Efectividad de la aplicación del programa Echomantra en una adolescente con anorexia nerviosa y su familiar: Un estudio de caso / Effectiveness of the application of the Echomantra in an adolescent girl with anorexia nervosa and her caregiver: A case study

El programa ECHOMANTRA tiene como finalidad facilitar la transición de las pacientes con un trastorno de la conducta alimentaria desde el ingreso hospitalario a su vida cotidiana. Consta de una intervención para los/las familiares (ECHO; Treasure et al., 2015) y otra para las pacientes (MANTRA, Schmidt, et al, 2014). El objetivo de este estudio fue evaluar la efectividad del programa ECHOMANTRA, aplicado junto al tratamiento usual, en una adolescente de 15 años con anorexia nerviosa (AN) y su madre. Se utilizó un diseño de caso único y medidas pre-post, con seguimiento a los 3 y 6 meses. En la paciente se evaluó: patología alimentaria (EDE-Q), estado emocional (DASS-21), ajuste psicosocial (EQ-5D-5L y el CIA 3.0) y motivación al cambio; y en la madre: emoción expresada (FQ), impacto de los síntomas (EDSIS), acomodación a la enfermedad (EAISA), estado emocional (DASS-21) y habilidades de cuidadora (CSS). Ambos programas constaban de 8 sesiones online individuales y semanales. Los resultados mostraron una reducción en la sintomatología de AN, aumento del IMC, mejora del estado emocional, motivación al cambio y ajuste psicosocial; y en la madre, mejoró el estado emocional y las habilidades de cuidado, y disminuyó la acomodación a la enfermedad, la emoción expresada y el impacto de los síntomas. Estos cambios se mantuvieron en el seguimiento. Ambas valoraron el programa como satisfactorio. La aceptabilidad y la eficiencia del tratamiento de la AN puede mejorarse utilizando el ECHOMANTRA para preparar la transición de la atención hospitalaria, apoyando a las pacientes y familiares. (AU)

The aim of the ECHOMANTRA program is to facilitate the transition from hospital back into the community. ECHOMANTRA is based on interventions for carers (Experienced Carers Helping Others, ECHO; Treasure et al. 2016) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA; Schmidt, et al., 2014). The aim of this study was to evaluate the effectiveness of the ECHOMANTRA program, applied together with the usual treatment, in a 15-yearold adolescent girl with anorexia nervosa (AN) and her mother. A single case design and pre-post measures were used, as well as follow-up at 3 and 6 months. The patient was assessed for: eating pathology (EDE-Q), emotional state (DASS-21), psychosocial adjustment (EQ-5D-5L and CIA 3.0) and motivation to change. In the mother: expressed emotion (FQ), symptom impact (EDSIS), accommodation to illness (EAISA), emotional state (DASS-21) and her caregiver skills (CSS) were assessed. Both programs consisted of 8 on-line sessions, which were conducted individually and on a weekly basis. The results showed a reduction in AN symptomatology, increased BMI, improved emotional state, motivation to change and psychosocial adjustment; and in the mother, improved emotional state and caregiving skills, and reduced accommodation to illness, expressed emotion and the impact of symptoms. These changes were maintained at follow-up. Both patient and family valued the program as satisfactory. Both the acceptability and efficiency of treatment for AN may be improved by using ECHOMANATRA to prepare for transition from inpatient care, by giving support to both patients and their carers. (AU)

Prevalencia de la Ortorexia Nerviosa en estudiantes universitarios españoles: relación con la imagen corporal y con los trastornos alimentarios / Prevalence of Orthorexia Nervosa in Spanish university students: relationship with body image and eating disorders

