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OBJECTIVE: This study examines the factorial structure and psychometric properties of the Eating Disorder-15 questionnaire (ED-15) in a large clinical sample, as well as the instrument's sensitivity to early clinical change in therapy and ability to measure remission. METHOD: Participants with eating disorders (N = 278) referred to the Flinders University Services for Eating Disorders in South Australia completed the ED-15 as well as other measures of eating disorder symptoms and co-occurring psychopathology, including depression, anxiety, and stress. RESULTS: Confirmatory factor analysis (CFA) revealed a two-factor model for the ED-15. The ED-15 had good internal consistency. It showed satisfactory concurrent validity with moderate correlations with the EDE-Q global score and contribution of unique variance to that score. Correlations indicated good convergent validity with clinical impairment and good divergent validity from depression, anxiety, and stress. The ED-15 showed a significant medium effect size change within the first four sessions of therapy. Good discriminant validity was indicated by cut-off scores used for remission, with significantly different levels of ED psychopathology and other impairments between the two groups. DISCUSSION: This study adds to the four previous psychometric studies of the ED-15, confirming robustness of the English version in a clinical sample. The brevity and psychometric robustness of the ED-15 makes it a preferable measure to the Eating Disorder Examination for sessional assessment of progress in treatment.
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PURPOSE OF REVIEW: The purpose of this systematic review and meta-analysis was to examine the use and efficacy of acute augmentation therapies in eating disorders. RECENT FINDINGS: A meta-analysis addressing this topic across psychological disorders found augmentation significantly improved therapy outcome with strongest findings for augmentations targeting biological mechanisms; however, only one study examined eating disorders. Our systematic review identified 29 studies examining people with eating disorders (N = 1831 participants, 93.7% female), of which 17 RCTs (n = 1162 participants) were included in the meta-analysis. Small subgroups of acute augmentations were identified. Adding acute augmentations to an intervention was effective in 72.4% of studies, with a significant effect on eating disorder outcomes (Hedges' g = 0.14, 95% CI: [0.02, 0.26]). Acute augmentation looks to be a promising approach regardless of weight status or whether it is added to treatment as usual or a single therapy approach.
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Objectives: To explore the relationships between age, gender, type of sport, perfectionistic self-presentation and motivation on body satisfaction among young athletes in one aesthetic sport (gymnastics) and one non-aesthetic sport (basketball). The study hypothesise that (1) age, gender and type of sport (aesthetic or non-aesthetic) will predict body satisfaction scores, (2) autonomous motivation will positively be related to body satisfaction and (3) perfectionistic self-presentation will negatively be related to body satisfaction. Design: Cross-sectional. Method: 209 athletes (132 gymnasts and 77 basketball players) aged 10-22 (median=13) years were recruited. After data screening, 200 athletes were included in analyses (females: n=155; males: n=45). Participants completed an online survey, which assessed demographic information, athlete motivation (Behavioural Regulation in Sport Questionnaire), perfectionistic self-presentation (Perfectionistic Self-Presentation Scale-Junior Form) and body satisfaction (Body Appreciation Scale-2). Results: Hierarchical multiple regression showed age, self-assigned gender, and two facets of perfectionistic self-presentation (ie, perfectionistic presentation and non-disclosure of imperfection) to predict reported levels of body satisfaction significantly. Subsequently, adding motivational variables did not improve the model. A moderation analysis showed that the relationship between non-disclosure of imperfection and body satisfaction was significantly moderated by gender. Conclusions: Two facets of perfectionistic self-presentation were associated with reported body satisfaction. Additionally, the relationship between non-disclosure of imperfection and body satisfaction appears to differ between female and male athletes. Researchers should move beyond sport types and identify factors (eg, perfectionistic self-presentation) at the individual and environmental levels that can protect young athletes' body satisfaction.
