0000000000044969
AUTHOR
Janet Treasure
Development and Validation of a Scale to Measure Caregiver Skills in Eating Disorders
Objective: The aim of this study was to develop and validate a new ques- tionnaire designed to measure caregiver skills that, in line with the interperso- nal component of the cognitive inter- personal maintenance model (Schmidt and Treasure, J Br J Clin Psychol, 45, 343–366, 2006), may be helpful in the support of people with anorexia nerv- osa (AN). A further aim is to assess whether this scale is sensitive to change following skills-based caregiver interventions. Method: The Caregiver Skills (CASK) scale was developed by a group of clinicians and caregivers. Preliminary versions of the scale devised for both caregivers and parents were given at baseline and at follow-up after two studies…
The Objective and Subjective Caregiving Burden and Caregiving Behaviours of Parents of Adolescents with Anorexia Nervosa
Objective The study aimed to examine caregiving burden and levels of distress, accommodating behaviours, expressed emotion (EE) and carers' skills, in parents of adolescents with anorexia nervosa. Method A semi-structured interview assessed the objective burden (time spent across caregiving tasks) in parents (n = 196) of adolescents (n = 144) receiving outpatient treatment for anorexia nervosa. Subjective burden (carers' distress), accommodating behaviours, EE and carers' skills were measured by self-report. Results Mothers, on average, spent 2.5 h/day of care, mainly providing food and emotional support, compared with 1 h/day by fathers. The level of distress and accommodating behaviour wa…
Assessment of test-meal induced autonomic arousal in anorexic, bulimic and control females
This study attempted to measure three different physiological responses to food intake in eating disordered subjects. Skin conductance level (SCL), heart rate and electroencephalogram were recorded before, during and after a test-meal in 42 females (14 anorexic inpatients, 10 bulimic outpatients and 18 control subjects). Significant increase in SCL during the meal was found in anorexics only. Pre-meal SCL was lower in bulimics than in controls and anorexics. No changes were found on heart rate or electroencephalogram in all groups of subjects. This suggests that anorexic inpatients may display a measurable arousal when confronted with a meal, whereas bulimic outpatients and control subjects…
Empirical examination of the interpersonal maintenance model of anorexia nervosa
Objective A cognitive interpersonal maintenance model of anorexia nervosa (AN) was first proposed in 2006 and updated in 2013 (Schmidt and Treasure, J Br J Clin Psychol, 45, 343-366, 2006; Treasure and Schmidt, J Eat Disorders, in press.). The aim of this study was to test the interpersonal component of this model in people with AN requiring intensive hospital treatment (inpatient/daypatient). Method On admission to hospital women with AN or eating disorder not otherwise specified (AN subtype; n = 152; P) and their primary carers (n = 152; C) completed questionnaires on eating symptoms (P), depression and anxiety (P, C), accommodation and enabling (C), and psychological control (C). Structu…
A longitudinal examination of dyadic distress patterns following a skills intervention for carers of adolescents with anorexia nervosa
Family interventions in anorexia nervosa (AN) have been developed to ameliorate maladaptive patterns of patient-carer interaction that can play a role in illness maintenance. The primary aim of this study is to examine the inter-relationship between baseline and post-treatment distress in dyads of carers and patients with AN to examine the interdependence between carers and patients. The secondary aim is to examine whether a carer skills intervention [Experienced Carer Helping Others (ECHO)] impacts on this inter-relationship. Dyads consisting of treatment-seeking adolescents with AN and their primary carer (n = 149; mostly mothers) were randomised to receive a carer skills intervention (EC…
A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa
AbstractBackgroundOutpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa.MethodsParticipants with anorexia nervosa (n= 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n= 99; experimental group) or TAU only (n= 88; control group). Outcomes were measured at end-of-intervention (6 w…
Patient and mentor language style matching as a predictor of working alliance, engagement with treatment as usual, and eating disorders symptoms over the course of an online guided self-help intervention for anorexia nervosa
Objective The aim of this study was to examine the processes involved in a guided self-help (GSH) pre-treatment intervention (RecoveryMANTRA) for patients with anorexia nervosa (AN), by measuring the levels of patient/mentor Language Style Matching (LSM). RecoveryMANTRA was supported by student mentors or peer mentors (recovered individuals) over six weekly chat-based sessions. We examined whether LSM during RecoveryMANTRA predicted patients'working alliance with the clinic therapist, motivation, eating disorder (ED) and general psychopathology. A further aim was to examine differences in LSM between student mentors and peer mentors. Method 87 AN adults received RecoveryMANTRA plus treatmen…
Social Difficulties As Risk and Maintaining Factors in Anorexia Nervosa: A Mixed-Method Investigation
Anorexia nervosa (AN) is a serious psychiatric disorder characterized by severe restriction of energy intake and dangerously low body weight. Other domains of functioning are affected, including social functioning. Although difficulties within this domain have started to be acknowledged by the literature, some important gaps remain to be filled. Do social difficulties predate the onset of the illness? What difficulties in particular are relevant for the development and maintenance of the illness? The aim of this study is to combine the use of quantitative and qualitative methods to answer these questions. Ninety participants with lifetime AN (88 women and 2 men) completed an online survey a…
Ego-syntonicity and ego-dystonicity of eating-related intrusive thoughts in patients with eating disorders.