Antecedentes: El objetivo de este estudio fue examinar la prevalencia de la Ortorexia Nerviosa (ON), y analizar su relación con la imagen corporal y conductas características de los Trastornos de la Conducta Alimentaria (TCA), en estudiantes universitarios. Método: Estudio transversal en el que participaron 534 estudiantes universitarios españoles, 422 mujeres y 112 hombres, con una edad media de 22.04 años (DT = 3.41). Se administraron los siguientes instrumentos: cuestionarios variables sociodemográficas y de hábitos alimentarios, el cuestionario ORTO-11-Es, la Teruel Ortorexia Scale (TOS), el Multidimensional Body Shape Relations Questionnaire (MBSRQ-45) y el Eating Attitudes Test (EAT-26). Resultados: El 30.5% de los estudiantes presentó un alto riesgo de ON. Se observaron mayores tendencias ortoréxicas en mujeres. El grupo que presentaba alto riesgo de ON frente al de bajo riesgo mostró un IMC medio-alto, seguían en mayor medida una alimentación de tipo vegano/vegetariano y presentaban puntuaciones significativamente superiores en el MBSRQ-45 (p < .00) y el EAT-26 (p < .00). Conclusiones: Los resultados obtenidos muestran una elevada prevalencia de ON en estudiantes universitarios y su relación con una peor imagen corporal, una mayor preocupación por el aspecto físico y con conductas características de los TCA.(AU)

Background: The aim of this study was to examine the prevalence of ON and analyze its relationship with self-image and ED behavior in university students. Method: Cross-sectional study with a sample of 534 Spanish university students, 422 women and 112 men with an age mean of 22.04 (SD = 3.41). Questionnaires administered: a sociodemographic and lifestyle questionnaire, the ORTHO-11-Es, the Teruel Orthorexia Scale (TOS), the Multidimensional Body Self Relations Questionnaire (MBSRQ-45) and the Eating Attitudes Test (EAT-26). Results: 30.5% of the sample were on high risk of developing ON. Higher orthorexic tendencies were observed in women. Those at high risk of ON showed higher BMI, higher proportion of veganism/vegetarianism and significantly higher scores on the MBSRQ-45 (p < .00) and EAT-26 (p < .00). Conclusions: Results showed a high prevalence of ON and its relationship with a worse self-image, concern with physical appearance and ED behaviors.(AU)

Adaptation and Implementation of an Intervention Programme on Spanish Carers and Adolescent Patients With an Eating Disorder: Study Protocol of a Randomized Controlled Trial.

Introduction: One of the major problems with inpatient treatment of adolescent girls with an eating disorder (ED) is that the strategies learned during their hospital stay are not easily applied or maintained in their daily lives, and this has been related to high rates of relapse and readmission. The ECHOMANTRA programme was developed to optimize outcomes during and following inpatient or day-patient treatment. ECHOMANTRA is based on interventions for carers (Experienced Carers Helping Others, ECHO) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA) and is developed from the cognitive interpersonal model of anorexia (Schmidt and Treasure, 2006; Treasure and Schmidt, 2013). This study aims to describe the study protocol of a randomized controlled trial (RCT) for evaluating the efficacy of an adaptation of a novel intervention for patients and carers (ECHOMANTRA) to be implemented as an add-on to treatment-as-usual (TAU). Method: In a multi-center pilot RCT, 80 female adolescent patients with a DSM-5 diagnosis of an ED and their carers will be invited to participate in the study. They will then be randomized to receive either the ECHOMANTRA intervention as an add-on to TAU or TAU alone. A repeated measures design will be conducted across four time points. Primary outcomes will be patient psychological well-being and eating disorder symptoms, and secondary outcomes will include body mass index, obsessive-compulsive symptoms, perfectionism, motivation to change and psychosocial adjustment. For carers, outcome variables will include psychological well-being, expressed emotion, accommodation and enabling behaviors, burden, and care skills. Discussion: The results from this trial will establish the effectiveness of ECHOMANTRA and may reveal whether and to what extent this novel intervention can optimize outcomes during and following inpatient treatment. This study will also provide the adaptation of the ECHOMANTRA in the Spanish context for inpatient/day-care treatment.

Positive and Negative Emotional Eating Are Not the Same-The Spanish Version of the Positive-Negative Emotional Eating Scale (PNEES).

