Effectiveness of the Maudsley Model of Anorexia Nervosa Treatment for Adults: A systematic review.

BACKGROUND: Maudsley Model of Anorexia nervosa (AN) Treatment for Adults (MANTRA) is recommended by NICE for the treatment of adults with AN. However, despite this fact, the approach remains relatively understudied. The aim of this study was to systematically update the research evidence regarding the use of the MANTRA in the treatment of Eating Disorders (ED). METHOD: The databases used were Web of Science, Scopus, and PsycInfo, including studies up to 31 May 2023. PRISMA guidelines were followed, and Cochrane tools were used to assess the risk of bias. The search focused on identifying published articles that discussed the usefulness of MANTRA as a component of treatment for ED, following PICO criteria. RESULTS: Nine studies spanning the period from 2011 to 2023 were included. Findings suggested that MANTRA was effective in improving body mass index (BMI), eating symptomatology and emotional state. There were generally no significant differences compared to other treatment conditions. Limitations to interpreting this systematic review include the methodological quality of included studies and the elevated risk of bias. CONCLUSIONS: This review was the first to examine the effectiveness of MANTRA. The results indicate that MANTRA has shown effectiveness similar to other treatments for adults AN patients in addressing key clinical variables. It has been used in different populations (adolescents, males, inpatients) and formats (group, online) However, more research is needed to determine its effectiveness.

The Spanish Validation of the Accommodation and Enabling Scale for Eating Disorders Among Carers: A Pilot Study.

Literature suggests that families may accommodate patients' symptoms in attempts to alleviate family conflict and stress. These accommodating and enabling behaviours may have a negative impact on carers and those they care for. There are no self-report questionnaires validated in Spanish to measure accommodation among relatives of patients with an eating disorder. The aim of this study was to examine the psychometric properties of the Spanish version of the Accommodation and Enabling Scale for Eating Disorders (AESED-S) among relatives of eating disorder patients. A cross-sectional study of 90 relatives was carried out to explore the factor structure, reliability and validity of the AESED-S. The internal consistency of the Spanish version of the AESED subscales was good, ranging from .89 to .81. The correlation of the five subscales with conceptually related measures (negative caregiving experience and distress) supports the convergent validity of this instrument in this sample. Results indicated that the Spanish version of the AESED provides a reliable and valid tool for assessing family accommodation in the context of having a relative with an eating disorder.

Validation of the Spanish version of the eating disorders quality of life instrument (EDQOL).

BACKGROUND: The Eating Disorders Quality of Life instrument (EDQOL) is a disease-specific health related quality of life self-report questionnaire designed for disordered eating patients. Although the EDQOL is one of the most suitable and widely used questionnaires in many countries, no prior research has addressed the psychometric properties of the Spanish adaptation of the EDQOL. Therefore, the aim of this study is to examine the psychometric properties of the Spanish version of the EDQOL among ED patients. METHODS: 141 female eating disorder patients, with a mean age of 18.06 years (SD = 6.31), completed the EDQL in addition to the Eating Disorder Examination Questionnaire (EDEQ), the Depression, Anxiety and Stress Scales (DASS-21), the Clinical Impairment Assessment (CIA 3.0) and the Health Survey (SF-12). We calculated item/scale characteristics, internal consistencies and bivariate correlations with other measures of quality of life and adjustments. We assessed the goodness-of-fit of the 4-factor model using confirmatory factors analysis and explored the sensitivity of change following skill-based interventions. RESULTS: The fit of the 4-factor model was acceptable (Root Mean Square Error of Approximation: 0.07, Standard Root Mean Square Residual: 0.07). Cronbach's alpha was excellent for the total (.91) and acceptable for all subscales (0.78-0.91). The construct validity was found with measures of psychological distress, depression, anxiety, quality of life and clinical impairment. The psychological and physical/cognitive scales and the EDQOL global scale were responsive to change. CONCLUSION: The Spanish EDQOL version is a useful instrument to assess quality of life in eating disorder patients and to evaluate outcomes of skills-based interventions.

Eating Disorders (EDs) have a severe impact on many domains of quality of life (QOL). Therefore QOL needs to be addressed in effectiveness research and clinical practice. Furthermore, QOL is a very relevant concept in the treatment of chronic diseases and its evaluation requires specific health-related questionnaires. One widely used self-report measure to assess the quality of life in eating disorders is the Eating Disorder Quality of Life (EDQOL). Despite its high clinical relevance, EDQOL has not been previously investigated in the Spanish context. To overcome this gap, the present study aimed to validate the Spanish version of the EDQOL in a sample of Spanish eating disorder patients. The findings showed that the Spanish version of the EDQOL is robust in terms of reliability, factor structure and construct validity. This questionnaire may be preferred by clinicians and researchers interested in ED-specific health related quality of life impairment and as an additional indicator of ED severity.

