[Aggression regulation in eating disorders: evidence for a brief body and movement oriented intervention]. / Agressieregulatie bij eetstoornissen: evidentie voor een kortdurende module psychomotorische therapie1.

BACKGROUND: Individuals with eating disorders tend to internalise their anger and aggression excessively. However, an evidence-based intervention, targeted on this persistent issue, was missing until now. Therefore, a body and movement oriented intervention was developed, which supports patients to reframe and redirect anger and aggression against the destructive influence of the eating disorder.
AIM: To study the effectiveness of the aggression regulation intervention.
METHOD: The intervention was tested in a first randomised controlled trial (RCT) in an outpatient setting and in a two-center RCT in a multidisciplinary day hospital setting. Coping with anger was measured by the Self-Expression and Control Scale (SECS). Eating disorder pathology was measured by the Eating Disorder Examination Questionnaire (EDE-Q).
RESULTS: Both RCTs delivered first evidence for the brief body and movement oriented intervention to reduce excessive anger internalisation in individuals with eating disorders. Moreover, in the outpatient trial the eating disorder pathology was significantly more reduced in the intervention group compared to the control group.
CONCLUSION: There is first evidence for the effectiveness of a body and movement oriented approach of reducing excessive anger internalisation in individuals with eating disorders.

Risk assessment and shared care planning in out-patient forensic psychiatry: cluster randomised controlled trial.

BACKGROUND: Forensic psychiatry aims to reduce recidivism and makes use of risk assessment tools to achieve this goal. Various studies have reported on the predictive qualities of these instruments, but it remains unclear whether their use is associated with actual prevention of recidivism in clinical care. AIMS: To test whether an intervention combining risk assessment and shared care planning is associated with a reduction in violent and criminal behaviour. METHOD: A cluster randomised controlled trial (Netherlands Trial Register number NTR1042) was conducted in three out-patient forensic psychiatric clinics. The intervention comprised risk assessment with the Short Term Assessment of Risk and Treatability (START) and a shared care planning protocol formulated according to shared decision-making principles. The control group received usual care. The outcome consisted of the proportion of clients with violent or criminal incidents at follow-up. RESULTS: In total 58 case managers and 632 of their clients were included. In the intervention group (n = 310), 65% received the intervention at least once. Findings showed a general treatment effect (22% of clients with an incident at baseline v. 15% at follow-up, P<0.01) but no significant difference between the two treatment conditions (odds ratio (OR) = 1.46, 95% CI 0.89-2.44, P = 0.15). CONCLUSIONS: Although risk assessment is common practice in forensic psychiatry, our results indicate that the primary goal of preventing recidivism was not reached through risk assessment embedded in shared decision-making.