness, ideals regarding body shape, family living circumstances and the role of food in the community. Participants acknowledged stigma among their community associated with mental health issues, including EDs and concerns about confidentiality when approaching services, particularly primary care. Originality/value General practitioners and specialist services need to be aware of the potential barriers to help-seeking for EDs as early specialist help is recommended for effective treatment. An educational campaign around EDs specifically designed with the SA community in mind may improve awareness, reduce stigma and promote early help-seeking.