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Li C, Lyu S, Yan J, Meng X. The effect of gender in binge eating behavior in Chinese culture: the serial mediation model of body dissatisfaction and self-acceptance. Front Psychol 2023; 14:1285272. [PMID: 38144993 PMCID: PMC10739541 DOI: 10.3389/fpsyg.2023.1285272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The gender difference of binge eating behavior been highlighted by previous studies. However, psychological mechanisms underlying the gender difference of binge eating behavior remain unclear. This study addressed this issue from a sociocultural perspective. Methods Firstly, we investigated the mediation effect of body dissatisfaction on the gender difference of binge eating behavior. Secondly, we examine the serial mediating role of body dissatisfaction and self-acceptance in gender differences of binge eating behavior. Here, we analyzed data from 703 Chinese university students using SPSS 26.0 and SPSS PROCESS. Results In Chinese culture, body dissatisfaction and self-acceptance independently or through a serial way mediate the gender differences in binge eating behaviors. Discussion We discussed the implications and limitations of the present study.
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Affiliation(s)
- Chunlu Li
- Department of Histology and Embryology, School of Basic Medical Sciences, Guizhou Medical University, Guiyang, Guizhou, China
- Key Laboratory for Research on Autoimmune Diseases of Higher Education Schools in Guizhou Province, Guiyang, China
- Guizhou Health Development Research Center, Guiyang, China
| | - Shuhui Lyu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, China
| | - Jimin Yan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, China
| | - Xiaolu Meng
- Guizhou Health Development Research Center, Guiyang, China
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, China
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Lee Y, Yoon H, Kim T, Jung H. Food Insecurity during the Pandemic in South Korea: The Effects of University Students' Perceived Food Insecurity on Psychological Well-Being, Self-Efficacy, and Life Satisfaction. Foods 2023; 12:3429. [PMID: 37761140 PMCID: PMC10528267 DOI: 10.3390/foods12183429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
This study examined the impact of university students' perceptions of food insecurity on psychological well-being, self-efficacy, and life satisfaction and observed that the students' gender plays a moderating role in this causal relationship, based on a total of 491 university students who participated in this empirical study. This study used SPSS (Version 22.0) and AMOS (Version 20.0) for the analyses. This study examines the structural relationship of this causal model. Our findings suggest that students' perceived food insecurity negatively affects the status of their psychological well-being and self-efficacy. However, contrary to expectations, perceived food insecurity has no negative effects on students' life satisfaction. In addition, the level of students' psychological well-being positively influences their life satisfaction, while self-efficacy does not. The moderating effects of gender differences in this research were also disclosed. Limitations and future research directions are also discussed.
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Affiliation(s)
- Yoojin Lee
- Smart Education Platform, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea; (Y.L.); (T.K.)
| | - Hyehyun Yoon
- Department of Culinary Arts and Foodservice Management, College of Hotel & Tourism Management, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea;
| | - Taehee Kim
- Smart Education Platform, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea; (Y.L.); (T.K.)
| | - Hyosun Jung
- Center for Converging Humanities, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
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McDonald S, Williams AJ, Barr P, McNamara N, Marriott M. Service user and eating disorder therapist views on anorexia nervosa recovery criteria. Psychol Psychother 2021; 94:721-736. [PMID: 33761183 PMCID: PMC8451855 DOI: 10.1111/papt.12340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recovery from anorexia nervosa (AN) is difficult to define, and efforts to establish recovery criteria have led to several versions being proposed. Using the perspectives of people with histories of AN and therapists working in the field, we sought to explore the face validity of Khalsa et al (2017) as one of the most recent examples of proposed systematic recovery criteria. DESIGN We interviewed 11 health service users (SUs) with histories of AN who had previously received treatment alongside 8 eating disorder therapists (EDTs), exploring their views on the proposed AN recovery criteria. METHODS Data from verbal and written interviews were analysed thematically. Separate thematic analyses of SU and EDT interviews highlighted where concerns converged and diverged across participants. RESULTS Both groups saw some merits of having universally recognized recovery criteria, and the multidimensional approach was welcomed, but EDTs were uncomfortable with considering their use in therapy and SUs felt key components were missing around emotional coping and life quality. SUs disliked the prominence of body mass index (BMI) in the criteria, and all struggled with the proposed duration for recovery. Conceptually, the notion of recovery as an endpoint rather than a journey was contested. CONCLUSIONS Our findings indicate disparities between academically derived recovery criteria and lived experiences and indicate perceived challenges in using such criteria in therapeutic settings. Including SUs and EDTs in the development of criteria may improve the likelihood of consolidating AN recovery criteria, but conceptual challenges remain. PRACTITIONER POINTS AN recovery is complex, and the use of research-based AN recovery criteria in therapeutic settings could have a detrimental effect on SUs' outcomes. EDTs should be aware of efforts to define AN recovery criteria. EDTs should engage with debates on defining AN recovery and seek to promote participation in such debates to SUs.
