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.

Eating disorders

Psychiatry ◽  
2019 ◽  
Author(s):  
Rebecca McKnight ◽  
Jonathan Price ◽  
John Geddes
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Weight Control ◽  
Positive Association ◽  
Classification Systems ◽  
Eating Disordered ◽  
Icd 10 ◽  
Abnormal Eating ◽  
Significant Impairment

The term ‘eating disorder’ describes a range of conditions characterized by abnormal eating habits and methods of weight control which lead to a significant impairment of psychological, social, and physical functioning. Eating disorders are serious, complex conditions; they are not simply a problem of eating too much or too little, or an attempt to achieve the perfect physique. Anorexia nervosa has the highest mortality of any psychiatric disorder, and it is notoriously difficult both to engage eating- disordered patients, and to treat them success­fully. There is a positive association between early diag­nosis and prognosis, so the skills to recognize an eating disorder— whether they present with psychological or physical symptoms— are essential for all clinicians. At the time of writing, the description of eating dis­orders within diagnostic classification systems has been undergoing considerable change. Under the ICD- 10 and DSM- IV classification systems, three main eating disorders were recognized (Fig. 27.1): … 1 anorexia nervosa; 2 bulimia nervosa; 3 eating disorder not otherwise specified (EDNOS). … However, this classification has been shown to have various difficulties: … ● The majority of cases were attracting an ‘EDNOS’ label, whereas it was supposed to be a residual category (Fig. 27.1). ● EDNOS contained within it the subdiagnosis ‘binge eating disorder’ (BED). Recent research has demonstrated BED accounts for approximately 10 per cent of eating disorders in clinical cohorts. ● The categorical nature of the system does not allow for the fact that most eating disorders change over time, and frequently move back and forth along the spectrum of presentations. ● The DSM- 5 classification system (see ‘Further reading’) has tried to tackle the first two of these difficulties, and the upcoming ICD- 11 will echo these changes (Table 27.1) There is now a separate category for BED, and three other defined conditions. This is a positive change, but has only reduced the ‘NOS/ unspecified’ percentage to some extent, and has not considered the changeable nature of eating disorder symptomatology. Hopefully in the future a solution to the difficulty of turning a spectrum of pathology into a categorical system will emerge.

An internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial

2013 ◽  
Vol 44 (9) ◽  
pp. 1947-1963 ◽  
Author(s):  
K. Hötzel ◽  
R. von Brachel ◽  
U. Schmidt ◽  
E. Rieger ◽  
J. Kosfelder ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Treatment Outcome ◽  
Eating Disorder ◽  
Controlled Trial ◽  
Intervention Group ◽  
Self Esteem ◽  
Post Treatment ◽  
Control Group ◽  
Motivational Enhancement Therapy ◽  
Motivation To Change

BackgroundPrevious research has demonstrated an association between low motivation to change and an unfavorable treatment outcome in patients with an eating disorder. Consequently, various studies have examined the effects of motivational enhancement therapy (MET) on motivation to change and treatment outcome in eating disorders. In each of these studies, MET was administered in a face-to-face setting. However, because of its anonymity and ease of access, the internet provides several advantages as the format for such an intervention. Therefore, the current study investigated the effects of an internet-based program (‘ESS-KIMO’) to enhance motivation to change in eating disorders.MethodIn total, 212 females were accepted for participation and assigned randomly to the intervention condition (n = 103) or waiting-list control condition (n = 109). The intervention consisted of six online MET sessions. Before and after the intervention or waiting period respectively, participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED), the Pros and Cons of Eating Disorders Scale (P-CED), the Self-Efficacy Scale (SES), and the Rosenberg Self-Esteem Scale (RSES). A total of 125 participants completed the assessment post-treatment. Completer analyses and intent-to-treat analyses were performed.ResultsSignificant time × group interactions were found, indicating a stronger increase in motivational aspects and self-esteem, in addition to a stronger symptom reduction on some measures from pre- to post-treatment in the intervention group compared to the control group.ConclusionsInternet-based approaches can be considered as useful for enhancing motivation to change in eating disorders and for yielding initial symptomatic improvement.

