A description of virtual skills workshops for supporters of loved ones with eating disorders: Indicators of benefit and acceptability, clinical reflections and consideration of neurodiversity.

OBJECTIVE: Providing information and support to those supporting a loved one with an eating disorder is a key part of evidence-based service provision. We report on how we took our workshops for supporters online during the Covid-19 Pandemic when country-side physical distancing restrictions meant we were unable to work face to face. METHODS: We outline the structure of an eight-session 2-h workshop series delivered fortnightly facilitated by a multidisciplinary team of clinicians, researchers and experts by experience. We use a repeated-measures design to understand the possible benefits of the workshops on supporter skills (n = 76). RESULTS: Measured using the Caregiver Skills Scale, we observed small-sized improvements in the overall skills (D = 0.43) of n = 17 supporters who provided data at the end of the intervention. Supporters gave largely positive feedback on the virtual format. They particularly liked the opportunity to interact with other supporters. As facilitators, we overcome our initial anxiety around workshop delivery using a new platform and reflected that having more time to cover key information and for skills practice over a period of 16 weeks offered opportunities to develop and reflect on new skill together as a group. We were also able to work with larger groups of supporters, as several barriers to access were removed. CONCLUSIONS: As the workshops reached a larger number of supporters than through face to face delivery and were of benefit to those who reported on their skills, we plan to continue offering workshops to supporters online in future.

A description of multiple family workshops for carers of people with anorexia nervosa.

Carers of people with eating disorders are uncertain about how best to help and express the need for information. Fifty per cent of carers (usually parents) exhibit clinically significant anxiety and/or depression. This may result from a difficulty coping with the manifestations of anorexia nervosa (AN) in the sufferer. In turn, eating disorder symptoms can be maintained by family reactions to the illness. Thus, carer's own symptoms, plus their uncertainty about how to help, impinge upon the AN sufferer, exacerbating their symptoms and behaviours. In this paper, we describe an intervention which uses cognitive behavioural therapy principles to alleviate carer's depression and anxiety and motivational interviewing to target behaviours that maintain eating disorder symptoms, for example high expressed emotion and poor communication. This is given in the form of an educational workshop for two families.

A practical comparison of two types of family intervention: an exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for adults with anorexia nervosa.

BACKGROUND: Little is known about the outcome of involving families in the treatment of adults with anorexia nervosa. Carers of people with anorexia nervosa experience significant levels of distress. This may contribute to unhelpful behaviours which maintain the illness. AIMS: To evaluate the effectiveness and acceptability of family workshops with educational and skills-based components as compared to individual family work. METHOD: An exploratory randomised controlled trial of two forms of family intervention was conducted for inpatients with anorexia nervosa (n = 48) and their family members on a specialised unit for adults. RESULTS: In both groups, there was an improvement in patients' BMI and a reduction in carers' distress. There were no differences between groups. CONCLUSION: Preliminary findings suggest that workshop-based intervention with two families might be as effective as an individually focused family intervention. This may offer a more cost-effective intervention for this treatment-resistant group.

Expressed emotion in relatives of patients with eating disorders following skills training program.

OBJECTIVE: The first aim of this work was to examine whether high expressed emotion (EE) would be associated with psychological distress and negative appraisal of caregiving. The second aim was to examine whether could replicate the findings of (Uehara et al., Compr Psychiatr, 42, 132-138, 2001) regarding a reduction in EE in association with a psycho-educational intervention. METHOD: A prospective exploratory follow-up assessment of 47 caregivers in which EE was measured by Five Minutes Speech Sample, Experience of Caregiving Inventory and General Health Questionnaire (GHQ-12). RESULTS: High EE ratings were found in 26/47 (55%) carers at baseline. The high EE group had a higher negative aspects of caregiving (high EE = 109.8 vs. low EE = 93.7, p = 0.04). The number of carers with high-EE fell from 55% to 24% after intervention, and remained below at follow-up. The levels of distress and caregiving burden of the caregivers were also reduced. DISCUSSION: Fifty-five percent of the caregivers have high EE. High-EE relatives noted a higher caregiving burden than low-EE relatives particularly on the 'dimension of loss'. The level of EE was reduced following a skills training program.

Experience of caring for someone with anorexia nervosa: qualitative study.

BACKGROUND: Caring for someone with anorexia nervosa is distressing. AIMS: To gain a detailed understanding of carers' illness models and caregiving experiences. METHOD: Qualitative analysis and computerised text analysis were conducted on narratives written by parents as part of a family intervention at a specialist in-patient unit (20 mothers, 20 fathers). RESULTS: Themes concerned illness perceptions, impact on the family, and carers'emotional, cognitive and behavioural responses towards the illness. Parents perceived anorexia nervosa to be chronic and disabling. Carers blamed themselves as contributing to the illness and perceived themselves as helpless in promoting recovery. Mothers illustrated an intense emotional response, whereas fathers produced a more cognitive and detached account. CONCLUSIONS: Part of the distress in living with anorexia nervosa may be explained by unhelpful assumptions and maladaptive responses to the illness. Training parents in skills to manage the illness may improve outcome by reducing interpersonal maintaining factors.