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Affiliation(s)
- Sarah McDonald
- Department of PsychologyNottingham Trent UniversityUK,Eating Disorder ServiceNottinghamshire Healthcare Foundation NHS TrustUK
| | - A. Jess Williams
- Department of PsychologyNottingham Trent UniversityUK,University of BirminghamUK
| | - Phoebe Barr
- Department of PsychologyNottingham Trent UniversityUK
| | | | - Mike Marriott
- Department of PsychologyNottingham Trent UniversityUK
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Romano KA, Heron KE, Ebener D. Associations among weight suppression, self-acceptance, negative body image, and eating disorder behaviors among women with eating disorder symptoms. Women Health 2021; 61:791-799. [PMID: 34433381 DOI: 10.1080/03630242.2021.1970082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study aimed to clarify existing research that has inconsistently shown that weight suppression (differences between individuals' highest and current body weights) is associated with worse eating disorder (ED) behaviors and negative body image among women with lifetime EDs, by examining whether an understudied client-supported protective factor for ED pathology - self-acceptance - moderates these associations. Currently symptomatic women with lifetime EDs (N = 108) completed measures assessing self-acceptance and ED symptoms via an online survey. Moderated regressions examined whether self-acceptance moderated associations between weight suppression and both body image (weight/shape preoccupation, overvaluation, dissatisfaction) and ED behavior (dietary restraint, compensatory behaviors, binge eating) outcomes. Results indicated that weight suppression was associated with more severe negative body image and dietary restraint, but not compensatory behaviors or binge eating. In contrast, self-acceptance consistently emerged as a protective factor relative to all negative body image and ED behavior indices. This protective effect did not offset apparent risk factor associations between weight suppression, and negative body image and ED behavior outcomes. These results support further assessment of self-acceptance as an understudied protective factor for women's ED symptoms and as a mechanism of change in EDs intervention research. Women's weight suppression should be assessed during ED prevention initiatives.
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Affiliation(s)
- Kelly A Romano
- The Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Kristin E Heron
- The Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA.,Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Deborah Ebener
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, Florida, USA
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Kasson E, Vázquez MM, Doroshenko C, Fitzsimmons-Craft EE, Wilfley DE, Taylor CB, Cavazos-Rehg PA. Exploring Social Media Recruitment Strategies and Preliminary Acceptability of an mHealth Tool for Teens with Eating Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7979. [PMID: 34360270 PMCID: PMC8345665 DOI: 10.3390/ijerph18157979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/24/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Abstract
(1) Background: The current study leveraged social media to connect with teens with EDs to identify population specific characteristics and to gather feedback on an mHealth intervention. (2) Methods: We recruited teens with EDs from social media in two phases: (1) Discovery Group, (2) Testing Group. The Discovery Group (n = 14) participants were recruited from Facebook/Instagram and were asked to review the app for up to one week and provide qualitative feedback. After incorporating feedback from the Discovery Group, we refined our social media outreach methods to connect with 30 teens with EDs to pilot this mobile app. Recruitment from a variety of platforms on social media was successful, with the majority of enrolled participants in the Testing Group coming from Snapchat (60%) and a large percentage of participants belonging to gender and sexual minority groups (63%). (3) Results: Participants from both groups experienced extremely high rates of depression (100% Discovery, 90% Testing) and/or anxiety symptoms (100% Discovery, 93% Testing) in addition to ED symptoms, and noted this as a possible barrier to app engagement. (4) Conclusion: Use of social media for recruitment of teens with EDs is feasible and may connect with groups who may be more difficult to reach using traditional recruitment methods. Among the Discovery Group there was high acceptability of and interest in an app to support ED recovery, and characteristics of both groups demonstrated need for support in other mental health domains. Future studies should evaluate the preliminary efficacy of such tools among teens to determine the effects of such interventions on ED symptoms and other mental health outcomes.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Melissa M. Vázquez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Christine Doroshenko
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
| | - Denise E. Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Center for m2Health, Palo Alto University, Palo Alto, CA 94304, USA
| | - Patricia A. Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (E.K.); (M.M.V.); (C.D.); (E.E.F.-C.)
