Saskia Keville

Do adolescents with eating disorder not otherwise specified or full-syndrome bulimia nervosa differ in clinical severity, comorbidity, risk factors, treatment outcome or cost?

OBJECTIVE We wanted to know whether adolescents with eating disorder not otherwise specified (EDNOS) differ from those with bulimia nervosa (BN) in clinical features, comorbidity, risk factors, treatment outcome or cost. METHOD Adolescents with EDNOS (n = 24) or BN (n = 61) took part in a trial of family therapy versus guided self-care. At baseline, eating disorder symptoms, risk factors, and costs were assessed by interview. Patients were reinterviewed at 6 and 12 months. RESULTS Compared with EDNOS, BN patients binged, vomited and purged significantly more, and were more preoccupied with food. Those with EDNOS had more depression and had more current and childhood obsessive-compulsive disorder. 66.6% of EDNOS versus 27.8% of BN patients were abstinent from bingeing and vomiting at 1 year. Diagnosis did not moderate treatment outcome. Costs did not differ between groups. CONCLUSION EDNOS in adolescents is not trivial. It has milder eating disorder symptoms but more comorbidity than BN.

A feasibility study of mindfulness-based cognitive therapy for individuals with borderline personality disorder.

OBJECTIVES Mindfulness-based cognitive therapy (MBCT) was originally developed to prevent relapse in recurrent depression. More recently it has been applied to individuals at high risk of suicide or currently suffering with anxiety and depression. The aim of this study was to consider the feasibility of MBCT for individuals with a diagnosis of borderline personality disorder (BPD). DESIGN The design of the study was a repeated measures, quasi-experimental design employing within-subject and between-subject comparisons of a sample of participants with BPD. Based on previous studies and theoretical models of the effect of mindfulness and of cognitive therapy, pre- and post-group measures of mindfulness, depression, anxiety, dissociation, impulsivity, experiential avoidance, and attention were obtained. METHOD Participants attended an 8-week adapted MBCT (MBCT-a) group intervention. A total of 22 participants were assessed pre- and post-intervention and were subsequently divided for analysis into two groups: treatment completers (N= 16) and non-completers (number of sessions attended < 4; N= 6). RESULTS The study found that MBCT-a is acceptable to individuals with BPD. Using intention to treat analyses, only attentional control improved. However, post hoc analyses of treatment improvers (N= 9) identified changes in mindfulness and somatoform dissociation. A dose-effect analysis suggested a weak improvement in mindfulness, experiential avoidance, state anxiety, and somatoform dissociation. CONCLUSIONS This study suggests that further exploration of MBCT for use with individuals with BPD is merited. The study lends tentative support for attentional and avoidance models of the effects of mindfulness.

Why do adolescents with bulimia nervosa choose not to involve their parents in treatment

BackgroundAlthough the use of family therapy for adolescents with anorexia nervosa is well established, there has been limited research into the efficacy of family therapy in adolescents with bulimia nervosa (BN). No previous research has investigated why individuals with BN do or do not involve their parents in treatment. This is an exploratory study aimed at determining whether there are any differences between these individuals in terms of eating disorder symptomatology, psychopathology, familial risk factors, patients’ perception of parental expressed emotion (EE) and family functioning.MethodsParticipants were 85 adolescents with BN or Eating Disorder Not Otherwise Specified, recruited to a randomised controlled evaluation of the cost-effectiveness of cognitive-behavioural guided self-care vs. family therapy. Participants were interviewed regarding the history of their eating disorder and completed self-report measures.ResultsPatients who did not involve their parents in treatment were significantly older, had more chronic eating disorder symptoms, exhibited more co-morbid and impulsive behaviours and rated their mothers higher in EE. However, they did not have more severe eating disorder symptomatology.ConclusionsThese preliminary findings, although in need of replication with a larger sample and limited by the attrition rate in some of the self-report measures, indicate that patients who did not involve their parents in treatment may perceive their mothers as having a more blaming and negative attitude towards the patient’s illness. Public awareness about BN needs to be raised, focusing on reducing the stigma and negative views attached to this illness.

Close encounters of the uncertain kind: reflections on doing problem‐based learning (PBL) for the first time

Problem‐based learning (PBL) has been employed for over 30 years by a variety of disciplines and professional training programmes. Nevertheless, introducing PBL into a professional training programme for the first time can present many challenges for both trainers and trainees. This paper reports on the process of introducing PBL into a doctoral training programme in clinical psychology at a university in the UK. In particular, it provides some personal reflections from both trainees and trainers on the uncertainties created by doing PBL for the first time. These reflections are used as a foundation to discuss the role of the facilitator, strategies of dealing with uncertainty, and implications for clinical psychology training.

