Evaluation of a day treatment programme for eating disorders

A day hospital treatment programme is described for eating disordered patients who would otherwise require inpatient treatment. The characteristics at presentation of 106 consecutive patients are described. Of patients completing the programme, 65 could be recruited for the outcome study. At presentation, 26 per cent fulfilled DSM-IV criteria for anorexia nervosa, 65 per cent for bulimia nervosa and 9 per cent had an eating disorder not otherwise specified. The average length of treatment of all patients was 13 weeks. There was significant weight gain among the anorectic patients and a significant decrease in the average number of binges among the bulimic patients. Statistically significant improvements over time for psychological, sexual and socioeconomic adjustment were also obtained. © 1998 John Wiley & Sons, Ltd and Eating Disorders Association.     

Personality disorders in patients in a day‐treatment programme for eating disorders

The present study examined the prevalence of DSM‐III‐R personality disorders (PDs) and levels of depressive symptoms in patients in a day‐hospital programme for eating disorders. Sixty‐five patients diagnosed with anorexia nervosa and bulimia nervosa were administered the Personality Diagnostic Questionnaire Revised (PDQ‐R), the Eating Disorder Inventory (EDI) and the Beck Depression Inventory (BDI). In total, 49.2 per cent of all patients had at least one PD diagnosis. No significant difference was found between patients with bulimia nervosa and anorexia nervosa. Eating Disorder patients with at least one PD had higher scores on the BDI and three EDI subscales compared to patients without a PD. In general, the prevalence of Personality Disorders in the present sample tended to be closer to results quoted by studies with eating‐disordered outpatients rather than inpatients. Axis I disorders may affect personality state measures. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

Understanding the experience of drop‐out from treatment for anorexia nervosa

Research suggests that approximately 50 per cent of patients drop out prematurely from services for anorexia nervosa. This research set out to investigate the possible reasons for this high drop‐out rate. The experiences of eight women were explored through written accounts and semi‐structured interviews. The information was analysed using a social constructionist revision of grounded theory. A central theme of control emerged which was affected by interactions with the wider social system. The cumulative battle for control between the anorectic and others appeared to result in the act of dropping out as the treatment approach, timing and context recreated the setting conditions of lost control. The organizational and clinical implications of this model are discussed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

Let eating disorder patients decide: Providing choice may reduce early drop‐out from inpatient treatment

Premature drop‐out from treatment is a highly prevalent phenomenon among eating disorder (ED) patients. In a specialized inpatient treatment unit a major change was made in the admission strategy in 2001, giving a maximum of personal choice to the patients. A quasi‐experimental research was carried out comparing 87 patients treated till 2000 (‘old’ strategy) with 87 patients treated from 2001 on (‘new’ strategy). The results indicate that the provision of choice at the beginning of treatment significantly reduced drop‐out during the first weeks of inpatient treatment. No differences between both strategies on later drop‐out and weight change (in anorexia nervosa patients) during inpatient treatment were found. The results are discussed in the light of the importance placed on dynamics of personal choice, autonomy and volition within the framework of the self‐determination theory (SDT). Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

Drop‐out from treatment for the eating disorders: A problem for clinicians and researchers

All professionals who work in the field of eating disorders will have encountered patients who do not make it into or through a course of treatment. This paper considers some of the difficulties that drop‐out poses to clinicians and researchers. It also suggests strategies for addressing these challenges in future research and clinical practice. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

An evaluation of the effectiveness and short‐term stability of an innovative Australian day patient programme for eating disorders

There is a dearth of literature evaluating day patient treatment for eating disorders based upon the targeted goals of treatment, to conclude that day patient programmes are effective. This study aimed to explore the effectiveness of an innovative day patient programme by examining whether the seven key treatment goals improved across treatment and were maintained 3 months after discharge. Of the 58 participants who completed measures assessing BMI, eating disorder cognitions, behaviours, core beliefs, readiness to change, quality of life and perpetuating factors at admission, discharge and follow‐up, 44 completed the day programme with 14 non‐completers. The results demonstrated that all seven treatment goals improved across treatment and the improvements were maintained or further improved at 3 month follow‐up. The results are discussed in context of the published day patient programme literature with implications for future research to maximise optimal treatment outcomes from day patient treatment. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Drop‐out from inpatient treatment for anorexia nervosa: can risk factors be identified at point of admission?

