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Matheson BE, Bohon C, Le Grange D, Lock JD. Family-based treatment (FBT) for loss of control (LOC) eating in youth: Current knowledge and future directions. Eat Disord 2024; 32:1-12. [PMID: 38149636 PMCID: PMC10753090 DOI: 10.1080/10640266.2023.2229091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Loss of control (LOC) eating in youth is a common disordered eating behavior and associated with negative health and psychological sequalae. Family-based treatment (FBT) is an efficacious treatment for adolescent anorexia nervosa and bulimia nervosa (BN) but has not been formally evaluated for adolescents with LOC eating. This study is a secondary data analysis from a randomized controlled clinical trial (NCT00879151) testing FBT for 12-18-year-olds with BN. Data were reanalyzed to examine outcomes for LOC eating episodes, regardless of episode size. Abstinence rates, defined as zero LOC eating episodes (objective or subjective binge episodes) in the previous month, were calculated at the end-of-treatment (EOT), 6-month, and 12-month follow-up time points. Among 51 adolescent participants (M + SD: 15.94 + 1.53 y; 92% female; 23.5% Hispanic; 76.5% Caucasian), FBT significantly reduced LOC eating episodes, with 49% achieving LOC eating abstinence at EOT. At 6-month follow-up, 41% achieved LOC eating abstinence. Of those providing 12-month follow-up data, 73% achieved abstinence. This preliminary exploration suggests that FBT may be effective for youth with LOC eating, regardless of episode size. Additional research is needed to replicate these findings and extend treatments with developmental adaptations for younger children with LOC eating.
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Affiliation(s)
- Brittany E. Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Equip Health, Inc., Carlsbad, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago (Emeritus)
| | - James D. Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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2
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Gorrell S, Byrne CE, Trojanowski PJ, Fischer S, Le Grange D. A scoping review of non-specific predictors, moderators, and mediators of family-based treatment for adolescent anorexia and bulimia nervosa: a summary of the current research findings. Eat Weight Disord 2022; 27:1971-1990. [PMID: 35092554 PMCID: PMC9872820 DOI: 10.1007/s40519-022-01367-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/13/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE This scoping review presents an up-to-date synthesis of the current evidence base for non-specific predictors, moderators, and mediators of family-based treatment (FBT) for adolescent anorexia and bulimia nervosa. METHODS We identify ways in which end-of-treatment outcomes have been shown to differ based upon baseline clinical features and person-specific factors and explore psychological mechanisms that may explain differences in treatment response. We draw from this evidence base to outline recommendations for clinical practice, as well as directions for future clinical eating disorder research. RESULTS Noted findings from review include that early response in weight gain and parental criticism may be particularly influential in treatment for anorexia nervosa. Further, for adolescents with either anorexia or bulimia nervosa, eating-related obsessionality may be a key intervention target to improve outcomes. CONCLUSION In addition to highlighting a need for attention to specific patient- and caregiver-level factors that impact treatment response, recommendations for research and clinical practice include testing whether certain targeted treatments (e.g., exposure-based approaches) may be suitable within the context of FBT for eating disorders. LEVEL OF EVIDENCE Level I: Evidence obtained from: at least one properly designed randomized controlled trials; experimental studies.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL, USA
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3
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Chang PGRY, Delgadillo J, Waller G. Early response to psychological treatment for eating disorders: A systematic review and meta-analysis. Clin Psychol Rev 2021; 86:102032. [PMID: 33915335 DOI: 10.1016/j.cpr.2021.102032] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 04/04/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022]
Abstract
Early response is a well-established predictor of positive outcomes at the end of psychological treatments for common mental disorders. There is some prior evidence that this conclusion also applies to eating disorders, including three meta-analyses, but no moderators of that relationship have been identified. However, a number of further papers have been published since, which might influence the size of the effect of early response or the potential role of moderating factors. This pre-registered systematic review presents a comprehensive examination of this literature. Three databases were searched (Scopus, PsycInfo, PubMed). In total, 33 eligible studies were included in a narrative synthesis, and 25 studies were included in random-effects meta-analysis. The majority (91%) of studies were rated as having low or moderate risk of bias. Approximately half of patients across clinical samples showed early response to psychological therapy, which was most often defined as reliable symptomatic improvement during the first four sessions. A significant and moderate association was found between early response and post-treatment outcomes (r = 0.41 [95% CI: 0.32-0.481], p < .0001). Significant evidence of heterogeneity (Q[28] = 136.42, p < .0001; I2 = 80.2%) was evident. The review was limited by the exclusion of grey literature and only 76% of studies provided sufficient statistical information for meta-analytic synthesis, although we found no significant evidence of publication bias, χ2(1) = 0.001, p = .97. Overall, evidence accumulated over twenty years establishes early response as the most robust predictor of treatment outcomes in the field of eating disorders. However, only half of patients show early change in this way. Further research is needed to determine whether there are patient or clinician characteristics that predict early response to psychological treatment for eating disorders.
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Affiliation(s)
- Peter G R Y Chang
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Glenn Waller
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK.