The use of cognitive remediation therapy on a child adolescent eating disorder unit: Patients and therapist perspectives

2016 ◽  
Vol 22 (2) ◽  
pp. 288-300 ◽  
Author(s):  
Lucia Giombini ◽  
Robert Turton ◽  
Matteo Turco ◽  
Sophie Nesbitt ◽  
Bryan Lask
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Therapeutic Process ◽  
Cognitive Remediation ◽  
Additional Treatment ◽  
Cognitive Remediation Therapy ◽  
Adolescent Population ◽  
Therapist Perspectives ◽  
Therapy Programme

Cognitive remediation therapy (CRT) is an intervention for anorexia nervosa (AN) that focuses on ameliorating the neuropsychological inefficiencies that underlie the illness. The current literature has reported promising results regarding its efficacy as an intervention for AN. However, there is a scarcity of studies considering the implementation of CRT in a child and adolescent population. This article describes an individual CRT therapy programme for children and adolescents with AN delivered on an inpatient unit for eating disorders. It considers the therapeutic process including the differing viewpoints of the patients and the therapists. The article concludes that CRT can be viewed as an engaging therapeutic intervention that could be useful as an additional treatment for AN.

scholarly journals Review of Mindfulness-Related Interventions to Modify Eating Behaviors in Adolescents

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2917 ◽  
Author(s):  
Michael Omiwole ◽  
Candice Richardson ◽  
Paulina Huniewicz ◽  
Elizabeth Dettmer ◽  
Georgios Paslakis
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Eating Behaviors ◽  
Positive Association ◽  
Clinical Samples ◽  
Targeted Prevention ◽  
Healthy Foods ◽  
Eating Disordered ◽  
Treatment Techniques ◽  
Eating Disorder Psychopathology

There are few well-established treatments for adolescent eating disorders, and for those that do exist, remission rates are reported to be between 30 and 40%. There is a need for the development and implementation of novel treatment approaches. Mindfulness approaches have shown improvements in eating disorder-related psychopathology in adults and have been suggested for adolescents. The present review identifies and summarizes studies that have used mindfulness approaches to modify eating behaviors and to treat eating disorders in adolescents. Focused searches were conducted in Embase, Medline, and PsycINFO, and identified articles were checked for relevance. A small number of studies (n = 15) were designated as appropriate for inclusion in the review. These studies were divided into those that focused on the promotion of healthy eating/the prevention of disordered eating (n = 5), those that concentrated on targeted prevention among high risk adolescents (n = 5), and those that focused on clinical eating disordered adolescents (n = 5). Thirteen of the 15 studies reviewed reported at least one positive association between mindfulness treatment techniques and reduced weight/shape concerns, dietary restraint, decreased body mass index (BMI), eating in the absence of hunger (EAH), binge eating, increased willingness to eat novel healthy foods, and reduced eating disorder psychopathology. In summary, incorporating mindfulness to modify eating behaviors in adolescent non-clinical and clinical samples is still in the early stages, with a lack of data showing clear evidence of acceptability and efficacy. Further studies and preferably controlled conditions are warranted.

Internal Structure of the Spanish Adaptation of the Eating Disorder Inventory-3

2012 ◽  
Vol 28 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Paula Elosua ◽  
Alicia López-Jáuregui
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Internal Structure ◽  
Internal Consistency ◽  
Clinical Sample ◽  
Temporal Stability ◽  
Second Order ◽  
Order Structure ◽  
Eating Disorder Inventory ◽  
High Internal Consistency

In this study the Eating Disorder Inventory-3 was adapted to Spanish and analyzed the internal psychometric properties of the test in a clinical sample of females with eating disorders. The results showed a high internal consistency of the scores as well as high temporal stability. The factor structure of the scale composites was analyzed using confirmatory factor analysis. The results supported the existence of a second-order structure beyond the psychological composites. The second-order factor showed high correlation with the factor related to eating disorders. Overall, the Spanish version of the EDI-3 showed good psychometric qualities in terms of internal consistency, temporal stability and internal structure.

Pharmacotherapy for Eating Disorders

2017 ◽  
Author(s):  
Susan McElroy ◽  
Anna I. Guerdjikova ◽  
Nicole Mori ◽  
Paul E. Keck
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Mental Disorders ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Night Eating Syndrome ◽  
Night Eating

This chapter addresses the pharmacotherapy of the eating disorders (EDs). Many persons with EDs receive pharmacotherapy, but pharmacotherapy research for EDs has lagged behind that for other major mental disorders. This chapter first provides a brief rationale for using medications in the treatment of EDs. It then reviews the data supporting the effectiveness of specific medications or medication classes in treating patients with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other potentially important EDs, such as night eating syndrome (NES). It concludes by summarizing these data and suggesting future areas for research in the pharmacotherapy of EDs.

