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O'Shea M, Capon H, Evans S, Agrawal J, Melvin G, O'Brien J, McIver S. Integration of hatha yoga and evidence-based psychological treatments for common mental disorders: An evidence map. J Clin Psychol 2022; 78:1671-1711. [PMID: 35315071 PMCID: PMC9546402 DOI: 10.1002/jclp.23338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/19/2021] [Accepted: 02/12/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Interest in the use of yoga to enhance engagement with and augment the benefits of psychological treatment has grown. However, a systematic approach to reviewing existing research examining the use of yoga with psychological treatment is lacking. MATERIALS AND METHODS This mapping review identified and synthesised research trialling yoga as an integrated or adjunct therapy with evidence-based psychological interventions for the treatment of anxiety, depression, PTSD, and eating disorders. RESULTS Overall, the review identified ten published and three unpublished studies, representing either single group or small quasi-experimental research designs. DISCUSSION Limited but promising findings were shown for yoga with CBT for anxiety and depression, and the integration of yoga within intensive treatment models for PTSD. CONCLUSIONS Future research is encouraged to focus on controlled trials that enable examination of the component effect of yoga when applied with evidence-based psychological treatment and acceptability and feasibility data to further knowledge regarding a role for yoga in clinical practice.
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Affiliation(s)
- Melissa O'Shea
- Faculty of Health, School of Psychology, Deakin University, Geelong, Australia
| | - Hannah Capon
- Faculty of Health, School of Psychology, Deakin University, Geelong, Australia
| | - Subhadra Evans
- Faculty of Health, School of Psychology, Deakin University, Geelong, Australia
| | - Jyotsna Agrawal
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Glenn Melvin
- Faculty of Health, School of Psychology, Deakin University, Geelong, Australia
| | - Jennifer O'Brien
- Faculty of Health, School of Psychology, Deakin University, Geelong, Australia
| | - Shane McIver
- Faculty of Health, School of Health and Social Development, Deakin University, Geelong, Australia
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Skarbø T, Balmbra SM. Establishment of a multifamily therapy (MFT) service for young adults with a severe eating disorder - experience from 11 MFT groups, and from designing and implementing the model. J Eat Disord 2020; 8:9. [PMID: 32161647 PMCID: PMC7050140 DOI: 10.1186/s40337-020-0285-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders are serious illnesses leading to a substantially lowered quality of life not only for the patient but also for their family. They are difficult to treat, and many patients fail to complete their treatment. At the Regional Centre for Eating Disorders (RESSP) at Nordland Hospital in Bodø, in the north of Norway, it was apparent that many young adult patients maintained an active, ongoing relationship with their family of origin, and that parents and others were often highly involved in their life and illness. It was therefore desirable to develop a treatment model involving family members; specifically a multifamily therapy (MFT) group programme. METHODS The aim was to establish an MFT service at RESSP for young adult patients suffering from severe eating disorders. This involved, (1) work preparatory to the establishment of the new service, (2) the development and implementation of a suitable MFT model, and (3) sharing the skills and knowledge gained from our experiences to other professionals in the field, and in other settings. This work of development and change can be understood as a process of innovation and is here described within the framework of implementation theory. The work took place in a clinically naturalistic context at the centre. RESULTS The MFT model description is based on experience during its development as well as its final form. The stages of this development process and of the changes made in order to establish the new service are described, together with its core components. To date, 68 patients and 198 family members have participated. Dropout rate has been 7.4% and the majority of patients have continued in treatment after completion of the MFT groups. BMI measurements show a significant weight-gain for those with an underweight at start. 32 other professionals have been trained in the model, and a similar service started in 3 other units. CONCLUSION The new model has been welcomed by patients and families alike. The MFT group programme has had a strikingly low dropout rate and a majority of patients have continued in treatment. BMI measurements show a significant weight-gain for those being underweight at start. Other therapists have been trained in the model, and similar services set up elsewhere. In order to document and increase the usefulness of the MFT treatment, a research project has been initiated to evaluate experience and outcomes both quantitatively and qualitatively.