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Objective: This systematic review sought to understand the effectiveness of lived experience mentoring, by people recovered from an eating disorder, with clinical samples currently receiving eating disorder treatment. Methods: The systematic review was conducted using PsycINFO, MEDLINE, Scopus, and ProQuest Dissertations and Theses Global and reviewing reference lists of included papers. Articles were included if they: (1) were intervention studies that included peer (recovered from an eating disorder) involvement, (2) delivered the intervention to clinical samples (or carers with direct involvement in treatment), (3) were in English, and (4) included quantitative results. Results: Eleven studies were included across randomized control trials (RCTs), case series, and a case study; there was variation in quality. Findings varied considerably with some concluding that lived experience mentoring led to significant improvements for mentees, while other studies found no significant differences. Mentor outcomes were often not evaluated. Of those that did assess mentors, there is preliminary evidence for some benefits to participation but also the potential for harm. Discussion: There is a need for further research in this area using high-quality RCTs that address the risk of bias. It is important that lived experience peer mentors are monitored on key outcomes, provided with adequate training and ongoing supervision, and are reimbursed for their involvement. Public Significance: This systematic review is the first review to focus on the use of peer mentors recovered from an eating disorder contributing to interventions for people receiving treatment for an eating disorder. All included studies present quantitative results. Given the emerging interest of lived experience mentoring, understanding its effectiveness for both mentees and impacts on mentors continues to be of critical importance. Resumen. Objetivo: Esta revisión sistemática buscó comprender la efectividad de la consejería de la experiencia vivida por parte de personas recuperadas de un trastorno de la conducta alimentaria, con muestras clínicas que actualmente reciben tratamiento para el trastorno alimentario. Método: La revisión sistemática se realizó utilizando PsycINFO, MEDLINE, Scopus y ProQuest Dissertations, and Theses Global y revisando las listas de referencias de los artículos incluidos. Los artículos se incluyeron si: (1) eran estudios de intervención que incluían la participación de pares (recuperados de un trastorno de la conducta alimentaria), (2) administraban la intervención a muestras clínicas (o cuidadores con participación directa en el tratamiento), (3) estaban en inglés y (4) incluían resultados cuantitativos. Resultados: Se incluyeron once estudios en ensayos controlados aleatorios (ECA), series de casos y un estudio de caso; hubo variación en la calidad. Los hallazgos variaron considerablemente y algunos concluyeron que la consejería de la experiencia vivida condujo a mejoras significativas para los aprendices, mientras que otros estudios no encontraron diferencias significativas. Los resultados del mentor a menudo no se evaluaron. De los que evaluaron a los mentores, hay evidencia preliminar de algunos beneficios de la participación, pero también del potencial de daño. Discusión: Se necesitan estudios de investigación adicionales en esta área que utilicen ECA de alta calidad que aborden el riesgo de sesgo. Es importante que los mentores de pares de la experiencia vivida sean monitoreados en los resultados clave, provistos de capacitación adecuada y supervisión continua, y sean remunerados por su participación.Reprinted from Int J Eat Disord 2023; 56:331-349, with permission from Wiley. Copyright © 2023.
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Higher Education Institutes (HEIs) have been met with an unprecedented demand on their student counselling and wellbeing services in recent years with the impacts of COVID-19 and high rates of mental health concerns amongst student populations. Online mental health programs offer one solution by providing students with quick and easy access to effective therapeutic content. The Focused Minds Program is an evidence-based eight-module online self-guided cognitive behavioural intervention that targets the transdiagnostic risk factor of perfectionism and has been shown to decrease depression, anxiety, and disordered eating. The program was implemented at a UK university between 2021 and 2023. Recruitment occurred via departmental emails, academic staff, and the university's counselling staff and website. Participants were provided with access to the intervention for 6-weeks and completed weekly surveys of psychosocial measures. The trial's implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework: reach (uptake via the recruitment channels), effectiveness (outcomes on psychometric measures of mental wellbeing), adoption (staff and organisational support), implementation (intervention engagement and attrition), and maintenance (continued implementation across the trial period). Key barriers to successful implementation, as well as proposed solutions, are discussed to guide future online mental health interventions provided in HEIs.