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4
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Accurso EC, Waller G. A brief session-by-session measure of eating disorder psychopathology for children and adolescents: Development and psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y). Int J Eat Disord 2021; 54:569-577. [PMID: 33331681 PMCID: PMC8262257 DOI: 10.1002/eat.23449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/19/2020] [Accepted: 12/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Despite evidence supporting the use of measures to track ongoing progress and outcome in treatment, there is a relative absence of measures that are appropriate for this purpose in youth with eating disorders. This study examined the psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y) scale, including its ability to detect short-term change in symptomatology. METHOD Youth (N = 203) ages 8-18 years completed self-report questionnaires and semi-structured diagnostic interviews upon initial presentation for an outpatient eating disorders assessment at an academic medical center. RESULTS The ED-15-Y demonstrated excellent reliability (internal consistency, split-half reliability) and high sensitivity to change early in treatment (change from sessions 1 to 8, adjusting for baseline score). Further, these data demonstrate that the ED-15-Y has excellent convergent validity, being highly correlated with a well-tested, longer measure of eating disorders psychopathology-the Eating Disorders Examination-Questionnaire (EDE-Q). These data also support good discriminant and concurrent validity, differentiating between youth without an eating disorder or with ARFID and youth with eating disorders involving weight and shape concerns (e.g., anorexia nervosa, bulimia nervosa). DISCUSSION The ED-15-Y may be a useful tool to briefly assess eating disorder psychopathology in youth as young as 8 years old. Its sensitivity to change very early in treatment suggests that it has the potential to be used as a routine outcome measure in the context of treatment.
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Affiliation(s)
- Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Glenn Waller
- Department of Psychology, The University of Sheffield, Sheffield, UK
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Matheson BE, Bohon C, Lock J. Family-based treatment via videoconference: Clinical recommendations for treatment providers during COVID-19 and beyond. Int J Eat Disord 2020; 53:1142-1154. [PMID: 32533799 PMCID: PMC7323318 DOI: 10.1002/eat.23326] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/20/2022]
Abstract
The necessity to employ distance-based methods to deliver on-going eating disorder care due to the novel coronavirus (COVID-19) pandemic represents a dramatic and urgent shift in treatment delivery. Yet, TeleHealth treatments for eating disorders in youth have not been adequately researched or rigorously tested. Based on clinical experience within our clinic and research programs, we aim to highlight the common challenges clinicians may encounter in providing family-based treatment (FBT) via TeleHealth for children and adolescents with anorexia nervosa and bulimia nervosa. We also discuss possible solutions and offer practical considerations for providers delivering FBT in this format. Additional research in TeleHealth treatment for eating disorders in youth may lead to improved access, efficiency, and effectiveness of FBT delivered via videoconferencing.
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Affiliation(s)
- Brittany E. Matheson
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Cara Bohon
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - James Lock
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
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Gorrell S, Matheson BE, Lock J, Le Grange D. Remission in adolescents with bulimia nervosa: Empirical evaluation of current conceptual models. Eur Eat Disord Rev 2020; 28:445-453. [PMID: 32130757 DOI: 10.1002/erv.2729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/31/2020] [Accepted: 02/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The few randomized clinical trials (RCTs) investigating adolescent treatment for bulimia nervosa (BN) suggest variability in both rates of, and criteria for remission. The current study examined reactivity in remission rates, relative to various conceptualizations of remission in a single RCT data set. METHOD A data set of adolescents with BN who participated in an RCT (N = 110) was used to evaluate remission models based upon behavioral symptoms (e.g., binge eating), psychological symptoms (Eating Disorder Examination [EDE] scores), and combinations of these criteria. RESULTS At end-of-treatment (EOT), a remission model defined by behavioral symptom abstinence plus meaningful reduction in EDE global scores yielded comparable remission rates to a model defined by behavioral abstinence alone (i.e., 29% remitted). Participants with higher EOT EDE global scores were less likely to be abstinent from behavioral symptoms at 6- and 12-month follow-up (ps < .001). DISCUSSION Reduction in psychological symptoms with behavioral abstinence did not inform remission status at EOT, over and above behavioral symptom change alone. However, psychological symptom improvement by EOT may predict positive prognosis in posttreatment assessment. Results underscore the necessity of including psychological symptom improvement, as well as consistency across research and practice, in defining remission in adolescent BN.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Brittany E Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
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7
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Hamadi L, Holliday J. Moderators and mediators of outcome in treatments for anorexia nervosa and bulimia nervosa in adolescents: A systematic review of randomized controlled trials. Int J Eat Disord 2020; 53:3-19. [PMID: 31506978 DOI: 10.1002/eat.23159] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To critically appraise papers reporting on moderators and mediators of recommended psychological treatments for anorexia nervosa (AN) and bulimia nervosa (BN) in adolescents. METHOD A systematic search of databases was conducted including PsycINFO, Embase, MEDLINE, AMED, CINAHL, and the Cochrane Library. Studies were included where a randomized controlled trial (RCT) compared therapies for AN or BN and reported on moderators or mediators of treatment effect. Twenty-one eligible papers were included, all based on data from eight RCTs. RESULTS Family therapies were dominant in the literature. Individual or separated treatment appeared superior for families with more difficult relationships, whereas conjoint family treatment appeared to be superior where good family relationships were reported. Where there was greater eating disorder psychopathology in AN, including eating disorder-related obsessions and compulsions, the response was better to a family approach than to individual therapies. There was some evidence that a family treatment was superior for those engaging in purging behaviors in BN. Measures of family relationships, parental self-efficacy, and early change emerged as possible mediators; however, the quality of evidence was mixed and the findings, in some cases, arguably circular. Moderator and mediator analyses were underpowered in all studies, with multiple, and post-hoc, analyses being run, and a broad range of outcome measures used. DISCUSSION This review recommends that emerging findings are explored further in adequately powered trials of the different recommended therapies, with a move toward focusing on effect sizes. A consensus on acceptable definitions of outcome, including remission and recovery, would benefit future research.
