ABSTRACT
The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, ßs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.
Subject(s)
Cognitive Behavioral Therapy/methods , Cooperative Behavior , Feeding and Eating Disorders/therapy , Professional-Patient Relations , Adult , Feeding and Eating Disorders/psychology , Female , Humans , Male , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of this study was to examine the relationship between quality of life (QoL), weight, and eating disorder symptoms across treatment in individuals with severe and enduring anorexia nervosa (SE-AN). METHOD: Participants were 63 adult females with SE-AN presenting to an outpatient, multisite randomized clinical trial. QoL was assessed using three well-validated QoL questionnaire measures, the EDQOL, SF-12, and WSAS. Participants' weight and severity of symptoms was assessed by Eating Disorder Examination (EDE) and weekly BMI change. RESULTS: Predictors of QoL were evaluated in the context of concurrent, prospective,1 and lagged mixed-effects models. Changes in both BMI and EDE were found to significantly affect current and future QoL ratings. DISCUSSION: Findings suggest that improvements in QoL may be dependent on symptom change and weight gain. Treatments seeking solely to improve QoL may be unlikely to produce lasting change and clinicians should maintain a focus on weight and behavioral symptoms as much as on improvements in QoL.
Subject(s)
Anorexia Nervosa , Quality of Life , Adult , Anorexia Nervosa/classification , Anorexia Nervosa/psychology , Anorexia Nervosa/therapy , Body Weight , Female , Humans , Middle Aged , Prospective Studies , Psychotherapy , Severity of Illness Index , Surveys and Questionnaires , Symptom Assessment , Weight Gain , Young AdultABSTRACT
Body dissatisfaction (BD) is central to the development, maintenance and relapse of anorexia nervosa (AN). BD has been conceptualized as a multi-dimensional construct incorporating behaviours, cognitions and affect, yet little is known about the impact of weight and disordered eating on these aspects. 56 'below DSM-IV weight criteria for AN' (
Subject(s)
Anorexia Nervosa/diagnosis , Body Image/psychology , Body Weight , Adolescent , Adult , Anorexia Nervosa/psychology , Anxiety , Body Mass Index , Case-Control Studies , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Surveys and Questionnaires , Thinness/psychology , Young AdultABSTRACT
Recent research has emphasised the importance of therapeutic alliance to treatment outcomes for anorexia nervosa. This study aimed to examine the experiences of service users in developing therapeutic alliance whilst in treatment for their eating disorders. This qualitative study, using purposive sampling, recruited a sample of service users receiving treatment at a national eating disorders service. In-depth interviews were audiotaped and transcribed, with transcriptions being subject to interpretative phenomenological analysis. Participants were eight adult women receiving tertiary level eating disorder treatment in a specialist setting. The text analysis produced four dominant categories: alliance as a key experience; being active, not passive; taboo talking; and first impressions count. The development of therapeutic alliance is a core component of treatment. This study identifies important areas that contribute to the successful cultivation of positive therapeutic alliance.
Subject(s)
Anorexia Nervosa/therapy , Inpatients/psychology , Professional-Patient Relations , Adolescent , Adult , Anorexia Nervosa/psychology , Female , Humans , Psychotherapy , Treatment Outcome , Young AdultABSTRACT
OBJECTIVES: To investigate treatment drop-out by comparing clinical indicators of patients whose discharge was initiated by staff with those who initiated discharge themselves. METHOD: Ninety participants with anorexia completed questionnaires at admission and four weeks into hospitalized treatment. Weight data was collected over this same period. At discharge, participants were categorized into completer (n = 38) or patient-initiated (n = 36) /staff-initiated (n = 16) premature termination groups. RESULTS: Significant differences between staff-initiated and patient-initiated discharge groups were found at admission. Staff initiated groups were on average older (p = .035), and more likely to have had prior compelled treatment (p = .039). At 4 weeks those in the patient-initiated group had put on weight at a faster rate (p = .032) and reported a decrease in alliance (p = .017). At discharge, staff initiated discharge demonstrated greater time in treatment (p = .001), greater weight gain (p = .027), and a higher discharge BMI (p = .013). At discharge, staff-initiated drop-outs had comparable end-of-treatment outcomes to those who completed treatment as planned. DISCUSSION: There are key differences between those who prematurely discharge themselves from treatment, compared to those who are prematurely discharged by clinical staff. Future research into drop-out needs to take into account and recognize these differences.