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Guided self-help is an evidence-based intervention used globally. Self-help is a fundamental part of the stepped care model of mental health services that enables the efficient use of limited resources. Despite its importance, there is little information defining the role of the guide and the key competences required. In this context, the guide is defined as the person who facilitates and supports the use self-help materials. This article sets out the role of the guide in guided self-help. It considers practical issues such as the importance of engagement to motivate clients for early change, personalising the intervention, structuring sessions, how best to use routine outcome monitoring and supervision requirements. Key competences are proposed, including generic competences to build the relationship as well as specific competences such as being able to clearly convey the role of the guide to clients. Guides should be prepared for "self-help drift", a concept akin to therapist drift in more traditional therapies. Knowing how to identify mental health problems, use supervision and manage risk and comorbidity are all key requirements for guides. The paper concludes by calling for increased recognition and value of the role of the guide within mental health services.
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Mental Disorders , Self Care , Humans , Mental Disorders/therapy , Mental Health Services/standards , Evidence-Based Practice , Practice Guidelines as TopicABSTRACT
People with eating disorders are often placed on lengthy waitlists for treatment. This is problematic, as increased time spent on waitlists has been shown to predict dropout. We examined whether providing brief interventions to people on a waitlist improved retention or outcomes in treatment. Participants (N = 85) were referred to a university training clinic for 10-session cognitive behavioural therapy for non-underweight patients with eating disorders (CBT-T). While waitlisted for CBT-T, participants were randomised to one of two waitlist interventions or a control condition. In one waitlist intervention (CRT-Brief), participants received a cognitive remediation therapy session at the start of the waitlist period. In the other waitlist intervention (brief contact), participants were sent a short supportive email and psychoeducation halfway through the waitlist period. The control condition was waitlist as usual. There was no evidence to suggest that the waitlist interventions improved symptoms during the waitlist period or CBT-T. However, participants who received a waitlist intervention were three times more likely to complete treatment. The present study suggests that providing even brief contact while people are waitlisted for eating disorder treatment significantly improves retention. However, replication in a more adequately powered study is required.
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Less help-seeking for an eating disorder is predicted by higher levels of denial of, and failure to perceive, illness severity. This research evaluates a "backdoor" approach to early intervention by investigating whether internet cognitive behaviour therapy for perfectionism can significantly improve disordered eating. Additionally, we investigated whether a more interactive intervention impacted outcomes. Participants were recruited worldwide online; 368 were screened, 172 (46.7%) met inclusion criteria (endorsed high shape, weight, or eating concerns) and randomised to an interactive (Focused Minds Program; FMP) or static PDF intervention (Centre for Clinical Intervention; CCI-P) or waitlisted (control condition). Participants completed assessments on disordered eating, perfectionism, and a range of secondary variables at the end of treatment, and 1- and 3-month follow-up. Intent-to-treat analyses indicated that, compared to control, FMP resulted in significantly lower levels of disordered eating at each assessment and CCI-P at the 1- and 3-month follow-up (respective 3-month follow-up between group effect sizes of 0.78 and 0.54). There were no significant differences between the two active interventions on any measure except depression and hated self. Results suggest an alternative approach to directly tackling disordered eating that is low-cost is effective, with a more interactive intervention producing a more rapid effect.Trials Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621001448831.
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Cognitive Behavioral Therapy , Feeding and Eating Disorders , Internet-Based Intervention , Perfectionism , Humans , Australia , Cognitive Behavioral Therapy/methods , Feeding and Eating Disorders/therapy , InternetABSTRACT
OBJECTIVE: Future treatments for eating disorders (ED) need to be enhanced by targeting maintaining mechanisms. Literature suggests self-criticism and self-critical perfectionism act as key mechanisms exacerbating ED, and self-compassion protects against self-criticism. This meta-analysis examines associations between self-criticism and self-critical perfectionism on disordered eating (DE), and reviews how self-compassion and self-criticism relate to each other with respect to DE. METHOD: Searches across three databases yielded 135 studies across 42,952 participants. Heterogeneity, publication bias, and quality assessments were analyzed. Moderation analyses between self-criticism measures, self-compassion measures, between clinical and nonclinical samples, and between cross-sectional and experimental studies were also conducted. RESULTS: Random-effects models showed a medium positive link between self-criticism and DE (r = .37), and 10 subgroups pertaining to various measures of self-criticism utilized in literature showed small to large positive links with DE (r = .20-.52). Preliminary evidence also suggests negative relationships between self-compassion and DE (r = -.40 to -.43) and negative relationships between self-compassion and self-criticism (r = -.04 to -.88). DISCUSSION: Greater levels of self-criticism is linked with greater levels of DE and reduced levels of self-compassion, suggesting a need to tackle self-criticism and nurture self-compassion in standard treatments for ED. Understanding these interactions better in conjunction with dismantling intervention studies can help develop more effective and efficient interventions targeting self-criticism and self-compassion for people with DE. PUBLIC SIGNIFICANCE STATEMENT: Higher levels of self-criticism are linked with higher levels of DE and lower self-compassion. Self-compassion interventions could be more effective and efficient in reducing ED symptoms if self-criticism is tackled early in such treatments.