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Affiliation(s)
- Layla Hamadi
- Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Headington, Oxford.,Eating disorder CAMHS Community Services, Oxford Health NHS Foundation Trust
| | - Joanna Holliday
- Eating disorder CAMHS Community Services, Oxford Health NHS Foundation Trust
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8
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Matheson BE, Gorrell S, Bohon C, Agras WS, Le Grange D, Lock J. Investigating Early Response to Treatment in a Multi-Site Study for Adolescent Bulimia Nervosa. Front Psychiatry 2020; 11:92. [PMID: 32184746 PMCID: PMC7058584 DOI: 10.3389/fpsyt.2020.00092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/04/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This secondary data analysis seeks to replicate and extend findings that early response to treatment in adolescent bulimia nervosa (BN) predicts outcome, resulting in earlier identification of patients who might need a different treatment approach. METHODS Participants were 71 adolescents (M ± SD: 15.69 ± 1.55 years; 93% female; 75% non-Hispanic) with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of BN or partial BN enrolled in a two-site treatment study. Participants were randomized to cognitive behavioral therapy for adolescents (CBT-A), family-based treatment for BN (FBT-BN), or supportive psychotherapy (SPT). The Eating Disorder Examination was administered at baseline, end-of-treatment (EOT), 6-month, and 12-month follow-up. Binge eating and purge symptoms were self-reported at each session. Outcome was defined as abstinence of binge eating and compensatory behaviors (self-induced vomiting, laxative use, diet pills, diuretics, compensatory exercise, fasting) in the 28 days prior to assessment. Receiver operating characteristic (ROC) analyses were utilized to assess the viability of predicting treatment outcomes based on reduction of symptoms within the first 10 sessions of treatment. RESULTS ROC analyses suggest that reduction in purging at session 2 (AUC =.799, p < .001) and binge eating at session 4 (AUC =.750, p < .01) were independently related to abstinence of symptoms at EOT, regardless of treatment type. Symptom reduction later in treatment predicted outcome at follow-up, as change in binge eating at session 8 and purging at session 9 were the strongest predictors of abstinence at 6-month follow-up (AUCs =.726-.763, ps < .01). Change in binge eating, but not purging behaviors, was significantly related to abstinence at 12-month follow-up (AUC =.766, p < .01). Only slight differences emerged based on treatment group, such that reductions in symptoms most predictive of abstinence at EOT occurred one session sooner in FBT-BN than SPT. CONCLUSION Reductions in binge eating and purge symptoms early in adolescent BN treatment suggest better outcome, regardless of treatment modality. Additional research with larger samples is needed to better understand which treatments, if any, contribute to earlier change in BN symptoms and/or likelihood of improved patient response.
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Affiliation(s)
- Brittany E Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Sasha Gorrell
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, Emeritus, Stanford University School of Medicine, Stanford, CA, United States
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Neuroscience, Emeritus, The University of Chicago, Chicago, IL, United States
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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9
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Abstract
There are few systematic studies of treatment of bulimia nervosa (BN) in adolescents. Although family-based treatment has demonstrated preliminary evidence to support involvement of caregivers in treatment, there is significant opportunity for improvement in mitigating binge-eating and purging symptoms among adolescents afflicted with BN. When caregivers are unable to participate in treatment, there is evidence that BN-specific cognitive behavioral therapy approaches are helpful for some adolescents. Further research is needed to determine for whom, and under what conditions certain types of family involvement might be most effective in adolescent treatment of BN.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; The University of Chicago, Chicago, IL, USA.
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10
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Beintner I, Jacobi C. Are we overdosing treatment? Secondary findings from a study following women with bulimia nervosa after inpatient treatment. Int J Eat Disord 2018; 51:899-905. [PMID: 30070386 DOI: 10.1002/eat.22894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Provision of eating disorder (ED) treatment in practice is often guided by national health service structures rather than evidence-based treatment recommendations. Especially for more severely or chronically ill patients, clinicians seem to advocate a "the more the better" strategy of treatment provision. Exploring the dose-response relationship in ED treatment may shed light on both beneficial and detrimental effects of prolonged treatment provision. METHOD We utilized data from 64 women from the treatment-as-usual (TAU) group of a randomized controlled trial on Internet-based aftercare for women with bulimia nervosa who had received inpatient treatment. We examined the relationship between treatment duration and dose and (1) baseline patient characteristics and (2) treatment outcomes (abstinence from binge eating and compensatory behaviors, frequency of binge eating and vomiting, thin ideal internalization, and general psychopathology) at 18-month follow up. RESULTS On average, the women in our study were hospitalized for 9 weeks and most received high doses of subsequent outpatient psychotherapy (median: 45 sessions). The severity of symptoms that a patient experienced at hospital admission or discharge was largely unrelated to the amount of outpatient treatment she subsequently received. Longer inpatient treatments or higher doses of subsequent outpatient treatment did not result in more favorable outcomes. DISCUSSION Our findings suggest that, instead of providing costly long treatment without evidenced benefit to patients, there is a need for further exploration of and discussion about the risks and benefits of providing high doses of treatment for both individuals and the health care system.