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Affiliation(s)
- Tove Skarbø
- Regional Centre for Eating Disorders, Division of Addiction and Specialised Psychiatry, Nordland Hospital, Bodø, Norway
| | - Steven M Balmbra
- Regional Centre for Eating Disorders, Division of Addiction and Specialised Psychiatry, Nordland Hospital, Bodø, Norway
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Characteristics of patients in an eating disorder sample who dropped out: 2-year follow-up. Eat Weight Disord 2019; 24:767-775. [PMID: 28717972 DOI: 10.1007/s40519-017-0416-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/04/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This manuscript explores the characteristics of individuals diagnosed with an eating disorder who dropped out of treatment, compared with those who completed it. METHOD The participants were 196 patients diagnosed with eating disorders (according to DSM-IV-TR criteria) who consecutively began treatment for the first time in an eating disorders unit. They were assessed at baseline with a set of questionnaires evaluating eating habits, temperament, and general psychopathology. During the follow-up period, patients who dropped out were re-assessed via a telephone interview. RESULTS In the course of a 2-year follow-up, a total of 80 (40.8%) patients were labeled as dropouts, and 116 (59.2%) remaining subjects were considered completers. High TCI scores in the character dimensions of Disorderliness (NS4) (p < .01) and total Novelty Seeking (NST), along with low scores in Dependency (RD4), were significantly associated with dropout in the course of 2 years. Once the results were submitted to logistic regression analysis, dropout only remained associated with high scores in Disorderliness (NS4) and, inversely, with an initial Anorexia Nervosa (AN) diagnosis (p < .05). Reasons for dropout stated by the patients included logistic difficulties, subjective improvement of their condition, and lack of motivation. DISCUSSION Clinicians should handle the first therapeutic intervention with particular care in order to enhance their understanding of clients and their ability to rapidly identify those who are at risk of dropping out of treatment. LEVEL OF EVIDENCE Level III: Cohort Study.
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Basterfield A, Dimitropoulos G, Bills D, Cullen O, Freeman VE. "I would love to have online support but I don't trust it": Positive and negative views of technology from the perspective of those with eating disorders in Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:604-612. [PMID: 29498122 DOI: 10.1111/hsc.12557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2018] [Indexed: 06/08/2023]
Abstract
This qualitative study aims to explore how individuals who are seeking help and support for eating disorders use various forms of technology. Fifteen participants, recruited from an Eating Disorder Program in a hospital setting and an eating disorder community support centre, voluntarily participated in focus groups and individual interviews in 2015. The authors used thematic analysis to code and analyse the qualitative data, and three themes were identified: safety, connection and technology development. This study identifies the need for technology use to be addressed and integrated into clinical services for eating disorders, as well as for safe and helpful technology tools to be developed for this population.
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Affiliation(s)
- Annie Basterfield
- Bariatric Surgery Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Gina Dimitropoulos
- Eating Disorder Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
- Matheson Centre for Mental Health Research Education, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Donna Bills
- Eating Disorders Program, Lakeridge Health, Oshawa, ON, Canada
| | - Olivia Cullen
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Victoria E Freeman
- Eating Disorder Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Young Adults Eating Disorders Program, Southlake Regional Health Centre, Newmarket, ON, Canada
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Okamoto Y, Miyake Y, Nagasawa I, Shishida K. A 10-year follow-up study of completers versus dropouts following treatment with an integrated cognitive-behavioral group therapy for eating disorders. J Eat Disord 2017; 5:52. [PMID: 29177049 PMCID: PMC5693579 DOI: 10.1186/s40337-017-0182-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) has been recommended for the treatment of eating disorders, and group therapy is known to have certain advantages over individual therapy. The aim of the current study was to compare the 10-year prognosis of patients who completed integrated group CBT with those who dropped out and to examine the effect of completion of group CBT on the prognosis. METHODS The participants were 65 adult patients with eating disorders. All patients were women and Japanese. The average age (19-37) of the patients was 25.1 ± 3.8 years, and the average body mass index (BMI) was 17.7 ± 2.0. We conducted integrated group CBT with the patients and compared eating disorder symptoms, mood states, coping styles, and self-esteem before and after therapy. Furthermore, we compared clinical features and the 10-year prognosis of patients who completed the treatment and those who dropped out. RESULTS After 10 sessions of group therapy, Eating Attitudes Test scores, Profile of Mood States depression scores, and Coping Inventory for Stressful Situations emotion-oriented scores decreased, while Rosenberg's Self-Esteem Scale scores increased. Regarding the results of the 10-year follow up, the completer group had more patients with a good prognosis. In contrast, the dropout group had more patients with a poor prognosis. CONCLUSIONS Those who completed the integrated group CBT had a good prognosis. Group therapy gives the patients an opportunity to form peer relationships, and helps them to develop communication and socialization skills. Furthermore, in the group therapy sessions, the patients develop self-awareness by listening to other members of the group and they also develop interpersonal relationships. This effect may be temporary, but experience of group therapy may provide hope for the patient and increase the chance of the patient continuing treatment. TRIAL REGISTRATION Retrospectively registered in University Hospital Medical Information Network in Japan: No. 000028868 (May 19th, 2017).