Despite renewed interest in drop‐out from eating disorders treatment, few studies have investigated the issue in respect to the most expensive and intensive form of treatment, that is, inpatient treatment for anorexia nervosa (AN). This study investigates whether risk of treatment drop‐out can be determined from information routinely collected at point of admission. Using information from a multi‐site database collected in Australia and New Zealand, demographic and clinical data at point of admission were collated for 213 inpatient treatment episodes. One in five admissions ended with the patient unilaterally deciding to leave treatment without clinician endorsement. A lower body mass index, AN purging subtype and active fluid restriction made significant independent contributions to this risk. Drop‐out remains a highly disruptive method of discharge and while there is utility in predicting those most at risk, few variables commonly collated by clinicians contribute to their identification. The implications for clinical practice and future research are discussed. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association.     

Naturalistic outcomes for a day‐hospital programme in a mixed diagnostic sample of adolescents with eating disorders

Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day‐hospital programmes (DHPs), existing studies have included limited follow‐up, small samples, and a focus on restricting‐type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow‐up (n = 126; M_{follow up} = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow‐up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow‐up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow‐up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow‐up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.     

Therapist adherence and therapeutic alliance in individual cognitive‐behavioural therapy for adolescent binge‐eating disorder

To evaluate psychological treatments for adolescent binge‐eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic alliance and their associations in cognitive‐behavioural therapy (CBT) for adolescents with BED. In a randomised‐controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio‐taped CBT sessions from a sample of N = 64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between‐patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT.     

Efficacy of a partial hospital programme for adults with eating disorders

Partial hospital programmes (PHPs) have demonstrated efficacy in the treatment of eating disorders (EDs); however, few programmes have examined long‐term outcomes across diagnoses, including subtypes of anorexia nervosa (AN). The present study examined the effectiveness of PHP for adult patients (n = 243) with AN‐restricting subtype (n = 79), AN binge/purge subtype (n = 46), and bulimia nervosa (n = 118). These patients tended to have long‐standing courses of illness (43%, illness duration >7 years) and high levels of psychiatric comorbidity (92.2%). Patients completed questionnaires at admission, discharge, and follow‐up, M (SD) = 11.50 months (5.29). Through follow‐up, all diagnoses demonstrated significant improvements in weight, ED psychopathology, and comorbid symptoms, with some exceptions for the AN binge/purge group. In exploratory analyses, 49% of patients met criteria for full or partial remission at discharge and 37% at follow‐up. Results provide support for the effectiveness of PHP in improving ED outcomes in a severe sample through longer‐term follow‐up.     

Comorbid depressive symptoms and self‐esteem improve after either cognitive‐behavioural therapy or family‐based treatment for adolescent bulimia nervosa

This study examined the effect of family‐based treatment for bulimia nervosa (FBT‐BN) and cognitive behavioral therapy for adolescents (CBT‐A) on depressive symptoms and self‐esteem in adolescents with BN. Data were collected from 110 adolescents, ages 12–18, who met Diagnostic and Statistical Manual of Mental Disorders‐Fourth Edition, text revision criteria for BN or partial BN. Participants were randomly assigned to FBT‐BN or CBT‐A and completed measures of depressive symptoms and self‐esteem before and after treatment and at 6‐ and 12‐month follow‐up assessments. Depressive symptoms and self‐esteem significantly improved in both treatments, and neither treatment appeared superior on these clinical outcomes. Parents often worry whether FBT‐BN addresses comorbid depressive symptoms and low self‐esteem. Our findings address this concern, as they demonstrate that FBT‐BN does not differ from CBT‐A in improving depressive symptoms and self‐esteem, and both treatments result in symptom improvement. These findings can help clinicians guide families to choose a treatment that addresses BN and depressive symptoms and low self‐esteem.     