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Affiliation(s)
- Ina Beintner
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Corinna Jacobi
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187, Dresden, Germany
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11
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Barakat S, Maguire S, Surgenor L, Donnelly B, Miceska B, Fromholtz K, Russell J, Hay P, Touyz S. The Role of Regular Eating and Self-Monitoring in the Treatment of Bulimia Nervosa: A Pilot Study of an Online Guided Self-Help CBT Program. Behav Sci (Basel) 2017; 7:E39. [PMID: 28672851 PMCID: PMC5618047 DOI: 10.3390/bs7030039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Despite cognitive behavioural therapy (CBT) being regarded as the first-line treatment option for bulimia nervosa (BN), barriers such as its time-consuming and expensive nature limit patient access. In order to broaden treatment availability and affordability, the efficacy and convenience of CBT could be improved through the use of online treatments and selective emphasis on its most 'potent' components of which behavioural techniques form the focus. Method: Twenty-six individuals with BN were enrolled in an online CBT-based self-help programme and 17 completed four weeks of regular eating and food-monitoring using the online Food Diary tool. Participants were contacted for a weekly check-in phone call and had their bulimic symptom severity assessed at five time points (baseline and weeks 1-4). Results: There was a significant decrease in the frequency of self-reported objective binge episodes, associated loss of control and objective binge days reported between pre- and post-treatment measures. Significant improvements were also observed in most subscales of the Eating Disorder Examination-Questionnaire. Conclusion: This study provides encouraging preliminary evidence of the potential of behavioural techniques of online CBT in the treatment of BN. Online therapy with this focus is potentially a viable and practical form of treatment delivery in this illness group. These preliminary findings support the need for larger studies using control groups.
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Affiliation(s)
- Sarah Barakat
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia.
| | - Sarah Maguire
- Centre for Eating and Dieting Disorders, Boden Institute, University of Sydney, Sydney, NSW 2006, Australia.
| | - Lois Surgenor
- Department of Psychological Medicine, University of Otago at Christchurch, Christchurch 8140, New Zealand.
| | | | - Blagica Miceska
- Centre for Eating and Dieting Disorders, Boden Institute, University of Sydney, Sydney, NSW 2006, Australia.
| | - Kirsty Fromholtz
- Centre for Eating and Dieting Disorders, Boden Institute, University of Sydney, Sydney, NSW 2006, Australia.
| | - Janice Russell
- School of Medicine, University of Sydney, Sydney, NSW 2006, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia.
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12
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Nazar BP, Gregor LK, Albano G, Marchica A, Coco GL, Cardi V, Treasure J. Early Response to treatment in Eating Disorders: A Systematic Review and a Diagnostic Test Accuracy Meta-Analysis. Eur Eat Disord Rev 2016; 25:67-79. [PMID: 27928853 DOI: 10.1002/erv.2495] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/21/2016] [Accepted: 11/10/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Early response to eating disorders treatment is thought to predict a later favourable outcome. A systematic review of the literature and meta-analyses examined the robustness of this concept. METHOD The criteria used across studies to define early response were summarised following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Diagnostic Test Accuracy methodology was used to estimate the size of the effect. RESULTS Findings from 24 studies were synthesized and data from 14 studies were included in the meta-analysis. In Anorexia Nervosa, the odds ratio of early response predicting remission was 4.85(95%CI: 2.94-8.01) and the summary Area Under the Curve (AUC) = .77. In Bulimia Nervosa, the odds ratio was 2.75(95%CI:1.24-6.09) and AUC = .67. For Binge Eating Disorder, the odds ratio was 5.01(95%CI: 3.38-7.42) and AUC = .71. CONCLUSION Early behaviour change accurately predicts later symptom remission for Anorexia Nervosa and Binge Eating Disorder but there is less predictive accuracy for Bulimia Nervosa. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Bruno Palazzo Nazar
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK.,Federal University of Rio de Janeiro, Institute of Psychiatry (IPUB-UFRJ), Brazil
| | - Louise Kathrine Gregor
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Gaia Albano
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK.,University of Palermo, Department of Psychology and Educational Sciences, Palermo, Italy
| | - Angelo Marchica
- University of Palermo, Department of Psychology and Educational Sciences, Palermo, Italy
| | - Gianluca Lo Coco
- University of Palermo, Department of Psychology and Educational Sciences, Palermo, Italy
| | | | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
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13
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Linardon J, Brennan L, de la Piedad Garcia X. Rapid response to eating disorder treatment: A systematic review and meta-analysis. Int J Eat Disord 2016; 49:905-919. [PMID: 27528478 DOI: 10.1002/eat.22595] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This review aimed to (a) examine the effects of rapid response on behavioral, cognitive, and weight-gain outcomes across the eating disorders, (b) determine whether diagnosis, treatment modality, the type of rapid response (changes in disordered eating cognitions or behaviors), or the type of behavioral outcome moderated this effect, and (c) identify factors that predict a rapid response. METHOD Thirty-four articles met inclusion criteria from six databases. End of treatment and follow-up outcomes were divided into three categories: Behavioral (binge eating/purging), cognitive (EDE global scores), and weight gain. Average weighted effect sizes(r) were calculated. RESULTS Rapid response strongly predicted better end of treatment and follow-up cognitive and behavioral outcomes. Moderator analyses showed that the effect size for rapid response on behavioral outcomes was larger when studies included both binge eating and purging (as opposed to just binge eating) as a behavioral outcome. Diagnosis, treatment modality, and the type of rapid response experienced did not moderate the relationship between early response and outcome. The evidence for weight gain was mixed. None of the baseline variables analyzed (eating disorder psychopathology, demographics, BMI, and depression scores) predicted a rapid response. DISCUSSION As there is a solid evidence base supporting the prognostic importance of rapid response, the focus should shift toward identifying the within-treatment mechanisms that predict a rapid response so that the effectiveness of eating disorder treatment can be improved. There is a need for future research to use theories of eating disorders as a guide to assess within-treatment predictors of rapid response. © 2016 Wiley Periodicals, Inc. Int J Eat Disord 2016; 49:905-919.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Australian Catholic University, Melbourne, Victoria, 3065, Australia.