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Affiliation(s)
- Yuri Okamoto
- Health Service Center, Hiroshima University, 1-7-1, Kagamiyama, Higashihiroshima, Hiroshima, 739-8514 Japan
| | - Yoshie Miyake
- Health Service Center, Hiroshima University, 1-7-1, Kagamiyama, Higashihiroshima, Hiroshima, 739-8514 Japan
| | - Ichie Nagasawa
- Health Service Center, Hiroshima University, 1-7-1, Kagamiyama, Higashihiroshima, Hiroshima, 739-8514 Japan
| | - Kazuhiro Shishida
- Department of Psychiatry and Neurosciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
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Elmquist J, Shorey RC, Anderson SE, Temple JR, Stuart GL. The Relationship Between Eating Disorder Symptoms and Treatment Rejection among Young Adult Men in Residential Substance Use Treatment. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:39-44. [PMID: 27257382 PMCID: PMC4877080 DOI: 10.4137/sart.s33396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 11/05/2022]
Abstract
Research has demonstrated that individuals with substance use disorders (SUDs) and comorbid mental health problems evidence heightened negative consequences, including poorer treatment outcomes, a higher risk for relapse, and mortality compared to individuals with a single disorder. In this study, we focus on the comorbidity between SUDs and eating disorder (ED) symptomatology, as EDs are similarly associated with high rates of relapse, morbidity, and mortality. Of particular importance is research examining treatment rejection among individuals in treatment for SUDs with cooccurring ED symptomatology. This study seeks to add to the literature by examining treatment rejection among young adult men in residential treatment for SUDs (N = 68) with cooccurring ED symptomatology. Results from hierarchical regression analyses indicated that ED symptoms were significantly associated with treatment rejection after controlling for alcohol and drug use and problems and depression symptoms. Although this is a preliminary study, the results add to a growing body of research examining the comorbidity between SUDs and ED symptomatology. Future research examining this relationship is needed to further elucidate the treatment patterns among individuals with comorbid ED symptoms and substance use diagnoses.
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Affiliation(s)
- JoAnna Elmquist
- Department of Psychology, The University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Ryan C Shorey
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | - Jeff R Temple
- Department of OB/GYN, University of Texas Medical Branch Health, Galveston, TX, USA
| | - Gregory L Stuart
- Department of Psychology, The University of Tennessee, Knoxville, Knoxville, TN, USA
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Brachel RV, Windgassen A, Hötzel K, Hirschfeld G, Vocks S. Was passiert nach dem letzten Klick? ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2016. [DOI: 10.1026/1616-3443/a000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Bisherige Studien zeigen, dass internetbasierte Interventionen kurzfristig die Veränderungsmotivation bei Essstörungen verbessern können. Zur Stabilität dieser Effekte ist jedoch wenig bekannt. Fragestellung: Wie entwickeln sich die Veränderungsmotivation, die Essstörungspsychopathologie und das Selbstwertgefühl 8 Wochen nach Abschluss eines internetbasierten Motivationsprogramms? Methode: Neunzig Frauen bearbeiteten den Stages of Change Questionnaire for Eating Disorders, den Eating Disorder Examination-Questionnaire und die Rosenberg Self-Esteem-Scale unmittelbar (Post) sowie 8 Wochen nach Abschluss der Intervention (Katamnese). Ergebnisse: Es zeigten sich stabile Effekte in der Veränderungsmotivation sowie im Selbstwertgefühl. Zusätzlich zeigten sich in der Essstörungspsychopathologie signifikante Verbesserungen. Schlussfolgerungen: Die Studie belegt die längerfristige Wirksamkeit eines internetbasierten Motivationsprogramms für Frauen mit Essstörungen.
