Lisa Dawson

“Doing the Impossible” The Process of Recovery From Chronic Anorexia Nervosa

In this study, we aimed to explore the process of recovery over time from the perspective of those who had fully recovered from chronic anorexia nervosa (AN), using stringent recovery criteria. Eight women, assessed as fully recovered from chronic AN, told their story of the process of recovery. Data were analyzed using the qualitative method, narrative inquiry. Recovery was identified as a long and complex process that spanned four phases: from being unable or unready to change, to experiencing a tipping point where motivation increased and changed in quality, allowing the women to take action against the AN and finally allowing them to reflect and rehabilitate. Results provide a framework for understanding this complex process. Findings suggest that full recovery from chronic AN is possible and emphasize the importance of hope, motivation, self-efficacy, and support from others in the recovery process.

The recovery model and anorexia nervosa

Objective: Treatments in anorexia nervosa (AN) have not been wholly effective and, accordingly, practices need to be reviewed. The recovery model is an approach to treatment that has become a guiding principle for mental health policy worldwide that might provide promise for AN treatment. The model has received much attention in recent years; however, there is a dearth of literature exploring how useful this model is for AN. The aim of the current article was to consider the relevance of this model in AN. Methods: This article provides a summary of the recovery model and reviews the literature to establish whether it is compatible with AN. The possible utility of the approach in AN is explored and suggestions are made as to how the model might be implemented in treatment. Results: Qualitative studies examining the patient’s perspective of AN support the recovery model. Many evidenced-based treatments currently used in AN have elements that are consistent with a recovery model approach. Treatments that are most consistent with recovery approaches have been effective for those with chronic AN. Conclusion: It is proposed that the model might offer a way in which to add to current practice and might have particular relevance for those with chronic AN. Future research is required to better understand how the model can best be utilised in AN.

The assessment and treatment of unhealthy exercise in adolescents with anorexia nervosa: A Delphi study to synthesize clinical knowledge

This study aimed to explore and synthesize expert clinical knowledge on defining and managing unhealthy exercise in adolescents with AN. The Delphi methodology was used. Clinicians (n = 25) considered experts in the treatment of AN in adolescents were recruited internationally to form the panel. The first round of the questionnaires was comprised of five open-ended questions regarding defining, assessing, and treating unhealthy exercise in adolescents with AN. Statements were derived from this data using content analysis, and included as Likert-based items in two subsequent rounds, in which panellists were required to rate their level of agreement for each item. All 25 respondents completed the three rounds of questionnaires. Consensus was achieved for 59.0% of the items included in the second and third round of questionnaires. Although consensus was not achieved, compulsive exercise was the preferred term for the panel when referring to unhealthy exercise in adolescents with AN. The panel clearly delineated features of unhealthy and healthy exercise, and endorsed a number of items considered important to assess for when evaluating exercise in this clinical population. A variety of treatment approaches and strategies reached consensus. Notably, for those who are medically stable and progressing toward recovery, the panel recommended initial exercise restriction practices and reintroducing healthy exercise behaviors, rather than exercise cessation practices. The current findings can serve as preliminary treatment guidelines. A unified approach to labeling and defining unhealthy exercise in the eating disorder literature and clinical settings is required to achieve further progress.

Using the theory of planned behaviour to measure motivation for recovery in anorexia nervosa

Anorexia nervosa (AN) is a difficult to treat mental illness associated with low motivation for change. Despite criticisms of the transtheoretical stages of change model, both generally and in the eating disorders (EDs), this remains the only model to have been applied to the understanding of motivation to recover from AN. The aim of this pilot study was to determine whether the theory of planned behaviour (TPB) would provide a good fit for understanding and predicting motivation to recover from AN. Two studies were conducted - in the first study eight women who had recovered from chronic AN were interviewed about their experiences of recovery. The interview data were subsequently used to inform the development of a purpose-designed questionnaire to measure the components of the TPB in relation to recovery. In the second study, the resultant measure was administered to 67 females with a current diagnosis of AN, along with measures of eating disorder psychopathology, psychological symptoms, and an existing measure of motivation to recover (based on the transtheoretical model). Data from the interview study confirmed that the TPB is an appropriate model for understanding the factors that influence motivation to recover from AN. The results of the questionnaire study indicated that the pre-intention variables of the TPB accounted for large proportions of variance in the intention to recover (72%), and more specifically the intention to eat normally and gain weight (51%). Perceived behavioural control was the strongest predictor of intention to recover, while attitudes were more important in the prediction of the intention to eat normally/gain weight. The positive results suggest that the TPB is an appropriate model for understanding and predicting motivation in AN. Implications for theory and practice are discussed.