The literature points to the importance of distinguishing between positive and negative emotional eating in relation to overeating and binge eating. The aim of this study was to evaluate the Spanish version of the Positive-Negative Emotional Eating Scale (PNEES) in a Spanish community sample. The sample consisted of 628 participants. The mean age was 27.5 (SD = 12.7) and 70.1% of them were women. The participants completed the PNEES, and measures of anxiety and depression (HADS), and eating disorder-related scales (TFEQ-R18, BULIT-R, and EAT-26) that were selected to examine convergent validity. A confirmatory factor analysis was conducted, replicating the original two-factor solution, consisting of Negative Emotional Eating (PNEES-N) and Positive Emotional Eating (PNEES-P). The results showed an acceptable fit of the model (CFI = 0.986; TLI = 0.984, RMSEA = 0.055). Internal consistency ranged from ω = 0.92 to ω = 0.96 for both subscales and the total score. PNEES-P correlations with other variables were lower with respect to the PNEES-N, showing that they are different constructs. A mediation analysis was conducted, in which PNEES-P significantly predicted binge eating and PNEES-N was a partially mediator variable. The results showed that the adaptation process was successful.

Illness Perception in Adolescent Patients With Anorexia: Does It Play a Role in socio-Emotional and Academic Adjustment?

People's beliefs about their illness have been shown to affect their adjustment. The aim of this study was to describe illness perception in adolescent patients with anorexia nervosa (AN) and assess its relationship with socio-emotional and academic adjustment following Leventhal's Self-Regulation Model. Thirty-four female AN patients, with a mean age of 15.76 (SD = 2.00), completed the Revised Illness Perception Questionnaire (IPQ-R), the Psychosocial Adjustment to Illness Scale (PAIS) and the Hospital Anxiety and Depression Scale (HAD). Adolescent anorexia patients perceived that they had control over their illness and treatment would improve their condition. However, they also believed that it was highly distressing, going to last a long time and would have serious consequences. As for the causes of the disorder, they were attributed primarily to a specific eating disorder and psychological factors. The results showed that anorexia patients' illness perceptions were related to socio-emotional and academic adjustment. In this sense, identity with the illness was associated with a worse academic adjustment, while emotional representation was associated with a worse emotional and social adjustment. These findings highlight how important it is for patients' beliefs about their disease to be considered in the treatment of anorexia. In this respect, clinicians treating these patients should consider how certain beliefs affect their academic and socio-emotional adjustment. It would be interesting for patients to become aware of how these beliefs influence the strategies they use to cope with their disease as well as their adjustment to it.

Aplicación de la terapia centrada en la compasión en pacientes con un trastorno de la conducta alimentaria: un estudio piloto / Compassion-focused therapy in patients with eating disorders: A pilot study

La terapia centrada en la compasión (CFT) se ha desarrollado como una terapia multimodal que integra diferentes estrategias cognitivo conductuales, y recientemente ha empezado a ser aplicada en el ámbito de los trastornos de la conducta alimentaria (TCA). El objetivo de este trabajo ha sido desarrollar y aplicar un programa de intervención basado en la CFT en un grupo de pacientes con un TCA. La muestra estuvo compuesta por 10 personas diagnosticadas de un TCA. La media de edad fue de 20,2 años (DT= 8,06). se obtuvieron medidas de autocompasión, atención plena, actitudes hacia la comida, depresión, ansiedad, imagen corporal y autoestima. Los resultados mostraron un cambio significativo en autocompasión, actitudes hacia la comida, imagen corporal y autoestima. Estos resultados apoyan la aplicación de la CFT a estos pacientes

Compassion-focused therapy (CFT) has been developed as a multimodal therapy that integrates different cognitive-behavioral strategies and has begun to be applied in the field of eating disorders recently. The aim of this work has been to develop and apply an intervention program based on CFT in a group of patients with eating disorders. The sample consisted of 10 participants diagnosed with an eating disorder. The mean age was 20.2 years (SD= 8.06). The following instruments were applied: measures of self-pity, mindfulness, attitudes toward food, depression, anxiety, body image and self-esteem. The results showed a significant change in self-pity, attitudes toward food, body image and selfesteem. These results support the application of CFT to these patients

Aplicación de un programa de estimulación cognitiva en adolescentes con un trastorno de la conducta alimentaria: un estudio piloto / Application of cognitive remediation therapy in adolescents with an eating disorder: A pilot study

