Working with families of adults affected by eating disorders: uptake, key themes, and participant experiences of family involvement in outpatient treatment-as-usual.

BACKGROUND: Eating disorders are associated with significant personal and family costs. Clinical guidelines recommend family members be involved and supported during care, but little has been reported regarding the preferences of adults around carer involvement in treatment. The necessary intensity of family work with adults is also unknown. A trial of a standardised brief family involvement method was conducted in an adult eating disorder service offering treatment-as-usual. Uptake and feasibility of implementing the approach as part of standard outpatient care and the preliminary impact on issues identified by adult patients and carers were evaluated. METHODS: Eligible referrals at an adult eating disorders outpatient clinic were offered as needed family consultation to address presenting interpersonal problems identified by patients and their family members, and outcomes were evaluated 4 weeks later. Pre and post intervention surveys identified participant self-reported change in (i) problem frequency, (ii) distress and disruption caused, and (iii) confidence regarding presenting problems. Open text responses provided an overview of patient and carer goals for family involvement and revealed how the novel method impacted these areas as well as overall experience of, and feedback regarding, the brief family intervention. RESULTS: Twenty-four female participants aged 18-53, and 22 carers participated in 31 consultations. Common concerns raised were eating disorder related interpersonal and communication issues. The focused sessions, offered on a one-at-a-time basis, showed preliminary effectiveness for reducing both patients and carer concerns. For example, adult patients reported that life interference from interpersonal problems was lower and confidence to deal with them was higher following family consultation. Carers also reported that frequency, level of worry, and life interference around presenting problems were lower after the structured family intervention. CONCLUSIONS: Brief family consultation, with a single focus on issues identified by family members and adult patients, was a safe and feasible procedure with adults affected by eating disorders. Effective at meeting the needs of participants, the framework investigated in the current study may also be a useful direction for adult services to consider when looking to support families and meet recommendations for their routine involvement in the outpatient care. TRIAL REGISTRATION: Australian Clinical Trials Register number: ACTRN12621000047897 (www.anzctr.org.au).

Eating disorders are serious problems that can have negative consequences for both the person affected and their family members. Research shows that family involvement can support treatment, but little is known about whether adults with eating disorders want their families involved or how much. This study asked if adding a brief family intervention to normal treatment would be safe, viable and effective. The uptake of, and impact from, a one-off family consultation was measured in 24 adult patients and 22 carers who identified the problems they were facing as a result of the eating disorder, how often these were happening, how worried they felt about them, and how much the issues were interfering in their life before and after the family session. Both the patients and carers reported change in these areas. Issues regarding the eating disorder and communication were the most common concerns of adult patients and carers. Feedback about the sessions was positive and one session was enough to address the immediate concerns for many families. Single session family consultation may be a promising option for services working with the families of adults affected by eating disorders to consider in the future.

How are families included in the treatment of adults affected by eating disorders? A scoping review.

OBJECTIVE: The involvement of families in the treatment of adults with eating disorders is recommended as a core component of comprehensive care, yet little is known about the optimal way to implement or routinely facilitate this. This article evaluates the recent evidence on the inclusion of families in treatment programs for adults with eating disorders. METHOD: A systematic literature search was conducted to identify evidence of family inclusive treatment approaches for adults with eating disorders. A scoping review framework was applied to assess and synthesize findings. RESULTS: Sixty-eight studies were identified. Substantial conceptual research contributing to the theoretical basis of current practice with families of adults with eating disorders and clinical applications in current use were identified. Most research used uncontrolled studies with few experimental designs, reflecting the standing of the extant literature. Common elements of existing approaches have been distinguished and shared core components of interventions identified. DISCUSSION: Results confirmed that family members of adults were willing to be involved with eating disorder treatment services and appeared to respond to interventions of varying intensity and duration. The impact on individual patients, and effect on treatment outcomes, are yet to be established. The localized settings of existing studies, the homogenous nature of interventions used, and the limited diversity in research subjects, make it difficult to generalize from the results to the wide range of adult eating disorder presentations seen in practice. Suggestions for future research and further clinical developments are discussed.

OBJETIVO: La participación de las familias en el tratamiento de adultos con trastornos de la conducta alimentaria se recomienda como un componente central de la atención integral, sin embargo, se conoce poco sobre la 13 forma óptima de implementarlo o facilitarlo de manera rutinaria. Este artículo evalúa la evidencia 14 reciente sobre la inclusión de familias en programas de tratamiento para adultos con trastornos 15 alimentarios. MÉTODO: Se realizó una búsqueda bibliográfica sistemática para identificar evidencia de 16 enfoques de tratamiento inclusivo familiar para adultos con trastornos alimentarios. Se aplicó un marco de revisión del alcance 17 para evaluar y sintetizar los hallazgos. RESULTADOS: Se identificaron 68 estudios 18. Se identificaron investigaciones conceptuales sustanciales que contribuyen a la base teórica de la práctica actual con familias de adultos con trastornos alimentarios y aplicaciones clínicas en 20 usos actuales. La mayoría de las investigaciones utilizaron estudios no controlados con pocos diseños experimentales, lo que refleja la posición de la literatura existente. Se han distinguido los elementos comunes 2 de los abordajes existentes y se han identificado componentes centrales compartidos de 3 intervenciones. DISCUSIÓN: Los resultados confirmaron que los miembros de la familia de los adultos 4 estaban dispuestos a participar en los servicios de tratamiento de los trastornos de la conducta alimentaria y parecían responder a intervenciones de intensidad y duración variables. Aún no se ha establecido el impacto en 6 pacientes individuales y el efecto en los resultados del tratamiento. Los 7 contextos localizados de los estudios existentes, la naturaleza homogénea de las intervenciones utilizadas y la diversidad limitada de los sujetos de investigación hacen que sea difícil generalizar de los resultados a la amplia gama de presentaciones de trastornos alimentarios en adultos observadas en la práctica. Se discuten sugerencias para investigaciones futuras y desarrollos clínicos adicionales.

The Effectiveness of Enhanced Cognitive Behavioural Therapy (CBT-E): A Naturalistic Study within an Out-Patient Eating Disorder Service.

BACKGROUND: The effectiveness of enhanced cognitive behavioural Therapy (CBT-E) for adults with a range of eating disorder presentations within routine clinical settings has been examined in only two known published studies, neither of which included a follow-up assessment period. AIM: The current study aimed to evaluate the effectiveness of CBT-E within an out-patient eating disorder service in Brisbane, Queensland, Australia, and incorporated a follow-up assessment period of approximately 20 weeks post-treatment. METHOD: The study involved 114 adult females with a diagnosed eating disorder, who attended an average of 20-40 individual CBT-E sessions with a psychologist or a psychiatry registrar between 2009 and 2013. RESULTS: Of those who began treatment, 50% did not complete treatment, and the presence of psychosocial and environmental problems predicted drop-out. Amongst treatment completers, statistically and clinically significant improvements in eating disorder and general psychopathology were observed at post-treatment, which were generally maintained at the 20-week follow-up. Statistically significant improvements in eating disorder and general psychopathology were observed amongst the total sample. CONCLUSIONS: The findings, which were comparable to the previous Australian effectiveness study of CBT-E, indicate that CBT-E is an effective treatment for adults with all eating disorders within out-patient settings. Given the high attrition rate, however, minimizing drop-out appears to be an important consideration when implementing CBT-E within clinical settings.