Therapist written goodbye letters: evidence for therapeutic benefits in the treatment of anorexia nervosa

AbstractBackground:Despite their use in clinical practice, there is little evidence to support the use of therapist written goodbye letters as therapeutic tools. However, preliminary evidence suggests that goodbye letters may have benefits in the treatment of anorexia nervosa (AN).Aims:This study aimed to examine whether therapist written goodbye letters were associated with improvements in body mass index (BMI) and eating disorder symptomology in patients with AN after treatment.Method:Participants were adults with AN (n = 41) who received The Maudsley Model of Anorexia Treatment for Adults (MANTRA) in a clinical trial evaluating two AN out-patient treatments. As part of MANTRA, therapists wrote goodbye letters to patients. A rating scheme was developed to rate letters for structure and quality. Linear regression analyses were used to examine associations between goodbye letter scores and outcomes after treatment.Results:Higher quality letters and letters that adopted a more affirming stance were associated with greater improvements in BMI at 12 months. Neither the overall quality nor the style of goodbye letters were associated with improvements in BMI at 24 months or reductions in eating disorder symptomology at either 12 or 24 months.Conclusions:The results highlight the potential importance of paying attention to the overall quality of therapist written goodbye letters in the treatment of AN, and adopting an affirming stance.

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Faculty Opinions recommendation of Eating disorder symptoms and quality of life: where should clinicians place their focus in severe and enduring anorexia nervosa?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718502443.793516520 ◽

2016 ◽

Author(s):

Glenn Waller

Keyword(s):

Quality Of Life ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Eating Disorder Symptoms

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A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder

Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ◽

10.1007/s40519-016-0264-x ◽

2016 ◽

Vol 21 (3) ◽

pp. 353-364 ◽

Cited By ~ 80

Author(s):

Tamás Ágh ◽

Gábor Kovács ◽

Dylan Supina ◽

Manjiri Pawaskar ◽

Barry K. Herman ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Bulimia Nervosa ◽

Binge Eating Disorder ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Validating the Danish version of the Eating Disorder Quality of Life Scale (EDQLS) in anorexia nervosa

Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ◽

10.1007/s40519-021-01310-5 ◽

2022 ◽

Author(s):

Laura Al-Dakhiel Winkler ◽

Sidse Marie Hemmingsen Arnfred ◽

Pia Veldt Larsen ◽

Michael Ejnar Røder ◽

Claire Gudex ◽

...

Keyword(s):

Quality Of Life ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Danish Version ◽

Quality Of Life Scale ◽

Life Scale

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Randomised controlled feasibility trial of real versus sham repetitive transcranial magnetic stimulation treatment in adults with severe and enduring anorexia nervosa: the TIARA study

BMJ Open ◽

10.1136/bmjopen-2018-021531 ◽

2018 ◽

Vol 8 (7) ◽

pp. e021531 ◽

Cited By ~ 19

Author(s):

Bethan Dalton ◽

Savani Bartholdy ◽

Jessica McClelland ◽

Maria Kekic ◽

Samantha J Rennalls ◽

...

Keyword(s):

Quality Of Life ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Controlled Trial ◽

Eating Disorder Symptoms ◽

Randomised Controlled

ObjectiveTreatment options for severe, enduring anorexia nervosa (SE-AN) are limited. Non-invasive neuromodulation is a promising emerging intervention. Our study is a feasibility randomised controlled trial of repetitive transcranial magnetic stimulation (rTMS) in individuals with SE-AN, which aims to inform the design of a future large-scale trial.DesignDouble-blind, parallel group, two-arm, sham-controlled trial.SettingSpecialist eating disorders centre.ParticipantsCommunity-dwelling people with anorexia nervosa, an illness duration of ≥3 years and at least one previous completed treatment.InterventionsParticipants received 20 sessions (administered over 4 weeks) of MRI-guided real or sham high-frequency rTMS to the left dorsolateral prefrontal cortex in addition to treatment-as-usual.OutcomesPrimary outcomes were recruitment, attendance and retention rates. Secondary outcomes included body mass index (BMI), eating disorder symptoms, mood, quality of life and rTMS safety and tolerability. Assessments were conducted at baseline, post-treatment and follow-up (ie, at 0 month, 1 month and 4 months post-randomisation).ResultsThirty-four participants (17 per group) were randomly allocated to real or sham rTMS. One participant per group was withdrawn prior to the intervention due to safety concerns. Two participants (both receiving sham) did not complete the treatment. rTMS was safe and well tolerated. Between-group effect sizes of change scores (baseline to follow-up) were small for BMI (d=0.2, 95% CI −0.49 to 0.90) and eating disorder symptoms (d=0.1, 95% CI −0.60 to 0.79), medium for quality of life and moderate to large (d=0.61 to 1.0) for mood outcomes, all favouring rTMS over sham.ConclusionsThe treatment protocol is feasible and acceptable to participants. Outcomes provide preliminary evidence for the therapeutic potential of rTMS in SE-AN. Largest effects were observed on variables assessing mood. This study supports the need for a larger confirmatory trial to evaluate the effectiveness of multi-session rTMS in SE-AN. Future studies should include a longer follow-up period and an assessment of cost-effectiveness.Trial registration numberISRCTN14329415; Pre-results.