Development and validation of the theory of planned behavior questionnaire in physical activity.

The Theory of Planned Behavior (TPB) is one of the main theoretical models in the study of the different variables, which influence in the practise of physical activity. The aim in this study was to develop a questionnaire based on TPB in physical activity context providing evidence for the validity of the obtained measures. The instrumental project included three independent studies. The first study entailed the construction and qualitative assessment of the items. In the second study, the analysis of factorial structure was performed by means of exploratory measures, and it showed that the reliability of measures was adequate. The third study provided evidence on the dimensionality of the scale. The confirmatory factorial analysis guaranteed the stability of factorial structure proposed by the TPB and provided evidence for the internal validity of the inventory. Moreover, this study provided evidence of its external validity.

Eating habits, physical activity, consumption of substances and eating disorders in adolescents.

The aim of this study was to evaluate the differences between adolescents with a high or low risk of developing an eating disorder (ED) in different health behaviors (eating habits, physical activity and the consumption of substances) per gender. The EAT-40 and the Inventory of Behavioral Health in Scholars were applied to 2142 middle school students from Alicante (Spain), of whom 52.8% were girls and 47.2% were boys, with an average age of 13.92 years old (Sd = 1.34). Results indicated that girls with a high risk of developing an ED consumed fewer meals, ate fewer unhealthy foods, followed more diets and paid more attention to nutritional components. Furthermore, they also performed more physical activity with the objective of losing weight, and consumed more tobacco, alcohol and medicines. Boys at high risk of developing an ED followed more diets and paid more attention to nutritional components. For boys, no more differences were found. These results suggest that any program directed at the prevention of ED should not only include nutritional education, but should also seek to promote regular physical activity with objectives other than weight loss or the burning of calories.

The dissimilarity between patients' and relatives' perception of eating disorders and its relation to patient adjustment.

This study aims to examine the relation between the degree of dissimilarity in patients' and relatives' perception of eating disorders (ED) and patient adjustment. Sixty ED patients and their relatives were interviewed. They completed the Spanish version for ED of the Revised Illness Perception Questionnaire (IPQ-R). Patients who agreed with their relatives that their illness was highly distressful, a chronic condition and with high identity, showed higher psychological distress than patients who did not agree with their relatives. When patients and relatives had fairly positive perceptions of illness controllability and curability, these patients showed lower levels of depression and anxiety.

Assesment of social support dimensions in patients with eating disorders.

UNLABELLED: The aim of this study is to assess social support dimensions (providers, satisfaction and different support actions) in patients with eating disorders (ED), looking at diagnosis, socio-demographic and clinical characteristics, and self-concept. METHOD: A total of 98 female ED patients were recruited. The ages of participants ranged from 12 to 34 (Mean = 20.8-years-old, SD=5.61). Patients have a primary DSM-IV-R diagnosis of anorexia nervosa (61.2%), bulimia nervosa (27.6%) or an unspecified eating disorder (11.2%). Social support was assessed using the Escala de Apoyo Social Percibido (EASP). This scale measures social support providers, satisfaction and specific social support actions, which can be grouped into informational, emotional and practical support. Self-concept was assessed using the Cuestionario de Autoconcepto (AF-5). RESULTS: The two most frequent providers for these patients were mothers (86.7%) and partners (73.1%). Patients' satisfaction with social support was high and they reported that they received informational support more frequently than emotional and practical support. Family self-concept showed positive relationships with social support dimensions. CONCLUSION: These results show the importance of the family network in connection with these disorders and its relation to self-concept.

Testing carer skill training programs in Spanish carers of patients with eating disorders.

BACKGROUND: The aim of this research was to conduct a pilot study to measure the effectiveness of the Collaborative Care Skills Training Workshops (CCSTW) on the outcomes of Spanish carers and to analyse the impact of this programme on the patient's wellbeing. We used psychoeducation as a comparison intervention in the study. METHOD: The study compared two forms of carer workshops. 64 carers and 37 eating disorder patients participated in this study. Carers were randomised to either the CCSTW or the Psycho-educational programme. This study used an experimental intervention design with evaluations before, after and at a 3-month follow-up. RESULTS: Carers receiving both intervention programmes showed an improvement in wellbeing indicating a benefit from the training. The course of burden, psychological distress, expressed emotion and illness perception was similar in the two groups. In patients whose caregivers had participated in CCSTW programme the levels of anxiety, depression and psychological distress decreased. CONCLUSIONS: These findings suggest that carer distress, burden, illness perception and expressed emotion can be alleviated if they are helped in this role. There appear to be secondary benefits of the CCSTW on patients' wellbeing.