| | - Leah Brennan
- School of Psychology, Australian Catholic University, Melbourne, Victoria, 3065, Australia
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Reuter L, Munder T, Altmann U, Hartmann A, Strauss B, Scheidt CE. Pretreatment and process predictors of nonresponse at different stages of inpatient psychotherapy. Psychother Res 2015; 26:410-24. [PMID: 25959603 DOI: 10.1080/10503307.2015.1030471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Up to 50% of psychotherapeutic treatments end without significant improvements. While there is first evidence about predictors of nonresponse in outpatient psychotherapy, there are currently no studies investigating predictors of nonresponse in inpatient settings. Based upon a previous systematic literature review, we analyzed the predictive value of initial patient characteristics on nonresponse in symptom distress. METHODS Treatment episodes from 546 patients, treated for at least 4 weeks, were assessed under naturalistic conditions. Nonresponse status (i.e., lack of a reliable improvement in symptom distress) was investigated at four different time points: at week 4, at discharge, and at a two follow-ups (3 and 12 months after discharge). Hierarchical binary logistic regression models were used to predict nonresponse. Sociodemographic data, clinical variables, and the previous response status were entered subsequently in the model. RESULTS A moderate or functional level of initial symptom distress, a comorbid personality disorder, and previous nonresponse were the most consistent predictors of nonresponse. CONCLUSIONS The results point to the importance of early outcome assessment and suggest the implementation of more symptom-specific treatments.
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Affiliation(s)
- Laurence Reuter
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany.,b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Thomas Munder
- c Psychologische Hochschule Berlin , Berlin , Germany
| | - Uwe Altmann
- b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Armin Hartmann
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany
| | - Bernhard Strauss
- b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Carl Eduard Scheidt
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany
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MacDonald DE, Trottier K, McFarlane T, Olmsted MP. Empirically defining rapid response to intensive treatment to maximize prognostic utility for bulimia nervosa and purging disorder. Behav Res Ther 2015; 68:48-53. [DOI: 10.1016/j.brat.2015.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 02/06/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
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Ciao AC, Accurso EC, Fitzsimmons-Craft EE, Le Grange D. Predictors and moderators of psychological changes during the treatment of adolescent bulimia nervosa. Behav Res Ther 2015; 69:48-53. [PMID: 25874955 DOI: 10.1016/j.brat.2015.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/27/2015] [Accepted: 04/03/2015] [Indexed: 11/23/2022]
Abstract
This study examined predictors of psychological change among 80 adolescents with bulimia nervosa (BN) participating in a randomized-controlled trial comparing family-based treatment (FBT) to supportive psychotherapy (SPT). Psychological outcomes (cognitive eating disorder pathology, depression, and self-esteem) were explored at baseline, post-treatment, and 6-month follow-up. Multi-level growth models examined predictors of rate of change in psychological outcomes and moderators of treatment effects. All psychological outcomes improved through 6-month follow-up (moderate to large effect sizes) across both treatments. Overall, few significant predictors were identified. Older adolescents had faster change in self-esteem relative to younger adolescents (p = 0.03). Adolescents taking psychotropic medication at baseline had faster change in eating concerns relative to adolescents not taking medication (p = 0.02). Age (p = 0.02) and baseline purging severity (p = 0.03) moderated the relationship between treatment condition and change in eating concerns, where younger adolescents and individuals with high baseline purging had greater change when treated with FBT relative to SPT. Age and purging did not significantly moderate change in other psychological outcomes. Bulimic symptom improvement did not predict change in psychological symptoms. Generally, FBT and SPT were equally efficacious with respect to psychological improvement, although FBT may be more efficacious in younger adolescents and those with more frequent purging.
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Dimitropoulos G, Freeman VE, Allemang B, Couturier J, McVey G, Lock J, Le Grange D. Family-based treatment with transition age youth with anorexia nervosa: a qualitative summary of application in clinical practice. J Eat Disord 2015; 3:1. [PMID: 25685349 PMCID: PMC4329223 DOI: 10.1186/s40337-015-0037-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family based treatment (FBT) has been empirically investigated in adolescents between the ages of 12 and 19 years of age. Although parental control over eating symptoms and the weight gain process are temporary and necessary due to serious medical complications, FBT may be developmentally inappropriate when working with older adolescents. To date, there are no studies identifying how the principles of this model are used differentially across different stages of adolescence. This study aimed to identify how clinicians informed by FBT employ this model with transition age youth (TAY) (16-21) with an eating disorder. METHODS Using content analysis, seven individual interviews and six focus groups were conducted with 34 clinicians from specialized Eating Disorder Treatment programs across Ontario, Canada. RESULTS Participants consistently reported modifying FBT to increase its developmental appropriateness with TAY in the following ways: working more collaboratively with the patient, increasing individual time spent with the patient prior to the family meeting, providing greater opportunities for the individual to practice eating without parental support and introducing relapse prevention in the latter phase of the treatment. CONCLUSIONS In all adaptations of the model, participants in focus groups and individual interviews cited the age of the individual with the eating disorder, their level of autonomy and independence in all areas of their lives, and their pending transfer of care from paediatric to adult eating disorder programs as main factors that influenced the modification of FBT with TAY. While adaptations were made across all three phases of FBT, adherence to the model progressively declined over the course of treatment with adaptations increasing significantly in the later phases. Future research is needed to evaluate the effectiveness of an adapted version of FBT with TAY.