OBJETIVO: Los futuros tratamientos para los trastornos de la conducta alimentaria (TCA) deben ser mejorados mediante la focalización en los mecanismos de mantenimiento. La literatura sugiere que la autocrítica y el perfeccionismo autocrítico actúan como mecanismos clave que exacerban los TCA, y que la autocompasión protege contra la autocrítica. Este meta-análisis examina las asociaciones entre la autocrítica y el perfeccionismo autocrítico en la alimentación disfuncional (AD), y revisa cómo la autocompasión y la autocrítica se relacionan entre sí con respecto a la AD. MÉTODO: Las búsquedas en tres bases de datos arrojaron 135 estudios con 42,952 participantes. Se analizaron la heterogeneidad, el sesgo de publicación y las evaluaciones de calidad. También se llevaron a cabo análisis de moderación entre las medidas de autocrítica, las medidas de autocompasión, entre muestras clínicas y no clínicas, y entre estudios transversales y experimentales. RESULTADOS: Los modelos de efectos aleatorios mostraron una asociación positiva media entre la autocrítica y la AD (r = .37), y 10 subgrupos relacionados con diversas medidas de autocrítica utilizadas en la literatura mostraron asociaciones positivas pequeñas a grandes con la AD (r = .20-.52). Además, evidencia preliminar sugiere relaciones negativas entre la autocompasión y la AD (r = −0.40-−0.43) y relaciones negativas entre la autocompasión y la autocrítica (r = −.04-−.88). DISCUSIÓN: Los niveles mayores de autocrítica están relacionados con mayores niveles de AD y niveles reducidos de autocompasión, lo que sugiere la necesidad de abordar la autocrítica y fomentar la autocompasión en los tratamientos estándar para los TCA. Comprender mejor estas interacciones en conjunto con estudios de intervención puede ayudar a desarrollar intervenciones más efectivas y eficientes dirigidas a la autocrítica y la autocompasión para personas con AD.
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Feeding and Eating Disorders , Self-Assessment , Humans , Self-Compassion , Cross-Sectional Studies , Empathy , Feeding and Eating Disorders/therapyABSTRACT
Perfectionism is a transdiagnostic process associated with a range of psychological disorders. Cognitive Behaviour Therapy for Perfectionism (CBT-P) has been demonstrated as efficacious across guided and unguided internet delivered interventions in reducing perfectionism and psychopathology. The aim of this pilot study was to understand perceptions and acceptability of an artificial intelligence supplemented CBT-P intervention (AI-CBT-P) in young people with lived experience of anxiety and depression (n = 8; age range 19-29 years, M = 24 years, SD = 3.77; 50 % female, 38 % male, 12 % non-binary). Young people reported that they were frequent users of artificial intelligence for study, work and general information, were positive about the intervention and using artificial intelligence for guidance in a self-help intervention, but also noted several concerns. Young people perceived numerous benefits to AI-CBT-P, including ease of access, low cost, lack of stigma and benefits for individuals with social anxiety. Overall, young people appear to be interested in, and have a positive view of, AI-CBT-P. Further research is now required to examine the feasibility and acceptability of the intervention.