A multi‐step cognitive behaviour therapy for eating disorders

This paper describes a novel model of cognitive behaviour therapy (CBT) for eating disorders called CBT‐Multi‐Step (CBT‐MS). The treatment, derived from the transdiagnostic cognitive behaviour theory of eating disorders described by Fairburn, Cooper and Shafran, expands the range of applicability of standard CBT. It is designed to be applicable to different levels of care (outpatient, intensive outpatient, day‐hospital, inpatient and post‐inpatient), and to eating disorder patients of all diagnostic categories, ages and BMI. Distinguishing CBT‐MS is the adoption of a multi‐step approach conducted by a multidisciplinary (but non eclectic) team, the inclusion of a CBT family module for patients < 18 years, and the use of meal planning and mechanical eating at all the levels of care. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Preoperative and post‐operative psychosocial interventions for bariatric surgery patients: A systematic review

Psychosocial interventions are increasingly being utilized to help patients prepare for, and adjust to changes following, bariatric surgery in order to optimize psychosocial adjustment and weight loss. The current systematic review examined the impact of preoperative and post‐operative psychosocial interventions with a behavioural and/or cognitive focus on weight, dietary behaviours, eating pathology, lifestyle behaviours, and psychological functioning. A PsycINFO and Medline search of publications was conducted in March 2019. Two authors assessed retrieved titles and abstracts to determine topic relevance and rated the quality of included studies using a validated checklist. Forty‐four articles (representing 36 studies) met the study inclusion criteria. The current evidence is strongest for the impact of psychosocial interventions, particularly cognitive behavioural therapy, on eating behaviours (eg, binge eating and emotional eating) and psychological functioning (eg, quality of life, depression, and anxiety). The evidence for the impact of psychosocial interventions on weight loss, dietary behaviours (eg, dietary intake), and lifestyle behaviours (eg, physical activity) is relatively weak and mixed. Psychosocial interventions can improve eating pathology and psychosocial functioning among bariatric patients, and the optimal time to initiate treatment appears to be early in the post‐operative period before significant problematic eating behaviours and weight regain occur.     

Different outcomes,psychopathological features,and comorbidities in patients with eating disorders reporting childhood abuse: A 3‐year follow‐up study

The aim of this study was to evaluate the role of childhood adversities in long‐term outcomes in eating disorders (EDs). One hundred thirty‐three eating disorder patients were studied by means of the Structured Clinical Interview for DSM‐IV and psychometric tests, at baseline, at the end of individual cognitive behavioural therapy, and at 3‐year follow‐up. As compared with the other patients, those reporting childhood abuse (overall: 24.8%; physical abuse: 20.3%; sexual abuse: 13.6%) showed higher impulsivity, psychiatric comorbidity, lower full recovery at follow‐up (12.1% vs. 31%), and higher diagnostic crossover (39.4% vs. 13.0%). The different rates of recovery were mostly due to a higher persistence of depression in abused patients (77.8% vs. 26.7%). Patients with both abuse and neglect had a higher probability of dropout. Eating disorder patients with childhood abuse represent a group of persons with more complex psychopathological features and a worse long‐term outcome, thus requiring specific treatment strategies.     

Many roads lead to Rome: Why does cognitive behavioural therapy remain unsuccessful for many eating disorder patients?

This paper makes the case that the widely used evidence‐based ‘CBT’ approaches remain unsuccessful in many eating disorder patients. Six critical ‘personal reflections’ are formulated on why many patients remain totally resistant toward our therapeutic endeavours. My reflections suggest that probably many roads may lead to Rome. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.