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Affiliation(s)
- Ruth von Brachel
- Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | - Anja Windgassen
- Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Katrin Hötzel
- Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | | | - Silja Vocks
- Klinische Psychologie und Psychotherapie, Universität Osnabrück
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Hötzel K, von Brachel R, Schmidt U, Rieger E, Kosfelder J, Hechler T, Schulte D, Vocks S. An Internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial. Psychol Med 2014; 44:1947-1963. [PMID: 24128818 DOI: 10.1017/s0033291713002481] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Previous research has demonstrated an association between low motivation to change and an unfavorable treatment outcome in patients with an eating disorder. Consequently, various studies have examined the effects of motivational enhancement therapy (MET) on motivation to change and treatment outcome in eating disorders. In each of these studies, MET was administered in a face-to-face setting. However, because of its anonymity and ease of access, the internet provides several advantages as the format for such an intervention. Therefore, the current study investigated the effects of an internet-based program ('ESS-KIMO') to enhance motivation to change in eating disorders. METHOD In total, 212 females were accepted for participation and assigned randomly to the intervention condition (n = 103) or waiting-list control condition (n = 109). The intervention consisted of six online MET sessions. Before and after the intervention or waiting period respectively, participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED), the Pros and Cons of Eating Disorders Scale (P-CED), the Self-Efficacy Scale (SES), and the Rosenberg Self-Esteem Scale (RSES). A total of 125 participants completed the assessment post-treatment. Completer analyses and intent-to-treat analyses were performed. RESULTS Significant time × group interactions were found, indicating a stronger increase in motivational aspects and self-esteem, in addition to a stronger symptom reduction on some measures from pre- to post-treatment in the intervention group compared to the control group. CONCLUSIONS Internet-based approaches can be considered as useful for enhancing motivation to change in eating disorders and for yielding initial symptomatic improvement.
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Affiliation(s)
- K Hötzel
- Department of Psychology, Clinical Psychology and Psychotherapy,Osnabrück University,Germany
| | - R von Brachel
- Department of Psychology, Clinical Psychology and Psychotherapy,Osnabrück University,Germany
| | - U Schmidt
- Section of Eating Disorders, Institute of Psychiatry,King's College London,UK
| | - E Rieger
- Research School of Psychology,Australian National University,Australia
| | - J Kosfelder
- Department of Social Sciences and Cultural Studies,University of Applied Sciences Düsseldorf,Germany
| | - T Hechler
- German Pediatric Pain Center, Children's and Adolescents' Hospital,Witten/Herdecke University,Datteln,Germany
| | - D Schulte
- Department of Psychology, Clinical Psychology and Psychotherapy,Ruhr-University Bochum,Germany
| | - S Vocks
- Department of Psychology, Clinical Psychology and Psychotherapy,Osnabrück University,Germany
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Jordan J, McIntosh VVW, Carter FA, Joyce PR, Frampton CMA, Luty SE, McKenzie JM, Bulik CM. Clinical characteristics associated with premature termination from outpatient psychotherapy for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:278-84. [PMID: 24842307 DOI: 10.1002/erv.2296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 11/10/2022]
Abstract
AIM The literature on clinical characteristics associated with premature termination of treatment (PTT) is beset with conflicting and non-replicated findings. This study explores clinical characteristics potentially associated with PTT in a randomised controlled outpatient psychotherapy trial for anorexia nervosa (AN). METHODS Participants were 56 women aged 17-40 years with spectrum AN. The completer group (n = 35) included those completing at least 15/20 planned sessions with the remainder of the sample comprising the PTT group (n = 21). Variables examined included demographic factors, psychosocial functioning, psychiatric history, lifetime comorbidity, temperament and eating disorder characteristics. Logistic regression was used to examine significant variables. A Kaplan-Meier survival curve was used to illustrate time taken to PTT. RESULTS The mean number of sessions in the PTT group was 8.1. Lower self-transcendence scores on the Temperament and Character Inventory were associated with PTT. CONCLUSIONS Recognising and addressing personality factors have the potential to enhance retention in treatment.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
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von Brachel R, Hötzel K, Hirschfeld G, Rieger E, Schmidt U, Kosfelder J, Hechler T, Schulte D, Vocks S. Internet-based motivation program for women with eating disorders: eating disorder pathology and depressive mood predict dropout. J Med Internet Res 2014; 16:e92. [PMID: 24686856 PMCID: PMC4004149 DOI: 10.2196/jmir.3104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology. OBJECTIVE The aim of the present study was to identify predictors of dropout from this Web program. METHODS A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants' age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method. RESULTS The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout. CONCLUSIONS Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.