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Worry and Rumination in Anorexia Nervosa

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465812000847 ◽

2012 ◽

Vol 41 (3) ◽

pp. 301-316 ◽

Cited By ~ 45

Author(s):

Helen Startup ◽

Anna Lavender ◽

Anna Oldershaw ◽

Richard Stott ◽

Kate Tchanturia ◽

...

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Anxiety Disorder ◽

Anxiety And Depression ◽

Healthy Controls ◽

Regression Analyses ◽

Set Shifting ◽

Neuropsychological Measures ◽

Comparison Groups ◽

Core Features

Background: Difficulties with comprehending and managing emotions are core features of the pathology of anorexia nervosa (AN). Advancements in understanding aetiology and treatment have been made within other clinical domains by targeting worry and rumination. However, worry and rumination have been given minimal consideration in AN. Aims: This study is the largest to date of worry and rumination in AN. Method: Sixty-two outpatients with a diagnosis of AN took part. Measures of worry, rumination, core AN pathology and neuropsychological correlates were administered. Results: Findings suggest that worry and rumination are elevated in AN patients compared with both healthy controls and anxiety disorder comparison groups. Regression analyses indicated that worry and rumination were significant predictors of eating disorder symptomatology, over and above the effects of anxiety and depression. Worry and rumination were not associated with neuropsychological measures of set-shifting and focus on detail. Conclusions: The data suggest that worry and rumination are major concerns for this group and warrant further study.

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Eating disorder symptoms and quality of life: Where should clinicians place their focus in severe and enduring anorexia nervosa?

International Journal of Eating Disorders ◽

10.1002/eat.22327 ◽

2014 ◽

Vol 48 (1) ◽

pp. 133-138 ◽

Cited By ~ 30

Author(s):

Bryony Bamford ◽

Christina Barras ◽

Richard Sly ◽

Colleen Stiles-Shields ◽

Stephen Touyz ◽

...

Keyword(s):

Quality Of Life ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Eating Disorder Symptoms

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Factors Associated with Disease-Specific Health Related Quality of Life in Women with Anorexia Nervosa

10.21203/rs.3.rs-132704/v1 ◽

2020 ◽

Author(s):

Laura Al-Dakhiel Winkler ◽

Claire Gudex ◽

Michael Ejnar Röder ◽

Carol E Adair ◽

Jan Magnus Sjögren ◽

...

Keyword(s):

Quality Of Life ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Well Being ◽

Health Related Quality ◽

Psychological Well Being ◽

Related Quality ◽

Health Related ◽

Disease Specific

Abstract Background: Health-related quality of life is severely affected in patients with anorexia nervosa due to both physical and psychological consequences of the disease, but it is still uncertain whether the same factors affect both clinical outcome and quality of life. It is also unknown whether there are differences between patients and controls in terms of self-reported physical, psychological and social well-being. Methods: Women with anorexia nervosa were recruited from specialized eating disorder centers in the five regions of Denmark. Healthy, normal-weight controls were invited via online social media to participate in the study. Six questionnaires including study characteristics, quality of life, eating disorder symptomatology, depression, work and social adjustment and psychological well-being were completed online by all participants. Results: 211 women with anorexia nervosa and 199 controls participated in the study. Women with anorexia nervosa reported significantly lower quality of life, both in terms of disease-specific HRQoL using the Eating Disorders Quality of Life Scale and on measures of general health, psychological well-being, and work functioning. Psychological and cognitive factors were highly associated with poor quality of life (p-value<0.05). Conclusions: Our findings suggest that attention to and management of disordered self-assessment and thought processes may be of special importance to women with anorexia nervosa and their families. It is possible that greater emphasis on such aspects alongside weight gain could enhance patient-clinician alliance and contribute to better treatment outcomes.

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