Epidemiology and Course of Eating Disorders

2010 ◽  
pp. 24-32 ◽  
Author(s):  
Pamela Keel
Keyword(s):  
Public Health ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
The Public ◽  
Purging Disorder ◽  
Not Otherwise Specified ◽  
Public Health Significance ◽  
Health Significance

The epidemiology of eating disorders holds important clues for understanding factors that may contribute to their etiology. In addition, epidemiological findings speak to the public health significance of these deleterious syndromes. Information on course and outcome are important for clinicians to understand the prognosis associated with different disorders of eating and for treatment planning. This chapter reviews information on the epidemiology and course of anorexia nervosa, bulimia nervosa, and two forms of eating disorder not otherwise specified, binge eating disorder and purging disorder.

The Classification of Eating Disorders

2010 ◽  
pp. 7-24 ◽  
Author(s):  
Kathryn H. Gordon ◽  
Jill M. Holm-Denoma ◽  
Ross D. Crosby ◽  
Stephen A. Wonderlich
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Latent Class ◽  
Minority Groups ◽  
Statistical Manual ◽  
Text Revision ◽  
Diagnostic And Statistical Manual ◽  
Key Issues ◽  
Dsm Iv

The purpose of the chapter is to elucidate the key issues regarding the classification of eating disorders. To this end, a review of nosological research in the area of eating disorders is presented, with a particular focus on empirically based techniques such as taxometric and latent class analysis. This is followed by a section outlining areas of overlap between the current Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) eating disorder categories and their symptoms. Next, eating disorder classification models that are alternatives to the DSM-IV-TR are described and critically examined in light of available empirical data. Finally, areas of controversy and considerations for change in next version of the DSM (i.e., the applicability of DSM criteria to minority groups, children, males; the question of whether clinical categories should be differentiated from research categories) are discussed.

Pharmacotherapy of the Eating Disorders

2010 ◽  
pp. 416-451 ◽  
Author(s):  
Susan L. McElroy ◽  
Anna I. Guerdjikova ◽  
Anne M. O’Melia ◽  
Nicole Mori ◽  
Paul E. Keck
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Mental Disorders ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Night Eating Syndrome ◽  
Night Eating

Many persons with eating disorders (EDs) receive pharmacotherapy, but pharmacotherapy research for EDs has lagged behind that for other major mental disorders. In this chapter, we first provide a brief rationale for using medications in the treatment of EDs. We then review the data supporting the effectiveness of specific medications or medication classes in treating patients with anorexia nervosa (AN), bulimia nervosa, binge eating disorder (BED), and other potentially important EDs, such as night eating syndrome (NES) and sleep-related eating disorder (SRED). We conclude by summarizing these data and suggesting future areas for research in the pharmacotherapy of EDs.

scholarly journals Association between the social support for mothers of patients with eating disorders, maternal mental health, and patient symptomatic severity: A cross-sectional study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Atsurou Yamada ◽  
Fujika Katsuki ◽  
Masaki Kondo ◽  
Hanayo Sawada ◽  
Norio Watanabe ◽  
...  
Keyword(s):  
Social Support ◽  
Eating Disorders ◽  
Eating Disorder ◽  
Psychological Distress ◽  
Self Efficacy ◽  
Maternal Mental Health ◽  
Self Esteem ◽  
Depression Symptoms ◽  
The Social ◽  
Distress Scale

Abstract Background Although caregivers of patients with eating disorders usually experience a heavy caregiving burden, the effects of social support on caregivers of patients with eating disorders are unknown. This study aimed to investigate how social support for mothers who are caregivers of patients with an eating disorder improves the mothers’ mental status and, consequently, the symptoms and status of the patients. Methods Fifty-seven pairs of participants were recruited from four family self-help groups and one university hospital in Japan. Recruitment was conducted from July 2017 to August 2018. Mothers were evaluated for social support using the Japanese version of the Social Provisions Scale-10 item (SPS-10), self-efficacy using the General Self-Efficacy Scale, loneliness using the University of California, Los Angeles Loneliness Scale, listening attitude using the Active Listening Attitude Scale, family functioning using the Family Assessment Device, depression symptoms using the Beck Depression Inventory (Second Edition), and psychological distress using the Kessler Psychological Distress Scale. Patients were evaluated for self-esteem using the Rosenberg Self-Esteem Scale, assertion using the Youth Assertion Scale, and their symptoms using the Eating Disorder Inventory. We divided the mothers and patients into two groups based on the mean score of the SPS-10 of mothers and compared the status of mothers and patients between the high- and low-scoring groups. Results High social support for mothers of patients with eating disorders was significantly associated with lower scores for loneliness and depression of these mothers. We found no significant differences in any patient scores based on mothers’ level of social support. Conclusions For patients with eating disorders, social support for a caregiver cannot be expected to improve their symptoms, but it may help prevent caregiver depression and loneliness.

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