Understanding drift in the treatment of eating disorders using a mixed-methods approach

Programme-Led and Focused Interventions for Recent Onset Binge/Purge Eating Disorders: Use and Outcomes in the First Episode Rapid Early Intervention for Eating Disorders (FREED) Network

OBJECTIVE

We aimed to compare use of, and outcomes from, programme-led and focused interventions (guided self-help and 10 session cognitive behavioral therapy for eating disorders [CBT-T]) relative to other psychological therapies (including group and individual CBT for eating disorders [CBT-ED]) in a national sample of emerging adults receiving early intervention for a non-underweight binge/purge eating disorder.

METHOD

Data were drawn from 54 English eating disorder services using the First Episode Rapid Early Intervention for Eating Disorders (FREED) model. Participants (N = 1097) had a mean age of 18.95 years (SD 2.42) and diagnoses of bulimia nervosa (n = 506; 45%), binge eating disorder (n = 121; 11%), another specified feeding or eating disorder (n = 460; 42%), or an eating disorder, unspecified (n = 10, 1%). Linear mixed models were used to assess for effects of time and treatment on binge eating and purging, eating disorder psychopathology, depression/anxiety, and body mass index.

RESULTS

11% (n = 117) of patients received guided self-help and 24% (n = 268) received CBT-T. Baseline eating disorder psychopathology and depressive/anxiety symptoms did not differ significantly across the guided self-help, CBT-T, group CBT-ED, and individual CBT-ED conditions. All treatments were associated with significant reductions in symptoms over time. GSH and CBT-T performed comparably to longer CBT-ED.

DISCUSSION

We provide additional evidence for the effectiveness of GSH and CBT-T in the treatment of non-underweight binge/purge eating disorders. Programme-led and focused interventions may be under-utilized and future research should explore when they are offered, and when not, both within and outside of early intervention settings.

New understandings meet old treatments: putting a contemporary face on established protocols

In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.