Risk factors, correlates, and markers in early-onset bulimia nervosa and EDNOS

OBJECTIVE This study aimed to investigate the specific risk factors, correlates, and markers associated with the development of symptomatology of early-onset BN and subclinical BN. METHOD Two semi-structured interviews were used to examine symptomatology and antecedent factors of bulimic symptoms in a sample of British adolescents. RESULTS Adolescents with early-onset eating pathology were significantly more likely to report an earlier age of menarche than those developing the disorder at the typical age, and were found to have a different pathway of symptom development. DISCUSSION Increased awareness of this may help identify those particularly at risk for developing an early-onset of eating pathology.

Motivation to change in recent onset and long-standing bulimia nervosa: Are there differences?

REASON FOR THE STUDY: Little is known about how motivation to change evolves over the course of an eating disorder. The present study compared ‘stage of change’ and motivation, confidence and readiness to change in two groups of patients with bulimia nervosa (BN), adolescents with a short duration of illness and adults with a long duration of illness. METHOD: Patients completed the Severity of eating disorder symptomatology scale, Hospital Anxiety and Depression Scale and measures of stage of change and motivation, readiness and confidence to change their bulimic symptomatology at pre-treatment.MAIN FINDINGS: Short- and long duration groups did not differ in illness severity, comorbidity, stage of change, motivation, readiness, and confidence to change. There were, however, some differences between groups in terms of the relationship between motivational measures, illness severity, duration and comorbidity. CONCLUSIONS: There seem to be more similarities than differences between adolescents with short duration of illness and those with well-established BN in terms of their motivation to change.

Reaching the journey’s end: reflections on the final phase of a problem‐based learning group

This paper represents the final phase of a journey within a self‐directed problem‐based learning group occurring on the Doctorate in Clinical Psychology Programme based at the University of Hertfordshire. It provides personal reflections from the trainees and trainers on the process of this type of experiential learning. We explore themes related to this experience, such as the emotional experiences evoked and strategies used to manage these; issues of power and responsibility; and the transitory nature of these experiences. We conclude with implications for the participation and facilitation of experiential learning groups within clinical training.

A river runs through it: enhancing learning via emotional connectedness. Can problem-based learning facilitate this?

The ability to undertake therapeutic work either directly or indirectly is central to many Clinical Psychology posts. This paper focuses on the acquisition of skills and knowledge gained through experiential learning components of a clinical psychology doctoral training programme following the introduction of Problem-Based Learning (PBL) into its academic curriculum in 2006. At UH, PBL began life for many trainees as a content-focused exercise developed to highlight how one might assess, formulate and intervene with issues presented within a case. Over time the task has increasingly incorporated a process focus, in which the content facilitates PBL groups to reflect on a broad range of concurrent processes, including personal contexts, interactions with others, and the influence of wider systems. This paper explores the overall learning experiences of PBL for trainees within one PBL group and how the exploration of underlying personal and group processes may facilitate a personal and emotional connection with the ‘client’. Further, we consider modes of conveying this information to enable an audience to emotionally connect with the case and the experiences of the group members. We conclude with a consideration of what we may learn for the benefit of future PBL groups within other disciplines.

In the eye of the storm: should I stay or should I go? Reflections on the middle phase of a problem‐based learning group

This paper reports on the middle phase of a problem‐based learning (PBL) group undergoing clinical psychology training at the University of Hertfordshire (UH). Trainers and trainees involved in PBL at UH provide some personal reflections on their experiences, highlighting some of the unique characteristics and dilemmas of participating in this middle phase of PBL. We explore themes around the dynamics within the group, the emotional experiences evoked for participants, and some of the strategies used to manage these emotions. We conclude with implications of this type of learning for clinical training.

‘… you kind of frantically go from one thing to the next and there isn’t any time for thinking any more’: a reflection on the impact of organisational change on relatedness in multidisciplinary teams

Abstract This paper reflects on the relational impact on Clinical Psychologists of NHS organisational change in the context of cuts and reorganisation. The reflections illustrate one theme drawn from a study of eight Clinical Psychologists working within adult Community Mental Health Multi-Disciplinary Teams. The paper considers the impact of competition and change in healthcare on the ability to engage in reflective practice potentially affecting client care due to reduced joint-working, consistency and creativity. The paper considers how acts of kindness (compassion) within organisational contexts at all levels can facilitate relatedness, reflection and more human care. It concludes by considering how shifting from short-term planning evaluating efficiencies based on perceived financial value, to thinking more widely and long-term about relational value may be of benefit to clinicians, clients and the system as a whole.