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Affiliation(s)
- Ruth von Brachel
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany.
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Hoetzel K, von Brachel R, Schlossmacher L, Vocks S. Assessing motivation to change in eating disorders: a systematic review. J Eat Disord 2013; 1:38. [PMID: 24999416 PMCID: PMC4081820 DOI: 10.1186/2050-2974-1-38] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 09/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with anorexia and bulimia nervosa are often ambivalent about their eating disorder symptoms. Therefore, a lack of motivation to change is a frequent problem in the treatment of eating disorders. This is of high relevance, as a low motivation to change is a predictor of an unfavourable treatment outcome and high treatment dropout rates. In order to quantify the degree of motivation to change, valid and reliable instruments are required in research and practice. The transtheoretical model of behaviour change (TTM) offers a framework for these measurements. OBJECTIVE This paper reviews existing instruments assessing motivation to change in eating disorders. METHOD We screened N = 119 studies from the databases Medline and Psycinfo found by combinations of the search keywords 'eating disorder', 'anorexia nervosa', 'bulimia nervosa', 'motivation', 'readiness to change', 'assessment', 'measurement', and 'questionnaire'. RESULTS Ultimately, n = 15 studies investigating psychometric properties of different assessment tools of motivation to change in eating disorders were identified. Reviewed instruments can be divided into those assessing the stages of change according to the TTM (6 instruments) and those capturing decisional balance (3 instruments). Overall, the psychometric properties of these instruments are satisfactory to good. DISCUSSION Advantages, disadvantages, and limitations of the reviewed assessment tools are discussed. So far, the TTM provides the only framework to assess motivation to change in eating disorders.
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Affiliation(s)
- Katrin Hoetzel
- Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069, Osnabrück, Germany
- Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Ruth von Brachel
- Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069, Osnabrück, Germany
- Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Lena Schlossmacher
- Department of Psychology, Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Silja Vocks
- Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069, Osnabrück, Germany
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Pingani L, Catellani S, Arnone F, De Bernardis E, Vinci V, Ziosi G, Turrini G, Rigatelli M, Ferrari S. Predictors of dropout from in-patient treatment of eating disorders: an Italian experience. Eat Weight Disord 2012; 17:e290-7. [PMID: 23449083 DOI: 10.1007/bf03325140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The aim of the study was to examine possible risk factors for dropout from in-patient treatment for eating disorders (ED). MATERIALS AND METHODS The present study consisted of a retrospective analysis of clinical and non-clinical available information about 186 patients suffering from ED consecutively admitted into the Villa Maria Luigia Private Hospital (Parma, Italy) in a three-year period (01/01/2006 - 31/12/2009). Sociodemographics, clinical history and current features, and results to the following psychometric instruments were analysed: Eating Disorder Questionnaire (EDQ), Predisposing, On-set and Maintaining risk factors list for Eating Disorders, Eating Disorders Inventory-II, Body Uneasiness Test and SCL-90. RESULTS Of the 186 patients, 46 (24.7%) voluntarily left the treatment program prematurely. Predictive factors included poor educational and professional achievements, parents' divorcing, parents' history of substance abuse and difficulties in interpersonal relationships. DISCUSSION Dropout is a multifactorial phenomenon with deep clinical consequences: the recognition of possible risk factors may support the choice of specific therapeutic strategies to improve the treatment of ED and its outcomes.