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Affiliation(s)
- Gina Dimitropoulos
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario Canada ; Eating Disorders Program, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Victoria E Freeman
- Eating Disorders Program, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Brooke Allemang
- Sickle Cell and Thalassemia Transition Clinic, The Hospital for Sick children, Toronto, ON Canada
| | - Jennifer Couturier
- Child and Adolescent Psychiatry, McMaster Children's Hospital, Hamilton, Canada
| | - Gail McVey
- Community Health Systems Resource Group, The Hospital for Sick Children, Toronto, ON Canada ; Ontario Community Outreach Program for Eating Disorders, Toronto, ON Canada
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA USA
| | - Daniel Le Grange
- Eating Disorders Program Department of Psychiatry and Department of Pediatrics, University of California, San Francisco, CA USA
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Brauhardt A, de Zwaan M, Hilbert A. The therapeutic process in psychological treatments for eating disorders: a systematic review. Int J Eat Disord 2014; 47:565-84. [PMID: 24796817 DOI: 10.1002/eat.22287] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 03/29/2014] [Accepted: 04/01/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE For eating disorders, a vast number of investigations have demonstrated the efficacy of psychological treatments. However, evidence supporting the impact of therapeutic process aspects on outcome (i.e., process-outcome research) has not been disentangled. METHOD Using the Generic Model of Psychotherapy (GMP) to organize various process aspects, a systematic literature search was conducted on psychological treatment studies for anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders not otherwise specified. RESULTS Improved outcomes resulted for family-based treatment compared to individual treatment, for individual compared to group treatment, booster sessions, and positive patient expectations (GMP contract aspect); for nutritional counseling and exercising but not exposure with response prevention as adjunct interventions (therapeutic operations); for highly motivated patients and, to a lesser extent, for therapeutic alliance (therapeutic bond); as well as for rapid response and longer overall treatment duration (temporal patterns). Regarding other GMP aspects, studies on self-relatedness were completely lacking and in-session impacts were rarely investigated. DISCUSSION As most studies assessed only a limited number of process aspects, the ability to draw conclusions about their overall impact regarding outcome is rather limited. Therefore, future process-outcome research is needed beyond investigations of treatment efficacy for eating disorders.
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Affiliation(s)
- Anne Brauhardt
- Leipzig University Medical Center, Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
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Abstract
Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.
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Affiliation(s)
- Kenisha Campbell
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecka Peebles
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Raykos BC, McEvoy PM, Erceg-Hurn D, Byrne SM, Fursland A, Nathan P. Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: Probably necessary but definitely insufficient. Behav Res Ther 2014; 57:65-71. [DOI: 10.1016/j.brat.2014.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 04/09/2014] [Accepted: 04/16/2014] [Indexed: 01/13/2023]
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Abstract
Family therapy has featured in the treatment of adolescent eating disorders for over 40 years, and the evolution of family therapy approaches, through a variety of theoretical lenses, has been significant. For instance, the recent dissemination of family-based treatment has resulted in a growing number of controlled empirical trials which continue to inform and augment treatment outcomes. In addition, a burgeoning number of alternate approaches to family therapy for eating disorders leave clinicians with more clinical considerations in practicing family therapy for eating disorders. In this paper, we aim to review the recent developments in family therapy for adolescent eating disorders, underscoring the impact on clinical practice and the likely implications for future research.
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Affiliation(s)
- Stuart B Murray
- The Redleaf Practice, 5 Redleaf Ave, Wahroonga, Sydney, NSW, 2006, Australia,
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23
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Abstract
OBJECTIVE Determine whether early weight gain predicts full remission at end-of-treatment (EOT) and follow-up in two different treatments for adolescent anorexia nervosa (AN), and to track the rate of weight gain throughout treatment and follow-up. METHOD Participants were 121 adolescents with AN (mean age = 14.4 years, SD = 1.6), from a two-site (Chicago and Stanford) randomized controlled trial. Adolescents were randomly assigned to family-based treatment (FBT) (n = 61) or individual adolescent focused therapy (AFT) (n = 60). Treatment response was assessed using percent of expected body weight (EBW) and the global score on the Eating Disorder Examination (EDE). Full remission was defined as having achieved ≥95% EBW and within one standard deviation of the community norms of the EDE. Full remission was assessed at EOT as well as 12-month follow-up. RESULTS Receiver operating characteristic analyses showed that the earliest predictor of remission at EOT was a gain of 5.8 pounds (2.65 kg) by session 3 in FBT (area under the curve (AUC) = 0.670; p = .043), and a gain of 7.1 pounds (3.20 kg) by session 4 in AFT (AUC = 0.754, p = .014). Early weight gain did not predict remission at follow-up for either treatment. A survival analysis showed that weight was marginally superior in FBT as opposed to AFT (Wald chi-square = 3.692, df = 1, p = .055). DISCUSSION Adolescents with AN who receive either FBT or AFT, and show early weight gain, are likely to remit at EOT. However, FBT is superior to AFT in terms of weight gain throughout treatment and follow-up.
