Paul Rhodes

A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents

Background Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN. Method We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12–18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT). Results The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group. Conclusions Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.

“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.

Do the components of manualized family‐based treatment for anorexia nervosa predict weight gain?

OBJECTIVE Family-based treatment for anorexia nervosa (FBT) has demonstrated efficacy in the treatment of adolescents with anorexia nervosa (AN) in a number of randomized control trials (RCT). The aim of the current research was to determine whether adherence to the key components of the model as outlined in the treatment manual predict weight gain or dropout. METHOD The 59 participants were under 19 years and had AN for less than 3 years. Five core treatment objectives and working alliance were measured across 20 sessions of FBT. RESULTS The core objectives of parents taking control, being united, not criticizing the patient and externalizing the illness predicted greater weight gain. Sibling support did not predict weight gain. The relationship between therapeutic alliance and weight gain was positive for mothers but negative for fathers. Dropout was predicted by low control and poor maternal-therapeutic alliance. DISCUSSION The results of this study lend further support for the efficacy of the FBT, demonstrating that the principles guiding clinical practice are those which lead to weight gain. The finding that parental control is the central predictor of change can also support the development of augmentations to the model.

Current approaches to managing fear of cancer recurrence; a descriptive survey of psychosocial and clinical health professionals

Fear of cancer recurrence (FCR) is common amongst cancer survivors and help with this problem is the most frequently reported unmet need in this population. This study investigated how FCR is perceived and managed by clinical health professionals (medical and nursing staff) and psychosocial professionals in oncology settings.

Five-years of family based treatment for anorexia nervosa: The Maudsley Model at the Children's Hospital at Westmead

The Eating Disorder Service at the Childrens Hospital at Westmead (CHW) in Sydney, provides comprehensive inpatient and outpatient treatment for children and adolescents with eating disorders. In 2003 the Maudsley Model of family based treatment for anorexia nervosa was introduced to support outpatient care. This has resulted in positive changes in the dynamics of the eating disorder team, a change in the philosophies that underpin the program and the experience of families that consult the service. There has also been a significant decrease in readmission rates. Our experience with the model has resulted in requests to provide training to other clinicians around Australia and a number of ongoing consultative relationships have followed. Implementation of the Maudsley model at CHW is described, followed by an overview of the theory and a summary of the key changes and challenges since moving in this new direction in 2003.

The Maudsley Model of Family‐Based Treatment for Anorexia Nervosa: A Qualitative Evaluation of Parent‐to‐Parent Consultation

This article describes the qualitative analysis of a randomized control trial that explores the use of parent-to-parent consultations as an augmentation to the Maudsley model of family-based treatment for anorexia. Twenty families were randomized into two groups, 10 receiving standard treatment and 10 receiving an additional parent-to-parent consultation. Parents of all families were interviewed regarding their experience of treatment and transcripts were analyzed with the assistance of QSR N-Vivo. Parents described parent-to-parent consultations as an intense emotional experience that helped them to feel less alone, to feel empowered to progress, and to reflect on changes in family interactions. These results suggest that parent-to-parent consultations are seen as a useful augmentation to the Maudsley model of family-based treatment for anorexia nervosa.

Behavioural and family systems interventions in developmental disability: towards a contemporary and integrative approach

While behavioural intervention is effective in the treatment of challenging behaviour, in developmental disability it can have significant limitations in the family setting. Families can sometimes find it difficult to make lifecycle transitions or respond to other stressful life events and become stuck in patterns of interaction that include the presenting behaviour. The aim of this paper is to present a theoretical and working model of intervention that integrates more contemporary behavioural and systemic orientations. Four stages for intervention are provided, each consisting of practical guidelines for the clinician. Three detailed case studies are also included.

Psychological intervention targeting distress for cancer patients: a meta‐analytic study investigating uptake and adherence

Although cancer care guidelines recommend screening for distress among cancer patients and offering psychological support when indicated, many patients decline offers of such support. This study aimed to quantify uptake and adherence to psychological support and to identify predictors of each.

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.

Why clinical psychology needs process research: An examination of four methodologies

This paper advocates for process research as a valid source of evidence in clinical psychology, research that focuses on why and how therapy works, both across the course of treatment and in the minutiae of interactions between therapist and client. Process research is consistent with the aims of the scientist-practitioner model, supporting the provision of practical and realistic guidance to clinicians. Specific examples of methods are provided, including the analysis of mechanisms of change, patient-focused research, conversational analysis and interpersonal process recall.