Subject(s)
Anorexia Nervosa/psychology , Motivation , Patient Discharge/statistics & numerical data , Patient Dropouts/statistics & numerical data , Professional-Patient Relations , Refusal to Treat/statistics & numerical data , Adolescent , Adult , Anorexia Nervosa/therapy , Body Mass Index , Coercion , Cohort Studies , Female , Hospitalization , Humans , Length of Stay , Male , Middle Aged , Patient Dropouts/psychology , Psychotherapeutic Processes , Surveys and Questionnaires , Survival Analysis , Treatment Outcome , United Kingdom , Young AdultABSTRACT
OBJECTIVES: This study aims to investigate treatment drop-out, and the associated roles of motivation, alliance, and behaviour change exhibited over the first four weeks of hospitalised treatment for anorexia. METHODS: 90 participants meeting DSM-IV criteria for anorexia nervosa completed questionnaires at admission, and four weeks into treatment. Weight data was collected over this same time period. At the end of treatment, participants were categorised into completer or premature termination groups. RESULTS: The overall rate of premature termination was 57.8%. Those who prematurely terminated treatment demonstrated lower discharge BMI (p<.0005), and weight gain (p<.0005) than those who completed. Therapeutic alliance proved significantly different between outcome groups at admission (p=.004). DISCUSSION: End-of-treatment outcomes for those who do not complete treatment are invariably poor. Therapeutic alliance appears to be a particularly important factor in this area.
Subject(s)
Anorexia Nervosa/therapy , Motivation , Patient Dropouts/psychology , Professional-Patient Relations , Adolescent , Adult , Anorexia Nervosa/psychology , Coercion , Cohort Studies , Female , Hospitalization , Humans , Logistic Models , Male , Middle Aged , Prospective Studies , Psychotherapeutic Processes , Surveys and Questionnaires , Treatment Outcome , Young AdultABSTRACT
Inpatient eating disorder units are increasingly being asked to admit patients at lower BMI's, often delaying hospital treatment until medically unavoidable. This paper aims to explore the impact of this trend on treatment outcome. Eighty-two adults with anorexia nervosa admitted to a national inpatient eating disorder ward were assessed for BMI at admission, length of hospitalisation, discharge BMI and re-admission within 1-year post-treatment. In the current study, admission BMI was unrelated to amount of weight gain during treatment or to length of hospital stay. As such patients admitted at lower BMI's had significantly lower BMI's on discharge from treatment. Low admission BMI's were related to significantly higher likelihoods of re-admission within 1 year. This study provides strong evidence for the benefit of early treatment episodes and with more successful treatment outcomes being related to higher weights at start of treatment.
Subject(s)
Anorexia Nervosa/therapy , Body Mass Index , Patient Admission/statistics & numerical data , Adolescent , Adult , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Patient Discharge , Time Factors , Treatment Outcome , Weight Gain , Young AdultABSTRACT
OBJECTIVE: The present study aimed to investigate the impact of Body Mass Index (BMI), duration of illness and severity of illness on quality of life within a sample of individuals in treatment for an eating disorder. In addition this study explored differences in specific areas of quality of life (Psychological, Physical/Cognitive, Work/School and Financial) according to specific eating disorder diagnoses. METHOD: Participants (N = 156) were adults currently receiving treatment for an eating disorder. Eating disorder symptomatology and quality of life were assessed using self-report questionnaires. BMI, duration of illness and eating disorder diagnosis was obtained during a clinical interview. RESULTS: Severity of the eating disorder and BMI were predictors of low quality of life. Duration of illness, contrary to clinical expectations was not a significant predictor of poor quality of life. In terms of differences across diagnostic groups, individuals with a diagnosis of anorexia nervosa in this sample were found to have lower psychological and physical/cognitive quality of life than those with an EDNOS or BN diagnoses.
Subject(s)
Anorexia Nervosa/psychology , Body Mass Index , Bulimia Nervosa/psychology , Quality of Life , Adolescent , Adult , Anorexia Nervosa/diagnosis , Body Image , Bulimia Nervosa/diagnosis , Feeding and Eating Disorders/psychology , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Quality of Life/psychology , Self Concept , Severity of Illness Index , Surveys and Questionnaires , Time Factors , Young AdultABSTRACT
Treatment drop-out rates for anorexia nervosa (AN) are notoriously high, and have remained so over the course of time, and across different treatment settings and modalities. The outcome for such patients is frequently poor. Despite the prevalence of this problem, there is little quality evidence as to why this is the case, and what the predictors of drop-out are. Methodological uniformity has been called for in order to develop a cohesive literature in this field, and this paper argues that we must also reflect upon how our labelling of 'the dropout' has shaped what we have examined to date, and how that has in turn led to a weak evidence base. A new, less pejorative term for those who do not complete treatment is needed to reflect the direction research in this area needs to take.