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Affiliation(s)
- L Pingani
- International PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.
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Dejong H, Broadbent H, Schmidt U. A systematic review of dropout from treatment in outpatients with anorexia nervosa. Int J Eat Disord 2012; 45:635-47. [PMID: 22684990 DOI: 10.1002/eat.20956] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Dropout from treatment has serious implications for patients, clinicians, and researchers. The aim of this study was to examine rates of dropout from outpatient treatment for anorexia nervosa (AN) and critically examine the various definitions of dropout used. METHOD A systematic review was conducted, including pharmacological and psychological interventions. All articles in PubMed, Web of Science, and the Cochrane Library were considered, and screened against a priori inclusion/exclusion criteria. Relationships between treatment outcome and dropout rate were examined across studies. RESULTS Nineteen relevant studies were identified, with dropout rates ranging from 4.8% (family therapy) to 100% (dietary advice). In most cases, dropout was in the range of 20-40%. Definitions of dropout used varied widely. A significant negative correlation was found between rate of dropout and body mass index (BMI) at 1 year, but this did not remain significant when differences in BMI at baseline were taken into account. DISCUSSION High rates of dropout from treatment for AN have serious implications for recovery, research, and the development of new treatments. A suggested reporting structure is proposed, with the aim of increasing the consistency of dropout reporting and facilitating greater understanding of this phenomenon.
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Affiliation(s)
- Hannah Dejong
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, United Kingdom.
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Rodríguez-Cano T, Beato-Fernandez L, Moreno LR, Vaz Leal FJ. Influence of attitudes towards change and self-directness on dropout in eating disorders: a 2-year follow-up study. EUROPEAN EATING DISORDERS REVIEW 2012; 20:e123-8. [PMID: 22302485 DOI: 10.1002/erv.2157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 12/08/2011] [Accepted: 12/21/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study examined dropout-related factors at the Outpatient Eating Disorders Treatment Programme. METHOD One hundred ninety-six eating disorders patients following DSM-IV diagnostic criteria that consecutively commenced treatment were recruited and followed up for a 2-year period. A total of 151 patients completed the whole assessment with a set of questionnaires evaluating eating and general psychopathology. The Attitudes towards Change in Eating Disorders questionnaire was used, and personality was evaluated using the Temperament and Character Inventory. During the follow-up period, patients were re-assessed. Two years later, 102 patients continued on treatment. RESULTS Scores on Precontemplation at the beginning were predictors for dropout at 2-year follow-up. Character variables, as Responsibility, Integrity and Self-acceptance were protective factors to be at Precontemplation stage. DISCUSSION The clinician's challenge is to help eating disorders patients to develop an unyielding sense of responsibility and self-acceptance, aimed to integrate the therapeutic choice into their own intrapersonal frame of goals.
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Fenger M, Mortensen EL, Poulsen S, Lau M. No-shows, drop-outs and completers in psychotherapeutic treatment: demographic and clinical predictors in a large sample of non-psychotic patients. Nord J Psychiatry 2011; 65:183-91. [PMID: 20854221 DOI: 10.3109/08039488.2010.515687] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A primary challenge in mental health services is a high rate of non-attendance (i.e. no-show and drop-out) for patients referred to treatment for psychiatric disorders. AIM The aim of the present study was to assess the influence of demographic and clinical variables on mental health treatment attendance and to investigate differences in predictors for no-shows and drop-outs. METHODS A naturalistic study of 2473 non-psychotic consecutive patients offered psychotherapeutic treatment at a community mental health centre in Denmark. Fifteen demographic and clinical variables were recorded at assessment. Bivariate and multiple logistic regression analyses were conducted to investigate the associations between these variables and no-show and drop-out. RESULTS Of the 2473 participants, 668 (27.0%) did not show up for treatment, whereas 290 (11.7%) dropped out of treatment. Regression analysis showed that the significant predictors of treatment no-show were: age below 25, no more than the compulsory 9 years of school education, no sick leave, a diagnosis of personality disorder, a Global Assessment of Functioning score (GAF) below 40 or above 70, no previous psychiatric/psychological treatment, no use of antidepressants and substance abuse. The significant predictors of treatment drop-out were: age below 45, no more than the compulsory 9 years of school education or up to 11 years of school education, no vocational/university education, unemployment and substance abuse. CONCLUSION No-show was predicted by both demographic and clinical factors, whereas drop-out was predicted by demographic factors and substance abuse as the only clinical factor. Results and strategies to reduce non-attendance are discussed.
