National roll-out of early intervention for eating disorders: Process and clinical outcomes from first episode rapid early intervention for eating disorders.

AIM: First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention model for young people with recent-onset eating disorders (ED). Promising results from a previous single-centre study and a four-centre study (FREED-Up) have led to the rapid national scaling of FREED to ED services in England (FREED-4-All). Our aim was to evaluate duration of an untreated ED (DUED), wait time target adherence, and clinical outcomes in FREED-4-All and compare these to the (benchmark) findings of the earlier FREED-Up study. METHOD: FREED services submit de-identified data to the central FREED team quarterly. The current study covers the period between September 2018 and September 2021. This FREED-4-All dataset includes 2473 patients. These were compared to 278 patients from the FREED-Up study. RESULTS: DUED was substantially shorter in the FREED-4-All dataset relative to the FREED-Up study (15 vs. 18 months). Adherence to the wait time targets was comparable in both cohorts (~85% of engagement calls attempted in <2 days, ~50%-60% of assessments offered in <14 days, ~40% of treatment offered in <28 days). Patients in the FREED-4-All dataset experienced significant improvements in ED and general psychological symptoms from pre- to post-treatment that were comparable to the FREED-Up study. These findings should be interpreted cautiously as only 6% of FREED-4-All patients had post-treatment data. CONCLUSIONS: Data from the FREED-4-All evaluation suggest that FREED is replicating at scale. However, these data are flawed, uncertain, proximate, and sparse and should therefore be used carefully alongside other evidence and clinical experience to inform decision making.

Illness representations, coping styles and mood in adults with epilepsy.

It has been generally accepted that psychosocial well-being in people with epilepsy may show an association with the type of coping strategies they adopt. However, relatively little attention has been paid to the way people with epilepsy perceive their illness (illness representations) in determining their well-being and whether these representations are related to coping strategies in determining psychological outcome. We administered the Illness Perception Questionnaire and the Ways of Coping scale and examined their relationship with anxiety and depression scores in 43 adults with chronic epilepsy. Within multiple regression analyses, whilst epilepsy variables were not significantly related to mood, after also adjusting for patients' gender, anxiety scores were best predicted by an increased relative use of escape-avoidance and a decreased relative use of distancing as coping strategies; increased depression scores were best predicted by greater relative use of escape-avoidant and self-controlling coping. Once coping factors had been accounted for, Illness Identity scores independently predicted anxiety scores, indicating that coping was not acting simply to mediate the impact of illness representations on patients' mood. However, illness representations did not independently predict depression, suggesting that in the case of negative affect, coping was acting as a mediating factor. Findings indicate the importance of aspects of epilepsy patients' cognitive representations of their illness, as well as of their coping styles in determining psychological well-being.