Abstract The main objective of the present study was to analyse the role of the ego-dystonicity and ego-syntonicity of eating disorder intrusive thoughts (EDITs) in the genesis and maintenance of eating disorders (EDs). Participants were 98 female patients with EDs, 56 Spanish and 42 English (27.19±9.59 years; body mass index (BMI): 18.72±2.87). All of them completed the eating attitudes test, the Eating Attitudes Test, the Eating Intrusive Thoughts Inventory, the Ego-Dystonicity Questionnaire-Reduced version, and the Ego-Syntonicity Questionnaire. Patients indicated that their EDITs were rational and also undesirable and immoral, suggesting that EDITs are not fully ego-syntonic or ego-dyst…
The Objective and Subjective Caregiving Burden and Caregiving Behaviours of Parents of Adolescents with Anorexia Nervosa
Objective: The study aimed to examine caregiving burden and levels of distress, accommodating behaviours, expressed emotion (EE) and carers' skills, in parents of adolescents with anorexia nervosa. Method: A semi-structured interview assessed the objective burden (time spent across caregiving tasks) in parents (n = 196) of adolescents (n = 144) receiving outpatient treatment for anorexia nervosa. Subjective burden (carers' distress), accommodating behaviours, EE and carers' skills were measured by self-report. Results: Mothers, on average, spent 2.5 h/day of care, mainly providing food and emotional support, compared with 1 h/day by fathers. The level of distress and accommodating behaviour…
Eating-related Environmental Factors in Underweight Eating Disorders and Obesity: Are There Common Vulnerabilities During Childhood and Early Adolescence?
Objective This study aimed to examine whether there is an association between individual, social and family influences and dysfunctional eating patterns early in life and the likelihood of developing a subsequent underweight eating disorder (ED) or obesity. Method The total sample comprised 152 individuals (underweight ED, n = 45; obese patients, n = 65; healthy controls; n = 42) from Barcelona, Spain. The Cross-Cultural Questionnaire (CCQ) was used to assess early eating influences as well as individual and family eating patterns and attitudes towards food. Results Even though a few shared eating influences emerged for both groups, unique factors were also observed. Whereas relationship wi…
Selective Processing of Food– and Body–Related Information and Autonomic Arousal in Patients with Eating Disorders
Both attentional bias (using the modified Stroop Task) and autonomic reactivity (skin conductance level) to food- and body-related information were assessed in 25 patients with eating disorders (15 patients with anorexia, 10 patients with bulimia) and 18 women controls. Patients with anorexia showed the greatest interference in color-naming food-related words. However, on this occasion there were no differences in body condition, probably because of heterogeneity of clinical samples and because the control group were staff members, so the target information was very familiar to them. The groups differed in their autonomic reactivity while performing the Stroop, the patients with anorexia re…
Development and validation of a scale to measure caregiver skills in eating disorders
Objective:- The aim of this study was to develop and validate a new questionnaire designed to measure caregiver skills that, in line with the interpersonal component of the cognitive interpersonal maintenance model (Schmidt and Treasure, J Br J Clin Psychol, 45, 343–366, 2006), may be helpful in the support of people with anorexia nervosa (AN). A further aim is to assess whether this scale is sensitive to change following skills-based caregiver interventions. Method:- The Caregiver Skills (CASK) scale was developed by a group of clinicians and caregivers. Preliminary versions of the scale devised for both caregivers and parents were given at baseline and at follow-up after two studies of ca…
Early Response to treatment in Eating Disorders: A Systematic Review and a Diagnostic Test Accuracy Meta-Analysis
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 t…
The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence
The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data…
A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK
Background Individual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored. Method Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177). Results One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI,…
The Use of a Nonimmersive Virtual Reality Programme in Anorexia Nervosa: A Single Case-Report
Objective: People with anorexia nervosa (AN) experience high levels of fear and anxiety related to eating. The aim of this case report was to describe the use of a virtual reality (VR) programme developed to facilitate exposure to food as a supplement to treatment for a person with AN. Method: A 21-year-old patient with AN was given the VR module in addition to the Maudsley Model of Treatment for Adults with Anorexia Nervosa. Weight, eating disorder symptomatology (EDE-Q) and general psychopathology (DASS) were assessed before and after the module was delivered. Results: At the end of the module, the patient reported lower levels of anxiety, safety behaviours and fears related to food. Both…
Selective processing of food— and body—related information and autonomie arousal in patients with eating disorders
Both attentional bias (using the modified Stroop Task) and autonomic reactivity (skin conductance level) to food- and body-related information were assessed in 25 patients with eating disorders (15 patients with anorexia, 10 patients with bulimia) amI 18 women controls. Patients with anorexia showed the greatest inrerference in color-naming foodrelated words. However, on this occasion there were no difierences in body condition, probably because of heterogeneity of clinical samples and because the control group were staff members, so the target information was very familiar to them. The groups differed in their autonomic reactivity while performing Ihe Stroop. Ihe patients with anorexia res…
Is the selective information processing of food and body words specific to patients with eating disorders?