Los recientes hallazgos neuropsicológicos señalan ciertos déficit cognitivos entre los pacientes con trastorno de la conducta alimentaria (TCA), como la rigidez cognitiva y la focalización excesiva en los detalles. En este contexto, emerge la terapia de estimulación cognitiva aplicada al campo de los TCA. En el presente estudio se aplica un programa de estimulación cognitiva en un grupo de pacientes diagnosticado de un TCA (n= 11), de entre 13 y 19 años (M= 16,18; DT= 1,99). Se analizaron las dimensiones cognitivas de coherencia central y flexibilidad cognitiva, mediante el "Test de copia y reproducción de memoria de figuras geométricas complejas" (REY) y el "Test de rastreo" (Trail Making Test, TMT), además de variables clínicas relevantes. El tratamiento estuvo formado por 10 sesiones semanales de 45 minutos. Los resultados ponen de manifiesto la relevancia del tratamiento para mejorar la coherencia central en pacientes con un TCA. Se plantea la necesidad de continuar investigando la eficacia de dicha terapia con estudios controlados aleatorizados, con grupos de control y desde una perspectiva transdiagnóstica

Recent studies have shown that patients with an eating disorder have deficits in neuropsychological functioning. Cognitive remediation therapy (CRT) was developed to improve these cognitive deficits. The objective of this study was to apply a CRT to a group of adolescents with an eating disorder (n= 11), whose age ranged between 13 and 19 (M= 16.18, SD= 1.99). Central coherence and cognitive flexibility were analyzed by means of the Rey Complex Figure Test and the Trail Making Test, and other clinical measures. Ten weekly 45-minute sessions were designed. The results of this study indicated that CRT is outstanding to improve central coherence in patients with an eating disorder. Further research is needed to evaluate the efficacy of CRT in this clinical population. Future research may incorporate randomized controlled trials with control groups as well as the use of a transdiagnostic perspective

Adaptation and validation of the Spanish version of the Social Comparison Scale in chronic illness patients.

This study examined the Social Comparison Scale in Spanish chronic illness context and analyzed its psychometric properties. The article presented the results of two studies. The first explored the test's dimensional structure in a sample of 202 patients in a range of several chronic illnesses. The second study examined the instrument's structure in a sample of 186 patients with specific chronic illness. The results replicated the original structure of the scale and proved to be valid for use with optimum reliability.

La ira como factor comórbido a los problemas interpersonales y de desajuste emocional en pacientes con un trastorno de la conducta alimentaria / Anger as comorbid factor for interpersonal problems and emotional dysregulation in patients with eating disorders

Los objetivos de este trabajo fueron analizar el nivel general de ira que presentan las pacientes con un Trastorno de la Conducta Alimentaria (TCA) en relación a un grupo normativo; analizar las diferencias en el control de la ira en función del diagnóstico; explorar la relación entre las dimensiones de la ira y escalas específicas del EDI-3 (desajuste emocional, déficit interpersonal, baja autoestima y ascetismo); y con el Índice de Masa Corporal (IMC). Metodología: Participaron 58 mujeres diagnosticadas de un TCA, que eran atendidas en régimen de hospitalización en el Hospital General Universitario Reina Sofía de Murcia. La edad media fue de 25,68 años (dt=7,00). Un 27,58% estaban diagnosticadas de ANR; un 15,51% de ANP. Un 41,37% de BN, y el 15,51% restante de un TCANE. Para la evaluación del TCA se empleó el Inventario EDI-3 y para el estudio de la ira se aplicó el Inventario STAXI-2. Resultados: Los análisis mostraron que los niveles generales de ira de estas pacientes eran más elevados que los de la población normativa con la que se comparó. Las pacientes diagnosticadas de ANR presentaban puntuaciones significativamente superiores que las pacientes diagnosticadas de BN en la escala control interno de la ira. Las escalas desajuste emocional, déficit interpersonal, baja autoestima y ascetismo presentaron correlaciones significativas con diferentes dimensiones de la ira. No se encontró una relación significativa entre IMC e ira. Conclusiones. Estos resultados manifiestan la importancia de incluir en cualquier abordaje terapéutico de los TCA el manejo de la ira