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Affiliation(s)
- Daniel Le Grange
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Erin C. Accurso
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - James Lock
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Stewart Agras
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Susan W. Bryson
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA
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Abstract
OBJECTIVE We describe cognitive-behavioral therapy for bulimia nervosa (CBT-BN) with a Latina woman that incorporates culturally relevant topics. METHOD A single case report of a 31-year-old monolingual Latina woman with BN describes the application of a couple-based intervention adjunctive to CBT-BN. RESULTS The patient reported no binge and purge episodes by session 20 and remained symptom free until the end of treatment (session 26). Improvement was observed in the Eating Disorders Examination (EDE) comparing baseline (EDE=5.74) with post treatment (EDE=1.25). CONCLUSIONS The case illustrates how cultural adaptations such as including a family member, being flexible on topics and scheduling, and providing culturally relevant interventions can lead to successful completion of a course of therapy and facilitate ongoing interventions to ensure continued recovery.
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Affiliation(s)
| | - Donald H Baucom
- Department of Psychology, University of North Carolina, Chapel Hill, NC
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC ; Department of Nutrition, University of North Carolina, Chapel Hill, NC
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Raykos BC, Watson HJ, Fursland A, Byrne SM, Nathan P. Prognostic value of rapid response to enhanced cognitive behavioral therapy in a routine clinic sample of eating disorder outpatients. Int J Eat Disord 2013; 46:764-70. [PMID: 23913536 DOI: 10.1002/eat.22169] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/26/2013] [Accepted: 07/01/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined whether rapid response to enhanced cognitive behavioral therapy (CBT-E) was associated with superior treatment outcomes in a transdiagnostic sample of patients with an eating disorder. METHOD Participants were 105 patients with a primary eating disorder diagnosis who received individual CBT-E at a community-based outpatient clinic. Patients completed measures of eating disorder and related pathology at baseline and post-treatment. The Eating Disorder Examination-Questionnaire (EDE-Q) was administered at baseline and again, on average, 4.6 weeks after commencing treatment to assess rapid response to CBT-E. Patients achieving reliable change on the EDE-Q at this point were classified as rapid responders. RESULTS No baseline differences distinguished rapid and nonrapid responders. Rapid responders had significantly lower scores on EDE-Q global at post-treatment, were more likely to achieve full remission, and required significantly fewer treatment sessions than nonrapid responders. One-quarter of the nonrapid responders went on to achieve full remission. There were no group differences on measures of anxiety and depression symptoms at the end of treatment. DISCUSSION Early change in treatment is encouraged to achieve the best possible prognosis in CBT-E. Those who did not achieve rapid response still had an overall significant improvement in symptoms from pretreatment to post-treatment, but a lower rate of full remission. Nonrapid responders are an important group of patients to study because they offer researchers an opportunity to improve clinical decision-making and treatment outcomes for patients who are at risk of suboptimal response.
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Affiliation(s)
- Bronwyn C Raykos
- Centre for Clinical Interventions, Department of Health in Western Australia, Perth, Australia
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McFarlane TL, MacDonald DE, Royal S, Olmsted MP. Rapid and slow responders to eating disorder treatment: a comparison on clinically relevant variables. Int J Eat Disord 2013; 46:563-6. [PMID: 23580395 DOI: 10.1002/eat.22136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Speed of response to eating disorder treatment is a reliable predictor of relapse, with rapid response predicting improved outcomes. This study investigated whether rapid, slow, and nonresponders could be differentiated on clinically relevant variables, and possibly identified prior to treatment. METHOD Female patients (N = 181) were classified as rapid, slow, or nonresponders based on the speed and magnitude with which they interrupted their bingeing and/or vomiting symptoms, and were compared on eating disorder behaviors and psychopathology and general psychopathology. RESULTS The rapid response group was marginally older and had a slightly shorter course of treatment than the slow response group. The rapid response group also had significantly fewer pretreatment binge episodes, and a longer course of treatment than the nonresponse group. However, the three response groups were not significantly different on any other examined variables. DISCUSSION The only pretreatment variable that differentiated response groups was symptom frequency, in that rapid responders had fewer binge episodes than nonresponders. No pre-existing variables differentiated rapid and slow response. Given that few individual pre-existing differences that might account for speed of response were identified, the clinical importance of facilitating a rapid response to treatment for all patients is discussed.