The selective processing of food- and body size-related information was investigated using a modified version of the Stroop task. Anorexic and bulimic patients and matched female controls were compared on the basis of categorical (diagnosis), dimensional (restraint and drive for thinness) criteria, or both. The findings suggest that the phenomenon assessed by the Stroop paradigm is not exclusive to patients with a clinical eating disorder, but patients and those control subjects who are restrained eaters with a high drive for thinness share a selective processing of information related to shape and eating. The discussion focuses on the implications of these findings. © 1993 by lohn Wiley & …
The relationship between working alliance with peer mentors and eating psychopathology in a digital 6‐week guided self‐help intervention for anorexia nervosa
Objective: The quality of working alliance (WA) is associated with treatment outcomes across several types of psychiatric disorders and psychological interventions. This study examined the role of WA with peer mentors (people with lived experience of illness) and student mentors (graduated psychology students) in a 6-week, digital, guided self-help (GSH) intervention for anorexia nervosa. Method: Ninety-nine patients rated weekly, for 6 weeks: (a) eating psychopathology using the short version of the Eating Disorder Examination Questionnaire (EDE-QS) and (b) WA with a student mentor (n = 14) or a peer mentor (n = 10). WA was assessed by asking patients the extent to which they felt comforta…
Shared genetic risk between eating disorder- and substance-use-related phenotypes: Evidence from genome-wide association studies
AbstractEating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa (BN) and problem alcohol use (genetic correlation [rg], twin-based=0.23-0.53). We estimated the genetic correlation between eating disorder and substance use and disorder phenotypes using data from genome-wide association studies (GWAS). Four eating disorder phenotypes (anorexia nervosa [AN], AN with binge-eating, AN without binge-eating, and a BN factor score), and eight substance-use-related phenotypes (drinks per week, alcohol use disorder [AUD], …
An examination of the impact of care giving styles (accommodation and skilful communication and support) on the one year outcome of adolescent anorexia nervosa: Testing the assumptions of the cognitive interpersonal model in anorexia nervosa
Abstract Background The cognitive interpersonal model predicts that parental caregiving style will impact on the rate of improvement of anorexia nervosa symptoms. The study aims to examine whether the absolute levels and the relative congruence between mothers' and fathers' care giving styles influenced the rate of change of their children's symptoms of anorexia nervosa over 12 months. Methods Triads ( n =54) consisting of patients with anorexia nervosa and both of their parents were included in the study. Caregivers completed the Caregiver Skills scale and the Accommodation and Enabling Scale at intake. Patients completed the Short Evaluation of Eating Disorders at intake and at monthly in…
Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment
Objective: To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome. Method: From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses (N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty-six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12-…
Network intervention analysis to assess the trajectory of change and treatment effects associated with the use of online guided self-help for anorexia nervosa
Aim The aim of this study was to use the innovative technique of Network Intervention Analysis (NIA) to examine the trajectory of symptom change associated with the use of a digital guided self-help intervention (RecoveryMANTRA) to augment treatment as usual in adult anorexia nervosa. Methods Self-reported eating disorder symptoms and mood (stress, anxiety and depression), work and social adjustment, motivation and treatment (Treatment as usual + RecoveryMANTRAand Treatment as usual) were included as nodes in the network and examined using NIA. Networks were computed at baseline (n = 88, 99), at end of treatment (6 weeks, n = 71, 75) and at 6- (n = 58, 63) and 12-month (n = 52, 63) follow-u…
A multicenter audit of outpatient care for adult anorexia nervosa: Symptom trajectory, service use, and evidence in support of “early stage” versus “severe and enduring” classification
Background: We explored the utility of “staging” anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12-month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment. Method: We conducted secondary analyses on data from a multisite clinical trial of adults with AN (n = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: “early stage” (illness duration <3 years; n = 60) and “severe and en…