Defining recovery from anorexia nervosa: a Delphi study to determine expert practitioners’ views

There is no consensus in the field of eating disorders as to how recovery from anorexia nervosa (AN) should be best defined. Definitions of recovery vary vastly between studies. This has been identified as a major barrier in the field. The aim of the current article was to determine whether leading experts could reach consensus on how to define recovery from AN and the best method/s for assessing this. This study used the Delphi technique, a method designed for reaching agreement on an issue. Participants were 21 international experts who completed 3 rounds of iterative questionnaires. Participants reached consensus on the need for a comprehensive definition of recovery, which includes physical, behavioural, and psychological indicators. There was a lack of consensus on specifying a body mass index cut-off or specific time frame required for recovery. The importance of quality of life in measuring and defining recovery was also emphasised. These findings add to a growing body of literature that suggests that recovery is more than the restoration of weight. While there were more areas of agreement than disagreement, results suggest that aspects of recovery from AN, such as universal weight criteria, remain difficult to define. Recommendations for defining and measuring recovery are proposed.

Recovery stories - helpful or unhelpful? A randomised controlled trial

Low motivation to change and low self-efficacy have been associated with poorer outcome in anorexia nervosa (AN). There is evidence to suggest that sharing personal accounts of successful recovery with patients might improve motivation as well as helplessness and hopelessness associated with recovery, providing an important resource for sufferers. However, no research to date has explored the helpfulness or unhelpfulness of recovery narratives, despite many patients accessing such stories. The aim of the current study was to determine the efficacy of recovery narratives as a means of improving motivation and self-efficacy, using a randomised controlled trial design. The primary outcome variable was change in motivation as measured by intentions to recover from AN and stage of change. More than fifty individuals with AN and subclinical AN participated in this online study. Participants were randomised to either receive recovery stories or to a wait-list controlled group. After completing base-line measures, participants read five short stories about recovery from AN, and completed post-intervention measures two weeks later. Preliminary findings revealed that participants self-reported varying levels of usefulness. Full results regarding the effectiveness of the intervention as a means of improving motivation and self-efficacy are presented and clinical and research implications discussed. This abstract was presented in the Learning from Consumers stream of the 2014 ANZAED Conference.

Quality of life as a vulnerability and recovery factor in eating disorders: a community-based study

BackgroundEmerging evidence suggests that changes in quality of life (QoL) predicts later changes in eating disorder (ED) symptoms. The objective of this study was to explore individual sufferers’ perspectives on the influence of QoL on the onset, maintenance, and/or remission of ED symptoms.Method19 women from the community with a history of eating disorders (n = 13 currently symptomatic; n = 6 recovered) were interviewed about their observations on the relationship between QoL and ED symptoms over time in their own lives. Interviews were audio-taped and transcribed, and then thematically analysed.ResultsThematic analysis uncovered two major themes: 1. QoL as a Vulnerability Factor, and 2. QoL as a Recovery Factor. In relation to the first theme, onset of ED symptoms was discussed by women in this study as having been triggered by impairment in QoL, including a general sense of lacking control in life, stress, abusive intimate relationships, poor role modelling from family, physical impairment related to obesity, peer pressure, and weight-related teasing. On the other hand, and in relation to the second theme, subsequent improvement in QoL was nominated as central to symptom improvement and recovery. QoL improvement was described by participants differently, but included increased general satisfaction in life, emotional maturation, prioritising and improving physical health, the development of a supportive intimate relationship and social relationships, and having children.ConclusionsImpairment in QoL may act as a trigger for the onset and maintenance of ED symptoms, whereas improvement in QoL may be central to eating disorder improvement and eventual recovery. Treatment should involve consideration of a core focus on QoL improvement as a potential ‘backdoor’ approach to improving ED symptoms.

