Effectiveness of the DROP training for military behavioral health providers targeting therapeutic alliance and premature dropout.

AbstractPremature discontinuation from behavioral health treatment is a major problem reducing effectiveness of care in military populations. A training was developed and delivered to 622 behavioral health providers across 15 sites within the Army behavioral healthcare system. The training taught two techniques to foster treatment engagement: (1) Progress Informed Treatment, consisting of reviewing symptom assessments and outcome measures, and (2) assessment and discussion of the treatment alliance via a paper survey given near the end of each session. Eighty-five percent of providers indicated the training was useful and 89% of providers incorporated a technique into their practice. Dropout before the fourth session was significantly reduced in the six months following training, from 72.5% to 67.1% in Service Members (SM; X2(1, N=9127) = 39.58, p < .001). In both the pre and post-training periods, providers working at the Master's level, SM aged 17 or 46 or older, and clients receiving a mood, PTSD, anxiety, adjustment, substance or childhood/adolescent psychiatric diagnosis experienced significantly less dropout, while SM aged 18-21 had significantly more dropout. This training is a feasible and available option to increase treatment engagement and improve treatment outcomes for service members.

Metabolic, anthropometric, and psychological characteristics of obese binge eaters.

This study examined the relationship of binge eating to a variety of metabolic, anthropometric, and psychological characteristics in 132 obese women seeking weight reduction. Contrary to findings of a reduced resting metabolic rate (RMR) in persons with bulimia nervosa, no significant differences were observed between obese bingers and nonbingers in RMR or thyroid hormones. Nor did the two groups differ significantly in weight, percentage body fat, body fat distribution, or serum lipid levels. Consistent with previous findings, however, binge eaters did score significantly higher in depression and other measures of psychopathology, as assessed by the Minnesota Multiphasic Personality Inventory. They also scored significantly higher in disinhibition and hunger but significantly lower in cognitive restraint. All of these findings await confirmation in subjects diagnosed according to criteria proposed for a new binge eating disorder. The present results, however, provide little support for the hypothesis that binge eating in obese individuals is related to reduced resting energy requirements.