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Affiliation(s)
- Traci L McFarlane
- Department of Psychiatry, University Health Network, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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Debar LL, Wilson GT, Yarborough BJ, Burns B, Oyler B, Hildebrandt T, Clarke GN, Dickerson J, Striegel RH. Cognitive Behavioral Treatment for Recurrent Binge Eating in Adolescent Girls: A Pilot Trial. Cogn Behav Pract 2013; 20:147-161. [PMID: 23645978 DOI: 10.1016/j.cbpra.2012.04.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There is a need for treatment interventions to address the high prevalence of disordered eating throughout adolescence and early adulthood. We developed an adolescent-specific manualized CBT protocol to treat female adolescents with recurrent binge eating and tested its efficacy in a small, pilot randomized controlled trial. We present lessons learned in recruiting adolescents, a description of our treatment approach, acceptability of the treatment for teens and parents, as well as results from the pilot trial. Participants in the CBT group had significantly fewer posttreatment eating binges than those in a treatment as usual/delayed treatment (TAU-DT) control group; 100% of CBT participants were abstinent at follow-up. Our results provide preliminary support for the efficacy of this adolescent adaptation of evidence-based CBT for recurrent binge eating. The large, robust effect size estimate observed for the main outcome (NNT=2) places this among the larger effects observed for any mental health intervention.
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Affiliation(s)
- Lynn L Debar
- Kaiser Permanente Center for Health Research, Portland
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Abstract
Onset of bulimia nervosa (BN) typically occurs in adolescence and is frequently accompanied by medical and psychiatric sequelae that may have detrimental effects on adolescent development. Potentially serious medical consequences and high comorbid rates of mood disorders and suicidality underscore the need for early recognition and effective treatments. Research among adolescents with BN has lagged behind that of adults, although evidence is accumulating to support the efficacy of family-based interventions and cognitive behavioral treatments that are adapted for use with adolescent populations. The aim of the current article is to provide an overview of recent research on epidemiology, risk factors, diagnostic issues, and treatment interventions focusing on adolescent BN, and to highlight areas for future research.
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Abstract
OBJECTIVE The purpose of this study was to determine if early weight gain predicted remission at the end of treatment in a clinic sample of adolescents with anorexia nervosa (AN). METHOD Sixty five adolescents with AN (mean age = 14.9 years, SD = 2.1), from two sites (Chicago n = 45; Columbia n = 20) received a course of manualized family-based treatment (FBT). Response to treatment was assessed using percent ideal body weight (IBW) with remission defined as having achieved ≥ 95% IBW at end of treatment (Session 20). RESULTS Receiver operating characteristic analyses showed that a gain of at least 2.88% in ideal body weight by Session 4 best predicted remission at end of treatment (AUC = 0.674; p = 0.024). DISCUSSION Results suggest that adolescents with AN, receiving FBT, who do not show early weight gain are unlikely to remit at end of treatment.
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Affiliation(s)
- Peter M. Doyle
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois,Correspondence to: Peter M. Doyle, Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S Maryland Ave, MC 3077, Chicago, Illinois 60637,
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - Katharine Loeb
- School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey,Department of Psychiatry, Mount Sinai School of Medicine, New York, New York
| | - Angela Celio Doyle
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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Abstract
BACKGROUND Bulimia nervosa (BN) is a serious psychiatric disorder characterized by frequent episodes of binge eating and inappropriate compensatory behavior. Numerous trials have found that antidepressant medications are efficacious for the treatment of BN. Early response to antidepressant treatment, in the first few weeks after medication is initiated, may provide clinically useful information about an individual's likelihood of ultimately benefitting or not responding to such treatment. The purpose of this study was to examine the relationship between initial and later response to fluoxetine, the only antidepressant medication approved by the US Food and Drug Administration (FDA) for the treatment of BN, with the goal of developing guidelines to aid clinicians in deciding when to alter the course of treatment. METHOD Data from the two largest medication trials conducted in BN (n=785) were used. Receiver operating characteristic (ROC) curves were constructed to assess whether symptom change during the first several weeks of treatment was associated with eventual non-response to fluoxetine at the end of the trial. RESULTS Eventual non-responders to fluoxetine could be reliably identified by the third week of treatment. CONCLUSIONS Patients with BN who fail to report a 60% decrease in the frequency of binge eating or vomiting at week 3 are unlikely to respond to fluoxetine. As no reliable relationships between pretreatment characteristics and eventual response to pharmacotherapy have been identified for BN, early response is one of the only available indicators to guide clinical management.
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Affiliation(s)
- R Sysko
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA.
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Hildebrandt T, McCrady B, Epstein E, Cook S, Jensen N. When should clinicians switch treatments? An application of signal detection theory to two treatments for women with alcohol use disorders. Behav Res Ther 2010; 48:524-30. [PMID: 20359693 DOI: 10.1016/j.brat.2010.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 02/24/2010] [Accepted: 03/01/2010] [Indexed: 11/21/2022]
Abstract
Statistical application of signal detection theory has been used to study the clinical utility of early treatment response in a range of treatments and psychiatric disorders. The current study sought to examine the predictive value of weekly within-treatment drinking using receiver operator curves (ROCs) and zero-inflated Poisson (ZIP) regression in 102 women with alcohol use disorders (AUDs) randomized to either alcohol behavioral individual treatment (ABIT; n = 52) or alcohol behavioral couples treatment (ABCT; n = 50). ROC analyses indicated that failure to achieve or sustain abstinence by the end-of-treatment and one-year follow-up was predicted with reasonable accuracy by week 4 percent days abstinent (PDA) in ABIT. ZIP models yielded similar results with evidence for within-treatment PDA with week 6 PDA predicting both the abstinence as well as percent days drinking at the end-of-treatment and one-year follow-up. Within-treatment PDA was a significantly better predictor of outcomes for ABIT than ABCT, despite a better overall treatment response for ABCT. Implications for stepped care models of alcohol treatment are discussed and recommendations for future research made.
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