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LaMarre A, Rice C. Healthcare providers' engagement with eating disorder recovery narratives: opening to complexity and diversity. MEDICAL HUMANITIES 2021; 47:78-86. [PMID: 32122937 DOI: 10.1136/medhum-2019-011723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
Interdisciplinary healthcare providers (HCPs) receive only minimal training in identifying, referring for and treating eating disorders and may feel ill-prepared to manage them. There is a need for brief interventions that prepare HCPs for work with people with eating disorders, particularly when they do not fit stereotypes about who might experience an eating disorder. One method for enacting brief interventions that make change in this realm is using digital stories (short videos) to generate awareness and knowledge. In this article, we discuss the results of a pilot study exploring the impact of viewing digital stories created by people in eating disorder recovery and their supporters on an interdisciplinary group of HCPs. We showed five stories to 22 HCPs who filled out qualitative prequestionnaires and postquestionnaires about their experiences of viewing the films and how they conceptualised recovery. Providers found the stories evocative; the stories appear to have complexified their perspectives on recovery. HCPs desired more diverse, detailed and lengthy stories, indicating that pursuing digital storytelling for HCP education and awareness may hold promise. Through centring the voices of people with eating disorders and in recovery, digital stories may also provide new ways of talking about recovery that open up possibilities for embracing difference.
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Affiliation(s)
- Andrea LaMarre
- Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Carla Rice
- Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
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Romano KA, Lipson SK. Dietary restraint patterns and eating disorder help-seeking. Eat Weight Disord 2021; 26:159-168. [PMID: 31853888 DOI: 10.1007/s40519-019-00833-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/10/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Determine whether gender differences exist in associations among central barriers to and facilitators of eating disorder (ED) help-seeking-ED stigma, negative affect, perceived ED treatment need-as a function of individuals' probability of classification within empirically derived groups characterized by different dietary restraint patterns. METHOD As part of the cross-sectional, multi-institute Healthy Bodies Study, women (n = 2215) and men (n = 986) attending three colleges and universities in 2015 completed measures of ED symptoms, affect, and ED help-seeking in an online survey. Structural equation mixture modeling was used to (1) classify women and men, separately, into distinct classes characterized by unique dietary restraint patterns and (2) test associations among the three ED help-seeking barriers and facilitators within each class. RESULTS Five dietary restraint symptoms (food amount limiting attempts, fasting, food avoidance, following food/diet rules, desiring an empty stomach) clustered within four classes among women and three classes among men, which were characterized by qualitative and quantitative similarities and differences. Further, opposite patterns were generally found in associations among the ED help-seeking barriers and facilitators for women versus men as a function of the way dietary restraint symptoms clustered within each class. For example, bivariate associations between worse ED stigma and negative affect relative to greater perceived ED treatment need were both significant only among women in their lowest restraint severity class, whereas these associations were both significant among men in their highest severity class. DISCUSSION These findings can help to increase the reach of ED intervention efforts, including increasing ED help-seeking rates. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Kelly A Romano
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA.
- Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA.
| | - Sarah K Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
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Kenny TE, Boyle SL, Lewis SP. #recovery: Understanding recovery from the lens of recovery-focused blogs posted by individuals with lived experience. Int J Eat Disord 2020; 53:1234-1243. [PMID: 31886573 DOI: 10.1002/eat.23221] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Definitions of eating disorder (ED) recovery have primarily focused on symptom management (i.e., weight regain, reduced/absent ED behaviors, and normalized ED thoughts). Notwithstanding the importance of these approaches, there are arguably additional considerations in ED recovery. In order to get a more comprehensive understanding of recovery, it is necessary to turn to individuals with lived experience. Here, we examine how individuals with lived experience of an ED conceptualize and define recovery in narrative, recovery-focused blogs and consider how this understanding may contribute to definitions of recovery in the field. METHOD Inductive thematic analysis was used to examine 168 blogs posted by at least 120 unique authors (95% women; 36% reporting anorexia nervosa diagnosis) to 10 moderated, ED websites. RESULTS Results from the thematic analysis yielded seven themes: recovery as (1) existing in contrast to the ED, (2) existing in a broader context, (3) subjective, (4) a choice, (5) a complex, nonlinear process, (6) transformative, and (7) overcoming. DISCUSSION The present findings are consistent with previous qualitative research, suggesting that recovery is multifaceted and encompasses more than just symptom management. Notably, bloggers highlighted that recovery may not be equally attainable for all individuals, citing numerous social justice issues in the conceptualization of recovery. This multifaceted and intersectional view of recovery is consistent with consumer models of recovery. We argue that a dimensional model of recovery may be a good starting framework for researchers and clinicians to develop a more comprehensive definition of recovery.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Sarah L Boyle
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
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LaMarre A, Rice C. The eating disorder recovery assemblage: Collectively generating possibilities for eating disorder recovery. FEMINISM & PSYCHOLOGY 2020. [DOI: 10.1177/0959353520941353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this paper, we explore the affective-discursive-material aspects of the supportive eating disorder recovery assemblage. We approach recovery as an “assemblage” to facilitate an understanding of how human (people, systems of care, etc.) and nonhuman (affect, discourses, etc.) forces generate possibilities or impossibilities for recovery. Moving away from framings of recovery as an individual achievement, we consider the relationality and dynamism of eating disorder recovery in interviews with 20 people in recovery and 14 supporters of people in recovery. We draw from experiential accounts to theorize a supportive eating disorder recovery assemblage in relation to trust and love mobilized in interactions and relationships. This supportive eating disorder recovery assemblage can scaffold new understandings of recoveries as multiple and co-produced. Supportive eating disorder recovery assemblages generate improvisational spaces, albeit loosely contained and bounded, for different pathways to and manifestations of “recoveries”. This work builds on a body of feminist scholarship on eating disorders/disordered eating that takes up gendered relationships of power in treatment settings, extending toward and analysing material, affective, embodied, and potentially affirming dimensions of care and emotion in participants’ lives.