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Affiliation(s)
- Morten Fenger
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark. Morten.Fenger@.regionh.dk
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16
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The effect of pre-exposure and recovery type on activity-based anorexia in rats. Appetite 2011; 56:567-76. [DOI: 10.1016/j.appet.2011.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/06/2011] [Accepted: 01/22/2011] [Indexed: 11/20/2022]
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17
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Vandereycken W, Devidt K. Dropping out from a specialized inpatient treatment for eating disorders: the perception of patients and staff. Eat Disord 2010; 18:140-7. [PMID: 20390617 DOI: 10.1080/10640260903585557] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Most studies of treatment drop-outs have focused on demographic and clinical patient characteristics as possible predictors. To get a better insight in the meaning of dropping-out from therapy, during 1 year the viewpoints of patients and staff were compared in each case (N = 21 or 15.2%) of premature termination of an inpatient treatment program for eating disorders. Both patients and staff were reporting as important reasons of drop-out: not enough freedom, treatment being too difficult, and lack of trust. Contrary to the staff, patients were more often satisfied with the therapy and therefore did not expect further benefit in continuing the inpatient treatment. The findings are discussed mainly within the context of patient-staff interaction. The authors propose to abandon the term "drop-out" because of its negative connotation.
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Affiliation(s)
- Walter Vandereycken
- Eating Disorders Unit, Alexian Brothers Psychiatric Hospital, Tienen, Belgium.
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18
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Fassino S, Pierò A, Tomba E, Abbate-Daga G. Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry 2009; 9:67. [PMID: 19818137 PMCID: PMC2765944 DOI: 10.1186/1471-244x-9-67] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 10/09/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dropout (DO) is common in the treatment of eating disorders (EDs), but the reasons for this phenomenon remain unclear. This study is an extensive review of the literature regarding DO predictors in EDs. METHODS All papers in PubMed, PsycINFO and Cochrane Library (1980-2009) were considered. Methodological issues and detailed results were analysed for each paper. After selection according to inclusion criteria, 26 studies were reviewed. RESULTS The dropout rates ranged from 20.2% to 51% (inpatient) and from 29% to 73% (outpatient). Predictors of dropout were inconsistent due to methodological flaws and limited sample sizes. There is no evidence that baseline ED clinical severity, psychiatric comorbidity or treatment issues affect dropout. The most consistent predictor is the binge-purging subtype of anorexia nervosa. Good evidence exists that two psychological traits (high maturity fear and impulsivity) and two personality dimensions (low self-directedness, low cooperativeness) are related to dropout. CONCLUSION Implications for clinical practice and areas for further research are discussed. Particularly, these results highlight the need for a shared definition of dropout in the treatment of eating disorders for both inpatient and outpatient settings. Moreover, the assessment of personality dimensions (impulse control, self-efficacy, maturity fear and others) as liability factors for dropout seems an important issue for creating specific strategies to reduce the dropout phenomenon in eating disorders.
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Affiliation(s)
- Secondo Fassino
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy.
| | - Andrea Pierò
- Mental Health Department ASL TO 4, Mental Health Centre, Via Blatta 10, Chivasso, 10034 Turin, Italy
| | - Elena Tomba
- Department of Psychology, University of Bologna, 40127 Bologna, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy
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Vandereycken W, Vansteenkiste M. Let eating disorder patients decide: Providing choice may reduce early drop-out from inpatient treatment. EUROPEAN EATING DISORDERS REVIEW 2009; 17:177-83. [PMID: 19306300 DOI: 10.1002/erv.917] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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).
