The therapeutic alliance in the early part of cognitive-behavioral therapy for the eating disorders

Objective:

This study examined the strength of the therapeutic alliance in the early stages of cognitive‐behavioral therapy (CBT) for the eating disorders, and whether the strength of that allianceis associated with early eating characteristics, comorbid Axis 1 and 2 features.

Method:

Forty‐four eating‐disordered patients completed measures of eating and Axis 1 and 2 characteristics at the start of therapy, and measures of the therapeutic alliance and eating characteristics at the sixth session of CBT.

Results:

The therapeutic alliance was strong, including in the domain of attachment. It was unrelated to initial eating pathology and early changes in eating cognitions and behaviors. However, there were links between initial emotional and interpersonal features and therapeutic alliance by the sixth session.

Discussion:

The findings counter suggestions that CBT for eating disorders is characterized by a poor therapeutic relationship. The therapeutic alliance is likely to be enhanced by addressing high levels of emotional distress and difficulties in interpersonal function where appropriate. This research needs to be extended to other therapies, other domains of function and different time points in therapy, to build a fuller picture of the role of the therapeutic relationship in working with the eating disorders. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)     

Body mass,frequency of eating and breakfast consumption in 9–13‐year‐olds

Background: Unhealthy eating patterns in childhood can lead to adverse health conditions, particularly obesity. However, debate remains around the precise eating behaviours that lead to these conditions. The present study aimed to address this lack of evidence by reporting on the eating frequency, breakfast consumption and body mass index (BMI, kg m^–2) of youth in the UK. Methods: A total of 264 (133 boys and 131 girls) participants, aged 10–13 years, completed self‐report measures of dietary intake via 3‐day food/drink diaries (Friday to Sunday). Trained researchers recorded height and weight to calculate the BMI. Diaries were analysed using dietplan 6 nutritional analysis software (Forestfield Software, Horsham, UK) and multivariate linear regression was used to examine any association between breakfast consumption, frequency of eating and BMI. Results: No relationship existed between BMI Z‐score, eating frequency and breakfast consumption. However, frequent breakfast consumers had significantly lower mean (SD) BMI Z‐scores [0.18 (1.06) versus 0.57 (1.23)] and higher intakes of iron, calcium and vitamin E than those who did not eat breakfast regularly. Those aged ≥11 years consumed breakfast less frequently [0.92 (0.20)] and were less likely to eat regularly [4.6 (1.4)] than those aged ≤10 years. Conclusions: Older boys were the least likely to eat regularly and the least likely to consume breakfast. Promoting the importance of regular eating, particularly breakfast consumption to these boys, may be essential to ensure healthier, long‐term eating patterns. Furthermore, the lower breakfast intakes in 11–13‐year‐olds and higher BMI Z‐scores of those who did not eat breakfast regularly should be monitored.