scholarly journals Balancing risk requires a balanced approach: Commentary on… severe and enduring eating disorders: recognition and management

2014 ◽  
Vol 20 (6) ◽  
pp. 402-404
Author(s):  
William Rhys Jones ◽  
John F. Morgan
Keyword(s):  
Eating Disorders ◽  
Therapeutic Alliance ◽  
Robust Approach ◽  
Balanced Approach ◽  
Complex Group ◽  
Tailored Approach

SummaryPaul Robinson's article provides an excellent summary of some of the challenges faced by clinicians working with patients with severe and enduring eating disorders (SEED) and outlines a robust approach to the recognition and management of this complex group of patients. This commentary expands on some of the points raised, adds some further views and suggests a tailored approach to establishing a therapeutic alliance with patients and carers.

Therapeutic Alliance in Web-based Treatment for Eating Disorders: Patient and Therapist perspectives (Preprint)

2021 ◽  
Author(s):  
Claudia Stoeten
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Therapeutic Alliance ◽  
Secondary Analysis ◽  
Positive Association ◽  
Treatment Completion ◽  
Post Treatment ◽  
Symptom Reduction ◽  
Total Patient ◽  
Therapist Perspectives

BACKGROUND In face-to-face therapy for eating disorders, the therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. Current, however, not much is known about the TA during web-CBT and its associations with symptom reduction, treatment completion and the perspectives of patients versus therapists. OBJECTIVE The present study aimed to investigate (1) differences between TA-ratings measured at interim and post-treatment, separately for patients and therapists, (2) the degree of agreement between therapists and patients (treatment completers and non-completers) for TA-ratings, and (3) associations between patient and therapist TA-ratings and both eating disorder pathology and treatment completion. METHODS A secondary analysis was performed on the RCT data of a web-CBT intervention for eating disorders. TA-ratings (HAQ) were measured at interim and post-treatment, focusing on treatment completers, non-completers and therapists. Paired t-tests were conducted to assess the change from interim to post-treatment. Intraclass correlations were calculated to determine cross-informant agreement with regards to HAQ-scores between patients and therapists. Through two stepwise regressive procedures (at interim and post-treatment), it was examined which HAQ-scores predicted (1) eating disorder pathology and (2) therapy completion. RESULTS Participants were 170 females with BN (n=33), BED (n=68), or EDNOS (n=69); mean age 39.6 (SD=11.5) years. For completers, HAQ-total scores and HAQ-Helpfulness scores improved significantly from interim to post-treatment. For non-completers, all HAQ-scores decreased significantly. For all HAQ-scales, agreement between patients and therapists was poor. However, agreement was slightly better post-treatment than at interim. The helpfulness subscale of the HAQ was negatively associated with eating disorder psychopathology at interim and post-treatment. A positive association was found between HAQ-total patient scores at interim and treatment completion. Lastly, post-treatment HAQ-total patient scores and post-treatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion. CONCLUSIONS The results showed that for web-CBT for eating disorders, in particular the confidence to improve one’s situation (HAQ-Helpfulness) is important for predicting eating disorder pathology and treatment completion. Furthermore, in the current web-CBT, the TA increased for completers and decreased for non-completers, according to both patients and therapists.

An Analysis of Consumer Perspectives Following Contact with an Eating-Disorders Service

2001 ◽  
Vol 35 (1) ◽  
pp. 99-103 ◽  
Author(s):  
Nicola R. Swain-Campbell ◽  
Lois J. Surgenor ◽  
Deborah L. Snell
Keyword(s):  
Eating Disorders ◽  
Therapeutic Alliance ◽  
Consumer Satisfaction ◽  
Postal Survey ◽  
Treatment Modalities ◽  
Approval Ratings ◽  
Mental Health Consumers ◽  
Treatment Type ◽  
Consumer Perspectives ◽  
First Contact

Objective: The views of consumers following contact with treatment for eating disorders represent an underresearched aspect of service provision. The aim of this paper is to examine patterns of consumer satisfaction following contact with a specialist eatingdisorders service. Method: Using both a structured and an open-ended questionnaire format, consumer perspectives were sought routinely through postal survey 3 months after the point of first contact. Responses were analysed from 120 patients who returned their questionnaires during the 2-year period ending in December 1998. Results: Although the structured response format indicated high rates of satisfaction, the open-ended format revealed five categories describing the perceived best and worst aspects following consultation with the service. The category of therapeutic alliance drew the majority of positive comments, while the most frequently cited worst aspect of consultation was the category of treatment type. Conclusions: People with eating disorders form a unique group of mental health consumers to survey for satisfaction. While approval ratings prompted by both structured and open-ended questions were high, and centred around the theme of therapeutic alliance, the most frequent source of negative commentary was activities and structures considered essential by traditional treatment modalities. This provides important insights into the predicaments of people with eating disorders presenting for treatment, and the importance of developing satisfaction surveys to accommodate such predicaments and concerns.

scholarly journals A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders

2017 ◽  
Vol 50 (4) ◽  
pp. 323-340 ◽  
Author(s):  
Tiffany A. Graves ◽  
Nassim Tabri ◽  
Heather Thompson-Brenner ◽  
Debra L. Franko ◽  
Kamryn T. Eddy ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Treatment Outcome ◽  
Therapeutic Alliance ◽  
Meta Analysis

scholarly journals Family relations in eating disorders: the Genogram as instrument of assessment