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AIM: Only one in four individuals with eating disorders (EDs) seek help, with many barriers to treatment-seeking present. Placing an early intervention model in primary mental health care settings is one approach to reducing these barriers. To date, only one model (emerge-ED) has been evaluated in the literature. METHODS: We aimed to replicate findings from the initial emerge-ED evaluation. We report on treatment outcomes in a new cohort and their views on barriers to treatment-seeking. We then examine how this early intervention model in primary health care has evolved to overcome the barriers to treatment delivery cited by health professionals in the initial evaluation. RESULTS: Eighty participants commenced treatment between July 2020 and March 2022 and completed a mean of 8.98 sessions, 70 (87.5%) completed >1 sessional measure on ED cognitions and behaviours, but only 31% (n = 24) completed lengthier assessments. Findings replicated initial emerge-ED outcomes, with small to moderate effect size decreases in the ED sessional measure at 70 days since treatment commencement for cognitions (d = .63) and ED behaviours (d = .09., .69). The most cited barrier by participants was "belief that my problem is not bad enough", reflective of denial of illness. Lastly, to overcome barriers to treatment delivery clinicians had to deviate from treatment protocols and work collaboratively with other healthcare providers. CONCLUSIONS: Our findings replicated the initial emerge-ED evaluation and highlight the importance of considering primary health care settings as an essential site in delivering early intervention services for EDs.
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OBJECTIVE: Atypical anorexia nervosa (AN) is a serious eating disorder that is more common in the population than AN. Despite this, people with atypical AN are less likely to be referred or admitted for eating disorder treatment and there is evidence that they are less likely to complete or benefit from existing interventions. This study examined whether baseline readiness and/or confidence moderated outcomes from 10-session cognitive behavioral therapy among people with atypical AN and bulimia nervosa (BN), and whether the impact of these variables differed between diagnoses. METHODS: Participants (n = 67; 33 with atypical AN) were a subset from an outpatient treatment study. Linear mixed model analyses were conducted to examine whether baseline readiness and/or confidence moderated outcomes. RESULTS: People with BN who had higher levels of readiness or confidence at baseline had steeper decreases in eating disorder psychopathology over time. There was no evidence that readiness or confidence moderated outcomes for people with atypical AN. DISCUSSION: This study suggests that the moderators that have been identified for other eating disorders may not apply for people with atypical AN and highlights a need for future work to routinely investigate whether theoretically or empirically driven variables moderate outcomes in this little-understood population. PUBLIC SIGNIFICANCE STATEMENT: People with bulimia nervosa with higher readiness and confidence experienced greater decreases in eating disorder symptoms than people with lower readiness and confidence when treated with cognitive behavioral therapy. These findings did not apply to people with atypical anorexia nervosa. Results demonstrate that future work is urgently required to identify helpful treatments for people with atypical anorexia nervosa as well as the variables that have a positive impact on outcomes in treatment for these individuals.
Subject(s)
Anorexia Nervosa , Bulimia Nervosa , Cognitive Behavioral Therapy , Feeding and Eating Disorders , Humans , Bulimia Nervosa/psychology , Anorexia Nervosa/psychology , Hospitalization , Ambulatory CareABSTRACT
Evidence-based cognitive-behaviour therapy for eating disorders (CBT-ED) differs from other forms of CBT for psychological disorders, making existing generic CBT measures of therapist competence inadequate for evaluating CBT-ED. This study developed and piloted the reliability of a novel measure of therapist competence in this domain-the Cognitive Behaviour Therapy Scale for Eating Disorders (CBTS-ED). Initially, a team of CBT-ED experts developed a 26-item measure, with general (i.e. present in every session) and specific (context- or case-dependent) items. To determine statistical properties of the measure, nine CBT-ED experts and eight non-experts independently observed six role-played mock CBT-ED therapy sessions, rating the therapists' performance using the CBTS-ED. The inter-item consistency (Cronbach's alpha and McDonald's omega) and inter-rater reliability (ICC) were assessed, as appropriate to the clustering of the items. The CBTS-ED demonstrated good internal consistency and moderate/good inter-rater reliability for the general items, at least comparable to existing generic CBT scales in other domains. An updated version is proposed, where five of the 16 "specific" items are reallocated to the general group. These preliminary results suggest that the CBTS-ED can be used effectively across both expert and non-expert raters, though less experienced raters might benefit from additional training in its use.
