The relation between two barriers to self-compassion and clinical characteristics in individuals with eating disorders.

There is growing support for the role of self-compassion in recovery from an eating disorder (ED) and two types of barriers have been identified in this population: (a) fears that self-compassion will result in a failure to meet personal and interpersonal standards (meeting standards); and (b) fears that self-compassion gives rise to difficult emotions such as grief and unworthiness (emotional vulnerability). OBJECTIVE: This research examined the relative contribution of meeting standards and emotional vulnerability barriers to the clinical characteristics of individuals with EDs. METHOD: Participants (N = 349) completed the fears of compassion for self-scale, and measures of self-compassion, ED and psychiatric symptom severity, interpersonal and affective functioning, quality of life and readiness for ED change. RESULTS: Together, the two barrier types accounted for significant variance in all study variables. Meeting standards was associated with lower readiness to change and greater over-control. In contrast, emotional vulnerability was associated with lower self-compassion, readiness, and quality of life, poorer interpersonal and affective functioning, and greater ED and psychiatric severity. CONCLUSION: While both barriers to self-compassion were related to functioning in individuals with EDs, the emotional vulnerability barrier accounted for more variance in pathology and may be most beneficial to target in treatment.

Is stage of change enough? Confidence as a predictor of outcome in inpatient treatment for eating disorders.

OBJECTIVE: While stage of change has been shown to be a robust predictor of eating disorder treatment outcome, little attention has been paid to the role of confidence. This study sought to better understand the role of confidence and the possible interaction it may have with stage of change in promoting eating disorder symptom change. METHOD: Participants were adult women in inpatient treatment for eating disorders. They completed measures of motivation for change, which assessed precontemplation, action, confidence and internality (changing for oneself vs. others) and eating disorder symptom severity at pretreatment (N = 159) and posttreatment (n = 59). Only treatment completer analyses were used. RESULTS: Precontemplation and confidence had significant effects on pretreatment and posttreatment symptom severity, while action only had a significant effect on pretreatment symptoms. Confidence was shown to moderate relations between both measures of stage of change (i.e., precontemplation and action) and symptoms posttreatment. Follow-up analyses indicated that high precontemplation was associated with poor outcome, irrespective of confidence, however, low precontemplation was associated with better outcome at high levels of confidence. The interaction between confidence and action was also significant at very high levels of confidence. That is, among individuals who had high action at baseline, those with low confidence had significantly poorer outcomes relative to those with high confidence. DISCUSSION: Findings indicate that stage of change and confidence are both important prognostic factors and suggest that early behavior change in the absence of confidence may not guarantee best outcomes in inpatient eating disorder treatment.

Where does it hurt? Location of pain, psychological distress, and alexithymia among outpatients seeking psychotherapy.

Objectives: Physical pain is prevalent among psychiatric outpatients, yet there has been little research regarding the types of pain reported. The purpose of this study was to survey outpatients seeking psychotherapy regarding pain locations and to examine associations between number of pain locations and psychiatric distress and alexithymia.Methods: Two hundred and seventeen patients were recruited from three Canadian hospitals that offer outpatient psychiatry services and short-term therapies. Participants were surveyed about their current physical pain using the Brief Pain Inventory. Participants also completed measures of psychiatric distress (Brief Symptom Inventory-18) and alexithymia (Toronto Alexithymia Scale-20).Results: The three most commonly reported pain locations were lower back, head, and neck. Findings revealed that anxiety, depression and alexithymia were associated with number of reported pain locations. Specifically, participants with three or more pain locations reported significantly higher depression, anxiety and alexithymia in comparison to those with no pain.Conclusions: Back, head and neck pains are highly prevalent among psychiatric outpatients. Multiple pain sites may reflect higher levels of psychiatric distress and greater impairment in emotional processing among psychiatric outpatients.

The relation between patient characteristics and their carers' use of a directive versus collaborative support stance.

OBJECTIVES: Collaborative support provided by carers (family and friends) of individuals with eating disorders has been shown to be integral to patient motivation and clinical outcome. Little is known about factors that contribute to carers' use of collaborative, as opposed to directive, support stance. This exploratory research investigated associations between patient characteristics and carers' support beliefs and behaviors. METHOD: Eating disorder patients (n = 72) completed measures of readiness for change, eating disorder, and psychiatric symptom severity, and interpersonal functioning. Their carers (n = 72) completed measures of collaborative and directive support. RESULTS: Patient demographic variables, readiness for change, and psychiatric symptom severity were not associated with carer beliefs or behaviors. However, some patient interpersonal functioning scores were; higher Domineering/Controlling scores were associated with carers viewing directive support as more helpful, and with their use of more directive support behaviors. Higher Vindictive/Self-Centered and Intrusive/Needy scores in patients were also associated with carers viewing directive support as more helpful. DISCUSSION: This exploratory study suggests that carers may be more prone to utilizing a directive, rather than a collaborative, support stance with patients experiencing higher levels of threat, anger, and hostility, and lower levels of safety, closeness, and trust.

Social support satisfaction in adults with eating disorders: Does stance matter?