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Affiliation(s)
- Andrea LaMarre
- Massey University, New Zealand
- University of Guelph, Canada
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Murray SB. Updates in the treatment of eating disorders in 2019: a year in review in Eating Disorders: The Journal of Treatment & Prevention. Eat Disord 2020; 28:21-31. [PMID: 32138636 DOI: 10.1080/10640266.2020.1723373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Empirical evidence continues to suggest that the majority of patients with eating disorders will not fully recover during treatment, and that treatment gains are vulnerable to relapse in the longer term. The urgent need for improved treatment options for those with eating disorders cannot be overstated. This review article provides an overview of treatment-related research findings published in Eating Disorders: The Journal of Treatment & Prevention during 2019. Importantly, this review encapsulates research (i) outlining guidelines in managing the medical risk inherent to the treatment of eating disorders, (ii) examining the treatment of eating disorders in cross-cultural contexts, (iii) expanding treatment research to novel and atypical eating disorder populations, and (iv) augmenting existing treatment approaches for anorexia nervosa and bulimia nervosa in novel contexts. These articles represent important contributions to the ongoing evolution of the treatment of eating disorders. However, further work is needed in precisely identifying the mechanisms of eating disorder psychopathology, such that emerging treatment efforts may be mapped onto specific targets.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
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Smith K, Dandil Y, Baillie C, Tchanturia K. Well-Being Workshops in Eating Disorder Wards and Their Perceived Benefits to Patients and the Multi-Disciplinary Team: A Pilot Study. Brain Sci 2019; 9:E247. [PMID: 31547489 PMCID: PMC6826568 DOI: 10.3390/brainsci9100247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022] Open
Abstract
A more holistic definition of patients' recovery from eating disorders (EDs) highlights that well-being interventions linked to self-compassion are under-researched and under-utilised. Staff burnout is also common in ED units (EDUs), linked to difficult relationships with patients and poor self-care, and is not well addressed. Therefore we piloted a series of joint well-being workshops to target these issues. Joint workshops were offered to patients (n = 55) and the multi-disciplinary team MDT (n = 34) in adult ED wards over two years. Experiences were evaluated quantitively and qualitatively. Mood post-workshops increased significantly for both groups (patients: p < 0.001, r = 0.49; MDT: z = 3.043, p = 0.002, r = 0.41), with the feeling that they deserved to take time for self-care (patients: z = 2.419, p = 0.016, r = 0.31); MDT: z = 2.814, p = 0.005, r = 0.38). Workshops were found to be enjoyable and highly relevant to well-being, but less useful by patients. Thematic analysis identified six themes: Enjoyment, recovery and well-being, relationships, content, structure and future ideas. Both groups experienced improved mood and increased enjoyment and awareness of well-being. Patient isolation was addressed, and the staff experienced stress reduction and increased productivity. Both groups experienced improved relationships.
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Affiliation(s)
- Katherine Smith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, King's College London, London SE5 8AF, UK.
| | - Yasemin Dandil
- South London and Maudsley NHS Foundation, London BR3 3BX, UK.
| | - Claire Baillie
- South London and Maudsley NHS Foundation, London BR3 3BX, UK.
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, King's College London, London SE5 8AF, UK.
- South London and Maudsley NHS Foundation, London BR3 3BX, UK.
- Department of Psychology, Illia State University, Tbilisi 0162, Georgia.
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