2015 ◽  
Vol 20 (5) ◽  
pp. 1435-1447 ◽  
Author(s):  
Carolina Leonidas ◽  
Manoel Antônio Santos
Keyword(s):  
Eating Disorders ◽  
Therapeutic Alliance ◽  
Family Relationships ◽  
Health Professionals ◽  
Family Relations ◽  
Stressful Events ◽  
Semistructured Interview ◽  
Need For Care ◽  
Emotional Distance ◽  
The Family

The present study aimed to evaluate the transactional patterns in families of women with EDs, through the use of the Genogram. The study included 12 girls and women linked to a multidisciplinary service. For the preparation of Genograms, a semistructured interview script was built that included specific topics regarding family relationships. Genograms´ analysis followed the recommendations professed by the specialized literature. It was evident that families presented few skills in managing stressful events and resolving conflicts, resulting in emotional distance between members and vulnerability of bonds. The Genogram was proved useful as a resource for research and evaluation in the area of EDs, and the generated data was convergent with the literature. Results provide important subsidies for health professionals, since they indicate the need for care and development of therapeutic alliance with the family in the treatment for EDs.

scholarly journals The abrupt transition from face-to-face to online treatment for eating disorders: a pilot examination of patients’ perspectives during the COVID-19 lockdown

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Yael Doreen Lewis ◽  
Roni Elran-Barak ◽  
Rinat Grundman-Shem Tov ◽  
Eynat Zubery
Keyword(s):  
Eating Disorders ◽  
Therapeutic Alliance ◽  
Duration Of Treatment ◽  
Related Factors ◽  
General Psychopathology ◽  
Abrupt Transition ◽  
Face To Face ◽  
Online Treatment ◽  
Exploratory Factor Analyses ◽  
Online Format

Abstract Background Studies investigating patients’ perspectives towards an abrupt transition from face-to-face to online treatment in eating disorders (EDs) are scarce. The current study aimed to (1) conduct a preliminary assessment of patients’ perspectives regarding this transition, and (2) explore potential demographic, clinical, and treatment-related factors associated with these perspectives. Methods Sixty-three patients with EDs whose treatment was moved to an online format, were surveyed during the COVID-19 lockdown (April–May 2020). A 6-item measure was developed to examine their perspectives toward this transition. Exploratory factor analyses (EFAs) were conducted to confirm the rational-theoretical structure of the measure (Eigenvalue = 3.745, explaining 62.4% of variance). The Cronbach’s alpha value was excellent (α = 0.878). Validated questionnaires were used to measure ED symptoms, general psychopathology, therapeutic alliance, and pandemic anxiety, and their associations with our transition-focused scale and telemedicine satisfaction were examined. Results Mixed views were found regarding the transition, with the majority (68%) stating that they would not choose to continue online therapy given the option. Longer duration of treatment (r = 0.291, p = 0.022), stronger therapeutic alliance (r = 0.293, p = 0.028), and higher COVID-19 anxiety (r = 0.276, p = 0.029) were linked with more positive views towards the transition. Conclusions Analyses suggest that patients’ perspectives towards the transition can be measured using a Likert-type 6-item scale. Findings highlight the various responses to online treatment and indicate a need to identify patients who may face difficulties in the transition to this newly ubiquitous treatment mode. Clinicians should be cognizant of these potential difficulties and consider appropriate modes of treatment in the ongoing pandemic situation.

scholarly journals Experience of Management of Anorexia Nervosa Patients With Extremely Severe Malnutrition In A Transdisciplinary Eating Disorders Inpatient Unit

2020 ◽  
Author(s):  
Marie Guinhut ◽  
Jean-Claude Melchior ◽  
Nathalie Godart ◽  
Mouna Hanachi
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Therapeutic Alliance ◽  
Medical Care ◽  
Acute Care ◽  
Severe Malnutrition ◽  
Medical Unit ◽  
Life Threatening ◽  
Low Bmi ◽  
First Time

Abstract BackgroundWe describe a transdisciplinary medical unit, referral center for the management of anorexia nervosa (AN) adult patients with extremely severe malnutrition.MethodHistory, organization and activity of the unit are described. Characteristics of all adult AN patients admitted for the first time in the unit between November 1997 and January 2014 and medical care provided are detailed, before discussing the value of such a unit.ResultsThe unit was established as an independent department in 2004 and has 180 to 200 admissions per year. The patients hospitalized in the department are clinically serious and unstable because of life-threatening somatic complications due to a low BMI (< 13 kg/m²). They are referred on criteria of somatic severity. They often had multiple hospitalizations in other acute care hospitals before being supported in the unit. Among a cohort of 386 adult AN patients admitted for the first time in the unit, mean age was 29.4 (± 11.5) years, mean BMI was 12.7 (± 2.2) kg/m² and 78.2% of patients had already been hospitalized in other hospitals.ConclusionThis specialized transdisciplinary unit where physician nutritionists and psychiatrists coordinate medical care together, allow a better understanding and management of extreme malnutrition associated with AN. Thanks to their expertise, care teams are less critical and less rejecting towards patients. Thus, therapeutic alliance is optimized.

Sign in / Sign up

Export Citation Format

Share Document