Subject(s)
Cognitive Behavioral Therapy , Feeding and Eating Disorders , Humans , Reproducibility of Results , Cognitive Behavioral Therapy/methods , Clinical Competence , Feeding and Eating Disorders/therapyABSTRACT
Eating disorders (EDs) are complex conditions with one of the highest mortality rates among psychiatric illnesses. While outpatient evidence-based treatments for EDs in adults exist, there is often utilisation of more intensive interventions as part of treatment. However, a comprehensive analysis of the impacts of intensive treatment (inpatient, residential and day program) on physical and psychosocial outcomes is lacking. Thus, the current systematic review and meta-analysis aimed to investigate the effectiveness of intensive treatments in adults with EDs for the outcomes of body mass index (BMI), disordered eating, depression, and quality of life, as well as a moderation analysis investigating a range of clinical characteristics. Overall, 62 studies were included in the meta-analysis. The results revealed that intensive treatment in adults yielded significant improvements in BMI (for underweight patients), disordered eating, depression, and quality of life. Treatment setting, length of stay and geographical region of the study all served as moderators for disordered eating and depression. Nevertheless, given the high heterogeneity in the meta- and moderation analyses, these results should be interpreted with caution. Future high-quality research is needed to determine the most beneficial elements of intensive treatment (compared to outpatient) in adults with EDs.
Subject(s)
Feeding and Eating Disorders , Quality of Life , Humans , Adult , Feeding and Eating Disorders/therapyABSTRACT
BACKGROUND: Perfectionism is significantly associated with symptoms of eating disorders in adolescents. Studies to date have not examined parent-supported CBT for perfectionism in eating disorders (CBT-P-ED). We co-designed the treatment and conducted a feasibility trial. METHODS: Eight parents of adolescents with eating disorders (M age = 48.75 years, 100% female) engaged in three co-design workshops to create a parent-supported CBT-P-ED self-help intervention. A further 10 parents (M age 41.8 years, 50% female) and their adolescent offspring (n = 10, M age 15.4 years, 60% female, 50% with self-reported diagnosis of anorexia nervosa) participated in a feasibility trial and provided feedback on the intervention. RESULTS: The parents who engaged in the co-design workshops suggested several areas to optimise the perfectionism intervention, including using plain language, the impact of parental perfectionism, how to engage with their adolescent in treatment and the importance of increasing eating disorder specific material. Feedback from the feasibility trial suggested that the intervention was acceptable and feasible with 100% of parents and adolescents saying it was useful, and no attrition. CONCLUSIONS: Parent-supported CBT-P-ED appears to be feasible. Future research is now required in a randomised controlled trial.
It has been repeatedly demonstrated that perfectionism can contribute to a variety of health issues. Perfectionism is a process centered on intense self-pressure to meet high standards, which has a significant impact on how an individual views themselves. Perfectionism is more prevalent in individuals with eating disorders than in those without it. There is a strong link between perfectionism and the onset of eating disorders, as well as an increase in disordered eating symptoms and a lower rate of recovery. There is currently no treatment available that addresses perfectionism in both parents and young people. The aim of the project was to work with parents and carers to co-design a parent-supported self-help program for young people that addresses perfectionism in eating disorders. We conducted three co-design workshops, followed by a four-week feasibility study to determine suitability and feedback on the intervention. The goal was to develop an intervention which can offer caregivers and young people easily available support that may aid in their understanding of perfectionism. It is hoped that by addressing perfectionism in young people with eating disorders, this approach will help them recover and thrive.
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The aim of this study was to provide a definition for body neutrality and understand the key strategies recommended to improve body neutrality for testing in future interventions. There is minimal academic literature on body neutrality and thus this study focused on examining websites where the concept has been discussed for some time. This was achieved using a realist synthesis of websites and a common elements approach to extract the key definition elements of body neutrality, strategies to improve body neutrality, in addition to the common critiques of both the body positivity and body neutrality movements. The initial search found 175 websites, of which 107 were included in the final synthesis, and common elements analysis followed after removal of duplicates and ineligible websites. Three elements, with several sub-elements, best operationalised the definition of body neutrality. Six strategies were found for development of a body neutrality intervention. This innovative study paves the way for rigorous evaluation of body neutrality. Recommendations for future work are provided, including the use of current measures, creating a new measure, and evaluating prevention and intervention programs including Single Session Interventions (SSIs).