This work was undertaken to analyze general levels of anger in patients with eating disorders (ED) compared to a normative group, diagnosis-dependent differences in expressing anger, and the relation between anger dimensions and specific items of the Eating Disorder Inventory, third revision (EDI-3) (emotional dysregulation, interpersonal deficit, low self-esteem, and asceticism) and body mass index (BMI). Methods: The study participants were 58 women with a diagnosis of ED hospitalized at the Reina Sofia General University Hospital in Murcia. The women had a mean age of25.68 (SD=7.00) years. The distribution of ED diagnoses was 27.58% anorexia nervosa with food restriction (AN-R), 15.51% anorexia nervosa with purging (AN-P), 41.37% bulimia nervosa (BN), and 15.51% eating disorder not otherwise specified (EDNOS). ED was evaluated using the EDI-3 and anger was assessed with the State-Trait AnxietyInventory-2 (STAXI-2). Results: The general anger levels of the patients with ED were higher than those of the normative group compared. Patients diagnosed of AN-R had significantly higher scores than patients diagnosed of BN on the internal control of anger scale. The emotional dysregulation, interpersonal deficit, low self-esteem, and asceticism scales correlated significantly with different anger dimensions. No significant relation was found between body mass index (BMI) an danger. Conclusions: These results show the importance of including anger management in any therapeutic approach to EDs

Anger as comorbid factor for interpersonal problems and emotional dysregulation in patients with eating disorders.

UNLABELLED: This work was undertaken to analyze general levels of anger in patients with eating disorders (ED) compared to a normative group, diagnosis-dependent differences in expressing anger, and the relation between anger dimensions and specific items of the Eating Disorder Inventory, third revision (EDI-3) (emotional dysregulation, interpersonal deficit, low self-esteem, and asceticism) and body mass index (BMI). METHODS: The study participants were 58 women with a diagnosis of ED hospitalized at the Reina Sofia General University Hospital in Murcia. The women had a mean age of 25.68 (SD=7.00) years. The distribution of ED diagnoses was 27.58% anorexia nervosa with food restriction (AN-R), 15.51% anorexia nervosa with purging (AN-P), 41.37% bulimia nervosa (BN), and 15.51% eating disorder not otherwise specified (EDNOS). ED was evaluated using the EDI-3 and anger was assessed with the State-Trait Anxiety Inventory-2 (STAXI-2). RESULTS: The general anger levels of the patients with ED were higher than those of the normative group compared. Patients diagnosed of AN-R had significantly higher scores than patients diagnosed of BN on the internal control of anger scale. The emotional dysregulation, interpersonal deficit, low self-esteem, and asceticism scales correlated significantly with different anger dimensions. No significant relation was found between body mass index (BMI) and anger. CONCLUSIONS: These results show the importance of including anger management in any therapeutic approach to EDs.

Perfeccionismo y factores de riesgo para el desarrollo de trastornos alimentarios en adolescentes españoles de ambos géneros / Perfectionism and risk factors for the development of eating disorders in Spanish adolescents of both genders

El objetivo de este trabajo fue evaluar las dimensiones del perfeccionismo que estaban relacionadas con conductas alimentarias de riesgo en adolescentes españoles de ambos géneros, así como analizar si existían diferencias significativas en estas dimensiones entre los adolescentes con mayor y menor riesgo de desarrollar un trastorno de la conducta alimentaria. Método: se administró la adaptación española de The Child and Adolescent Perfectionism Scale (CAPS) y el EAT- 40 a una muestra representativa de 2142 adolescentes de la provincia de Alicante (1130 chicas y 1012 chicos), con una media de edad de 13.96 años (DT = 1.34). Resultados: el perfeccionismo auto-orientado y el prescrito socialmente estaban relaciona-dos de forma positiva con la puntuación total en el EAT-40 y los diferentes factores que lo componen, en ambos géneros. Los adolescentes con mayor riesgo de desarrollar un trastorno alimentario presentaban un mayor perfeccionismo auto-orientado y prescrito socialmente que los adolescentes con menor riesgo de desarrollar el problema. Conclusión: Estos resultados sugieren la necesidad de identificar estas tendencias perfeccionistas en los adolescentes antes de que se conviertan en conductas patológicas, como un medio para prevenir el desarrollo de un trastorno alimentario