Although the role of social support is clearly established in the recovery of youth with eating disorders, little is known about factors that contribute to support satisfaction and improved treatment outcome in adults. This study examined the contribution of patient factors and perceived support stance used by family and friends in determining social support satisfaction. Individuals meeting DSM-IV criteria for an eating disorder (n = 182) completed measures of eating disorder and psychiatric severity, interpersonal functioning, perceived support stance used by family and friends, and social support satisfaction. Correlations indicated that both patient factors (lower psychiatric distress and fewer interpersonal difficulties) and perceived support stance (higher concerned and lower directive support) were associated with patient support satisfaction. Multiple regression analyses indicated that perceived support stance accounted for greater variance in social support satisfaction than did patient factors. Patient age was associated with differences in preferred support stance: expressions of caring were most critical for younger patients, whereas not being criticized or told what to do was most significant for older patients. This research suggests that the stance used when offering support is vital to the care of individuals with eating disorders.

Support stance in carers of adults with eating disorders: Factors associated with collaborative versus directive approaches.

The support provided by family and friends is integral to patient motivation and clinical outcomes across health care populations. However, little is known about factors that promote or interfere with the type of support offered. OBJECTIVE: This research examined factors associated with collaborative versus directive support among carers of adults with eating disorders. METHOD: Participants were mothers, fathers, partners, friends, and siblings (N = 141) of eating disorder patients in hospital or residential treatment. Two methodologies were used to assess directive and collaborative support stance: a questionnaire of support behaviors and coded responses to clinical vignettes. Measures of interpersonal functioning, psychiatric distress, caregiving experience, and closeness with their loved one were also completed. RESULTS: Although carers rated a collaborative stance as more helpful than a directive stance, 60% of responses to the clinical vignettes were directive. Across both methodologies, collaborative support behaviors were associated with beliefs about helpful support and with a less vindictive and cold interpersonal style. Whereas use of a directive support stance was exclusively associated with negative caregiving experiences, collaborative responses were associated with both positive and negative experiences. DISCUSSION: Although the benefits of collaborative support have been well established, this is the first study to examine factors associated with the use of support stance. Findings suggest a number of ways to help carers create and maintain collaborative relationships, including addressing beliefs and interpersonal style and capitalizing on both positive and negative experiences with their loved one. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:498-505).

Examining the Utility of a Telehealth Warm Handoff in Integrated Primary Care for Improving Patient Engagement in Mental Health Treatment: Randomized Video Vignette Study.

BACKGROUND: A warm handoff from a physician to a mental health provider is often patients' first contact with psychological services and provides a unique opportunity for improving treatment engagement in integrated primary care (IPC) settings. OBJECTIVE: In light of the COVID-19 pandemic, this study sought to examine the impact of different types of telehealth mental health referrals on both the anticipated likelihood of accepting treatment services and anticipated likelihood of continued treatment engagement. METHODS: A convenience sample of young adults (N=560) was randomized to view 1 of 3 video vignettes: warm handoff in IPC, referral as usual (RAU) in IPC, or RAU in standard primary care. RESULTS: Logistic associations between referral type and the likelihood of referral acceptance (χ21=10.9, P=.004) and the likelihood of continued engagement (χ21=32.6, P<.001) were significant. Participants who received a warm handoff were significantly more likely to anticipate both accepting the referral (b=0.35; P=.002; odds ratio 1.42, 95% CI 1.15-1.77) and engaging in continued treatment (b=0.62; P<.001; odds ratio 1.87, 95% CI 1.49-2.34) compared with those who received RAU in the standard primary care condition. Furthermore, 77.9% (436/560) of the sample indicated that they would be at least somewhat likely to access IPC mental health services for their own mental health concerns if they were readily available in their own primary care physician's office. CONCLUSIONS: A telehealth warm handoff resulted in the increased anticipated likelihood of both initial and continued engagement in mental health treatment. A telehealth warm handoff may have utility in fostering the uptake of mental health treatment. Nonetheless, a longitudinal assessment in a primary care clinic of the utility of a warm handoff for fostering referral acceptance and continued treatment engagement is needed to hone the adoptability of a warm handoff process and demonstrate practical evidence of effectiveness. The optimization of a warm handoff would also benefit from additional studies examining patient and provider perspectives about the factors affecting treatment engagement in IPC settings.

Self-compassion and its barriers: predicting outcomes from inpatient and residential eating disorders treatment.