Illness perception in eating disorders and psychosocial adaptation.

OBJECTIVE: The current study is based on the framework of the Self-Regulatory Model of Illness (SRM). The aim of this work was to examine perception of illness in eating disorder (ED) patients and investigate whether illness perception is related to psychosocial adaptation in these patients. METHOD: A total of 98 female ED patients completed the specific eating disorders Spanish version of the Revised Illness Perception Questionnaire (IPQ-R) and a range of adjustment variables including the Psychosocial Adjustment to Illness Scale (PAIS) and the Hospital Anxiety and Depression Scale (HAD). RESULTS: ED patients reported a moderate number of physical symptoms, and perceived their illness as controllable, treatable, highly distressing, as a chronic condition and with serious consequences. Emotional representation was the most significant dimension related to emotional adjustment. Illness identity and cure dimensions were the most significant dimensions associated with psychosocial adaptation. CONCLUSION: This study shows that patients' illness perceptions are related to illness adaptation. Illness identity was associated with emotional and psychosocial adjustment, and having faith that treatment may control the illness was related to positive benefits for ED. These results suggest that a psychological intervention, which addresses patients' illness representations, may assist in their adjustment to ED.

Adaptation and validation of the Spanish version of the Dieting Peer Competitiveness Scale to adolescents of both genders.

This study examined the Dieting Peer Competitiveness Scale; it is an instrument for evaluating this social comparison in young people. This instrumental study has two aims: The objective of the first aim was to present preliminary psychometric data from the Spanish version of the Dieting Peer Competitiveness Scale, including statistical item analysis, research about this instrument's internal structure, and a reliability analysis, from a sample of 1067 secondary school adolescents. The second objective of the study corresponds to confirmatory factor analysis of the scale's internal structure, as well as analysis for evidence of validity from a sample of 1075 adolescents.

[Avoidance coping style and the risk of developing an eating disorder in adolescents]. / Estrategias de afrontamiento evitativas y riesgo de desarrollar un trastorno de la conducta alimentaria en adolescentes.

The first aim of this study was to analyse the relationship between coping styles and strategies in Spanish adolescents of both genders, with high and low eating disorder risk. Secondly, this study aims to examine the relation of coping styles and coping strategies with eating disorder risk. The sample comprised 2142 adolescents (1.130 girls and 1.012 boys), mean age 13,96 years (SD= 1.34). They completed the Adolescent Coping Scale (ACS) and the Eating Attitude Test (EAT-40). The results showed high use of intropunitive avoidance coping in both female and male adolescents with high EAT-40 scores. The regression analysis indicated that, in both girls and boys, the intropunitive avoidance and the tension reduction coping strategy explained a high percentage of variance of eating disorder risk. The results of this study have implications for the prevention of these behaviours in adolescents, because people with a high risk of developing an eating disorder present a maladaptive coping style before the onset of the eating disorder.

Afrontamiento y trastornos de la conducta alimentaria: un estudio de revisión / Coping and eating disorders: A review

Se describen las estrategias de afrontamiento que utilizan las pacientes con TCA, y su relación con otras variables psicosociales, valorando sus efectos sobre la salud. Se revisaron losestudios empíricos sobre afrontamiento y variables psicosociales y clínicas en los TCA en los últimos 20 años, utilizando las bases de datos: Psyclit, Medline, Psicodoc, IME e ISOC,combinando por pares el descriptor de afrontamiento con los seleccionados para la muestra de estudio. Los resultados sugieren que estas pacientes utilizan estrategias evitativas y centradas en la emoción, y en menor medida estrategias aproximativas y centradas en el problema. Estetipo de afrontamiento también es característico de las mujeres con mayor riesgo para desarrollar el trastorno. Las estrategias evitativas y centradas en la emoción se relacionan en estas pacientes con una peor adaptación psicosocial, mientras que las aproximativas y centradas en elproblema, lo hacen en sentido contrario.

We reviewed the role of coping in eating disorders, and the relation of this concept with other psychosocial variables. We reviewed the empirical studies published in the last 20 years about coping and psychosocial and clinical variables in eating disorders using Psyclit, Medline, Psicodoc, IME and ISOC. The results suggest that eating disorders patients make more use of avoidance and emotion oriented coping, and are less likely to respond with active attempts to solve or problem-oriented coping mechanism, than subjects without the disorder. This type of coping is also more frequently used by women with higher tendency to develop an eating disorder. Avoidance and emotion-oriented coping are associated with poorer psychosocialadaptation, whereas active and problem-oriented coping are associated with better health outcomes in these patients.