The aim of this study was to assess the dimensions of perfectionism that are linked to risk eating behaviors in a representative sample of Spanish adolescents of both genders, and analyze the differences in these dimensions between adolescents with high and low eating disorder risk. Method: 2142 adolescents from Alicante (1130 girls and 1012 boys), mean age 13.96 years (SD = 1.34), completed the Spanish version of the The Child and Adolescent Perfectionism Scale (CAPS) and the EAT-40. Results: Self-Oriented Perfectionism and Socially Prescribed Perfectionism were positively associated with EAT-40 total score, and with the different factors that comprise it, in both genders. Adolescents with high risk of developing an eating disorder showed higher Self-Oriented Perfectionism and Socially Prescribed Perfectionism than adolescents with low risk of developing the disorder. Conclusion: These results suggest that it is necessary to identify these perfectionist tendencies in adolescents before they become pathological behaviors, in order to prevent the development of an eating disorder

Malestar psicológico y emoción expresada en cuidadores de pacientes con un trastorno de la conducta alimentaria / Expressed emotion and psychological distress in caregivers of patients with an eating disorder

El objetivo principal del presente estudio fue evaluar el nivel de emoción expresada y de malestar psicológico en cuidadores de pacientes con un trastorno de la conducta alimentaria, considerando las diferencias en función de las características sociodemográficas y clínicas. Participaron 53 cuidadores de pacientes con un trastorno de la conducta alimentaria que estaban siendo atendidas en la unidad de trastornos alimentarios del hospital de San Juan, Alicante. El 39.6% de los cuidadores fueron hombres y el 60.4% mujeres con edades comprendidas entre los 23 y los 69 años. El cuestionario utilizado para evaluar la emoción expresada fue el de Nivel de Emoción Expresada, (LEE) y para evaluar el malestar psicológico utilizamos la Escala de Ansiedad y Depresión Hospitalaria (HADS) y un cuestionario de salud general, (GHQ-12). Los resultados mostraron que no había diferencias estadísticamente significativas atendiendo al diagnóstico de la paciente, edad de los cuidadores y cuidadores primarios y secundarios, sin embargo se encontraron diferencias significativas en relación al género del cuidador, parentesco y al tiempo de evolución del problema. Además, los cuidadores con mayor emoción expresada presentaban más ansiedad y de-presión que los cuidadores con menor emoción expresada

The main objective of this study was to evaluate the level of expressed emotion and psychological distress in caregivers of patients with an eating disorder, considering the differences in terms of sociodemographic and clinical characteristics. Fifty-three caregivers of patients with an eating disorder participed. The 39.6% of caregivers were men and 60.4% women, aged between 23 and 69 years old. The questionnaire used to assess expressed emotion was the Spanish version of the Level of Expressed Emotion (LEE) and for assessing distress the Spanish version of the Hospital Anxiety and Depression scale (HADS) and the General Health Questionnaire (GHQ-12). The results showed no statistically significant differences in expressed emotion in relation to the patient diagnosis and age of the caregivers. Significant differences were found regarding the type of relationship, the gender of the caregiver and illness duration; the caregivers with higher EE had more anxiety and depression than caregivers with lower EE

Using common sense model in eating disorders.

UNLABELLED: The aim of this study was to explore the relationships proposed in the Common Sense Model (CSM) in eating disorder (ED) patients. METHOD: 98 female (ED) patients completed measures of illness representation and psychosocial adjustment. RESULTS: The confirmatory structural equation analysis revealed that illness representation dimensions were predictors of psychosocial adjustment. The hypothesis that coping mediates the relationship between illness representation and adjustment could not be confirmed. CONCLUSIONS: It may be helpful to consider the relationships between illness representation and adjustment when carrying out therapeutic work with these patients.