BACKGROUND: Individuals with eating disorders (EDs) experience barriers to self-compassion, with two recently identified in this population: Meeting Standards, or concerns that self-compassion would result in showing flaws or lead to loss of achievements or relationships, and Emotional Vulnerability, or concerns that self-compassion would elicit difficult emotions such as grief or anger. This exploratory study examined the utility of self-compassion and two barriers to self-compassion in predicting clinical outcomes in intensive ED treatments. METHOD: Individuals in inpatient (n = 87) and residential (n = 68) treatment completed measures of self-compassion and fears of self-compassion, and ten clinical outcome variables at pre- and post-treatment. RESULTS: Pre-treatment self-compassion was generally not associated with outcomes, whereas pre-treatment self-compassion barriers generally were. In both treatment settings, fewer Emotional Vulnerability barriers were associated with improved interpersonal/affective functioning and quality of life, and fewer Meeting Standards barriers were associated with improved readiness and motivation. Interestingly, whereas Meeting Standards barriers were associated with less ED symptom improvement in inpatient treatment, Emotional Vulnerability barriers were associated with less ED symptom improvement in residential treatment. CONCLUSIONS: Given that few longitudinal predictors of outcome have been established, the finding that pre-treatment barriers to self-compassion predict outcomes in both inpatient and residential settings is noteworthy. Targeting self-compassion barriers early in treatment may be helpful in facilitating ED recovery.

Self-compassion is associated with a number of positive health indicators and has been shown to support recovery from an eating disorder. This exploratory study examined whether self-compassion and barriers to self-compassion predict clinical outcomes in inpatient and residential eating disorders treatment settings. Whereas self-compassion was rarely associated with outcome, self-compassion barriers were associated with the majority of variables investigated. Given that few longitudinal predictors have been established in this field, the relation between barriers to self-compassion and outcome in both inpatient and residential settings is noteworthy. Targeting self-compassion barriers early in treatment may be helpful in facilitating eating disorder recovery.

Barriers to self-compassion in the eating disorders: The factor structure of the fear of self-compassion scale.

Individuals with eating disorders (EDs) endorse fears of being self-compassionate, as assessed by the Fears of Compassion for Self scale (FCSelf; Gilbert, McEwan, Matos, & Rivis, 2011), and higher fears predict poorer treatment outcomes. Previous research using the FCSelf demonstrated a single factor solution in a non-clinical sample. OBJECTIVES: This research sought to explore the factor structure of the FCSelf in a clinical population and to examine correlations with associated constructs. The factor structure obtained was compared with its structure in a student sample. METHODS: Individuals with EDs (n = 251) completed the FCSelf, and measures of readiness to change, self-compassion, quality of life, as well as psychiatric and ED symptom severity. A female student sample (n = 314) completed the FCSelf. RESULTS: In the clinical sample a two-factor solution exhibited best fit. Factor 1, labeled "Meeting Standards," contained items expressing concern about showing flaws and losing achievements and relationships. Factor 2, labeled "Emotional Vulnerability," contained items focusing on difficult emotions such as grief, unworthiness, and vulnerability. The two subscales exhibited acceptable internal consistencies and were significantly correlated with clinical outcome variables. In the student sample, the two factor model was superior to a single factor model but given that the latent correlation was so high (r = 0.89) a single summary score is recommended. CONCLUSION: Future research is needed to determine the value of addressing barriers related to meeting standards versus emotional vulnerability in helping individuals with EDs develop self-compassion and recover from their illness.

The Short Treatment Allocation Tool for Eating Disorders: current practices in assigning patients to level of care.

OBJECTIVE: The Short Treatment Allocation Tool for Eating Disorders (STATED) is a new evidence-based algorithm developed to match patients to the most clinically appropriate and cost-effective level of care (Geller et al., 2016). The objective of this research was to examine the extent to which current practices are in alignment with STATED recommendations. METHOD: Participants were 179 healthcare professionals providing care for youth and/or adults with eating disorders. They completed an online survey and rated the extent to which three patient dimensions (medical stability, symptom severity, and readiness) were used in assigning patients to each of five levels of care. RESULTS: The majority of analyses testing a priori hypotheses based on the STATED were statistically significant (all p's < .001), in the direction of STATED recommendations. However, a strict coding scheme evaluating the extent to which ratings were fully consistent with the STATED showed inconsistency rates ranging from 17 to 55% across the five levels of care, with the greatest inconsistencies involving the use of readiness information, and the lowest involving the use of medical stability information. DISCUSSION: Although practices were generally aligned with the STATED recommendations, readiness information was used least consistently in assigning patients to level of care.

Development of self-report scales measuring collaborative vs. directive support: Assessing beliefs and behaviors in carers of adults with eating disorders.

Collaboration is more acceptable and likely to produce favorable outcomes when providing care to individuals with eating disorders compared to directive care. We developed two self-report instruments that assess the extent to which carers (e.g., family, friends) of individuals with eating disorders provide collaborative vs. directive support (Support Behaviors Scale; SBH) and the extent to which carers believe that such approaches are helpful (Support Beliefs Scale; SBL). Participants were mothers, fathers, partners, friends and siblings (N=141) of eating disorder patients in hospital or residential treatment. Confirmatory factor analyses were used to test measurement models comprising collaborative and directive approaches identified in previous research. A 19-item three-factor model exhibited best fit for each scale and included three distinct caregiving approaches: two that were collaborative (encouraging, concerned), and one that was directive. The scales exhibited acceptable internal consistency. Reported caregiving behaviors (SBH) were correlated with beliefs about caregiving (SBL). The scales can be used to assess caregiving stance and outcomes for interventions aimed at promoting collaboration in carers.