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20
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Masson PC, Sheeshka JD. Clinicians' perspectives on the premature termination of treatment in patients with eating disorders. Eat Disord 2009; 17:109-25. [PMID: 19242841 DOI: 10.1080/10640260802714548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In-depth interviews concerning the premature termination of treatment (PTT) were conducted with seven clinicians in an inpatient eating disorders program. Motivation to be in the program and work on recovery, and the ability to establish a trusting relationship with staff were thought to be important factors in completing treatment. Patients who are asked to leave the treatment program, termed "administrative discharge" (AD), were believed by clinicians to differ from patients who dropped out of treatment in terms of having more reasons to stay in the program. While AD was described as a stressful process, particularly when there was disagreement among team members, it was considered necessary in order to maintain a recovery-centered community milieu. These findings, their implications and suggestions for future research are discussed.
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Affiliation(s)
- Philip C Masson
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Conrad R, Wegener I, Imbierowicz K, Liedtke R, Geiser F. Alexithymia, temperament and character as predictors of psychopathology in patients with major depression. Psychiatry Res 2009; 165:137-44. [PMID: 19084277 DOI: 10.1016/j.psychres.2007.10.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Revised: 10/19/2007] [Accepted: 10/24/2007] [Indexed: 11/24/2022]
Abstract
The study investigated the capacity of alexithymic personality features, in combination with temperament and character traits, age and gender, to predict psychopathological symptoms in patients with major depression. Consecutive patients (n=339) were investigated using the Toronto Alexithymia Scale-20 (TAS-20), the Temperament and Character Inventory (TCI), the Symptom Checklist-90-R (SCL-90-R), and the Hamilton Depression and Anxiety Rating Scales (HDRS, HARS). The amount of variance in SCL-90-R subscales and Hamilton scales predicted by TAS-20, TCI, age and gender was calculated by linear regression analyses. The 'difficulties identifying feeling' facet of alexithymia appeared to be a significant predictor of all dimensions of psychopathology. Among TCI scales harm avoidance was the strongest predictor for somatization, phobic anxiety, and anxiety (SCL-90-R, HARS); low self-directedness was the strongest predictor for obsessionality, depression (SCL-90-R, HDRS), interpersonal sensitivity and psychoticism; and low cooperativeness was the strongest predictor for hostility and paranoia. In conclusion, many psychopathological symptoms in major depression are associated with difficulties in the identification of emotions. Relative to alexithymia, Cloninger's psychobiological model of personality could predict psychopathological symptoms in a distinct and meaningful manner. The TAS-20 and the TCI are useful questionnaires for a better understanding of the relationship between psychopathology and personality in major depression.
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Affiliation(s)
- Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany.
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Rigaud D, Brayer V, Biton-Jélic V, Païs V, Pennacchio H, Brun JM. Intérêt de la nutrition entérale par sonde nasogastrique dans la boulimie. Presse Med 2007; 36:1354-63. [PMID: 17408917 DOI: 10.1016/j.lpm.2007.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 11/09/2006] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Few effective treatments are available for severe forms of bulimia nervosa, which are accompanied by malnutrition, anxiety, and depressive mood. We previously showed in an open study that nasogastric tube feeding (TF) reduced binges and purging in patients with anorexia nervosa. METHODS This prospective randomized trial compared bulimia patients in two treatment groups: one group received TF at home, together with psychotherapy, nutritional counseling and a support group while the control group received only psychotherapy, nutritional counseling, and a support group. Patients in the first group underwent TF for 8 weeks (exclusively for 10 days and associated with meals thereafter). Assessment was based on clinical examination, laboratory results, and a variety of questionnaires (our in-house instrument for measuring binge and vomiting episodes, eating disorder inventory, Beck's depression inventory and the Hamilton rating scale for anxiety), all performed at the onset of treatment and at 8 days, 8 weeks (i.e., the end of TF), and 3 months after treatment began. RESULTS Binges and vomiting disappeared faster and more frequently in TF patients than in the control group: 65% versus 29% (p<0.01). Three months later, these remained less frequent in the TF group than among controls (52% versus 33%, p=0.064). Nutritional status, depression, and anxiety improved more among the TF than control subjects (p<0.05). CONCLUSION Tube feeding was effective in these patients with bulimia nervosa, reducing the number of binge and vomiting episodes and improving nutritional status and mood.
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