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Behavior Therapy , Body Image , Humans , Body Image/psychologyABSTRACT
OBJECTIVE: While co-occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. METHOD: The literature on managing mental health conditions that co-occur with eating disorders is outlined and reviewed. RESULTS: In the absence of clear evidence to inform managing co-occurring mental health conditions, we advocate for use of an iterative, session-by-session measurement to guide practice and research. We identify three data-driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co-occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four-step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. DISCUSSION: Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co-occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co-occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co-occurring conditions; (5) detailed specification on how to determine which adjuncts to add. PUBLIC SIGNIFICANCE: Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence-based techniques. This paper outlines data-driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested.
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OBJECTIVE: This pilot study investigated the feasibility and preliminary efficacy of the metacognitive training for eating disorders (MCT-ED) program in adolescents with anorexia nervosa (AN). We report attrition and subjective evaluation as well as changes to cognitive flexibility, perfectionism and eating disorder pathology relative to waitlist controls. METHOD: Female (n = 35, aged 13-17 years) outpatients with a diagnosis of AN (n = 20) or atypical AN (n = 15) completed baseline measures of cognitive flexibility, perfectionism, and eating disorder pathology (May 2020-May 2022). Participants were randomly allocated to either treatment-as-usual (TAU) plus MCT-ED or TAU waitlist condition. All participants completed post-intervention and 3-month follow-up questionnaires. RESULTS: The MCT-ED condition had a treatment attrition rate <15%. Participants provided positive evaluation of the program. There were large between groups differences favoring MCT-ED at post-intervention and 3-month follow-up for concern over mistakes perfectionism (respective ds = -1.25, 95% CI [-2.06, -.45]; -.83, 95% CI [-1.60, .06]) with a significant group difference post-intervention but not 3-month follow-up. DISCUSSION: Findings provide tentative support for the feasibility of MCT-ED as an adjunct intervention for young people with AN, however replication is needed with a larger sample size to further explore its efficacy. PUBLIC SIGNIFICANCE: Metacognitive training for eating disorders (MCT-ED) is a feasible adjunct intervention for adolescents with anorexia nervosa. The intervention, which targets thinking styles and is delivered online by a therapist, received positive feedback, had high treatment retention, and led to reductions in perfectionism by the end of treatment compared to wait-list controls. Although these gains were not sustained long-term, the program is suitable adjunct intervention for young people with eating disorders.
Subject(s)
Anorexia Nervosa , Metacognition , Humans , Female , Adolescent , Anorexia Nervosa/therapy , Pilot Projects , Feasibility Studies , OutpatientsABSTRACT
PURPOSE: There is limited research exploring the usefulness of generic preference-based quality of life (GPQoL) measures used to facilitate economic evaluation in the context of posttraumatic stress disorder (PTSD). The aim of the current study was to explore the validity and responsiveness of a common GPQoL measure (Assessment of Quality of Life 8 Dimension [AQoL-8D]) in relation to a PTSD condition-specific outcome measure (Posttraumatic Stress Disorder Checklist for the DSM-5 [PCL-5]). METHOD: This aim was investigated in a sample of individuals (N = 147) who received trauma-focused cognitive-behavioural therapies for posttraumatic stress disorder. Convergent validity was investigated using spearman's correlations, and the level of agreement was investigated using Bland-Altman plots. Responsiveness was investigated by exploring the standardised response means (SRM) from pre-post-treatment across the two measures, which allow the comparison of the magnitude of change between the measures over time. RESULTS: Correlations between the AQoL-8D (dimensions, utility and summary total scores) and the PCL-5 total score ranged from small to large and agreement between the measures was considered moderate to good. While SRMs were large for the AQoL-8D and PCL-5 total scores, the SRM for the PCL-5 was nearly double that of the AQoL-8D. CONCLUSION: Our findings demonstrate that the AQoL-8D has good construct validity but present preliminary evidence that economic evaluations using only GPQoL measures may not fully capture the effectiveness of PTSD treatments.