Multiple family therapy for anorexia nervosa at the Eating Disorder Service, the Children's Hospital at Westmead

The Eating Disorder Service at The Childrens Hospital at Westmead (CHW) is a tertiary service that offers a range of family focused treatment options for young people with an eating disorder. Multiple Family Therapy (MFT) is the newest treatment option provided by the service. MFT is now a key intervention offered by a number of services overseas, most notably at the Maudsley Hospital, London, where the model was developed. Despite its use for more than a decade overseas, we are the first service in Australia to systemically integrate MFT as an additional treatment option within the standard suite of interventions offered. MFT theoretically builds upon the core constructs of family based treatment for anorexia nervosa, whilst adding the unique experience of solidarity for young people and their families. The content of MFT is experiential, involving activities and specific debriefing techniques to help families develop ways to work together against anorexia, increase attunement to their childs needs and feel more agency around the process of recovery. The MFT program at CHW provides the opportunity for up to eight families to work together for a 4-day workshop. Follow-up care is provided by outpatient family therapy or integration into the Intensive Family and Adolescent Eating Disorders Day Program. MFT targets families not progressing in outpatient care or who present with some other complexity with the view that engagement in treatment may be enhanced through the group experience of MFT and the opportunity to receive treatment input from multiple sources. The presentation will describe MFT constructs, the programs implementation at CHW, show material from the therapeutic activities completed and present preliminary data and family experiences from the first five groups.

Defining recovery from anorexia nervosa: a Delphi study to explore practitioners' views

There is no consensus as how best to define and measure recovery from anorexia nervosa (AN). Definitions of recovery vary vastly between studies, making them difficult to compare. This has been identified as a major barrier in the field. The aim of the current study was to explore how best to define and measure recovery according to expert researchers and clinicians. This research used the Delphi technique, a method used to gain consensus on an issue. Twenty leading international experts in the field completed three rounds of online questionnaires. This was a multi-stage process with each round building on the previous round until consensus was achieved amongst the panel. Preliminary findings have revealed that experts in the field define recovery from AN as more than the restoration of weight and absence of eating disordered behaviours. Participants suggested that recovery also includes experiencing normal levels of body dissatisfaction and improved quality of life and social functioning. Full findings are reported and the research and clinical implications for establishing a consensus definition in the field are discussed. This abstract was presented in the Anorexia Nervosa – Characteristics and Treatment stream of the 2013 ANZAED Conference.

Are recovery stories helpful for women with eating disorders? A pilot study and commentary on future research

BackgroundAnecdotally it is well known that eating disorder memoirs are popular with people with anorexia nervosa and recovery stories are readily available online. However, no research to date has empirically explored whether such stories are helpful for current sufferers. The aim of the current pilot study was to explore the efficacy of recovery narratives as a means of improving motivation and self-efficacy and to qualitatively explore patient perspectives of such stories.MethodFifty-seven women with anorexia nervosa and subclinical anorexia nervosa participated in this online study. Participants were randomised to either receive recovery stories or to a wait-list control group. After completing baseline measures, participants read five stories about recovery, and completed post-intervention measures two weeks later.ResultsThe quantitative results indicated that reading stories of recovery had no effect on motivation and self-efficacy over a two-week period. In contrast, the qualitative results showed that the stories generated thoughts about the possibility of recovery and the majority indicated they would recommend them to others.ConclusionsThis study adds to a growing body of research exploring the integration of voices of lived experience into treatment approaches. Future research should focus on 1) identifying for whom and at which stage of illness recovery stories might be helpful; 2) the mechanism via which they might operate; and 3) the most helpful way of presenting such stories.