Predictors of treatment acceptance and of participation in a randomized controlled trial among women with anorexia nervosa.
ABSTRACT This study aimed to identify predictors of acceptance of intensive treatment and of participation in a randomized controlled trial (RCT) among women with anorexia nervosa (AN).
Participant data were drawn from a tertiary care intensive treatment programme including a previously published RCT. Women with AN (N = 106) were offered intensive treatment, and 69 were approached to participate in an RCT of olanzapine's efficacy as an adjunctive treatment for AN. AN subtype and pretreatment psychological variables were used to predict acceptance of intensive treatment and RCT participation.
AN binge purge subtype and higher depression and body dissatisfaction predicted intensive treatment acceptance. No variable predicted RCT participation among treatment acceptors.
Clinicians may focus on enhancing motivation or use a stepped care approach to increase intensive treatment acceptance especially among women with AN-restricting type and among all those with AN who have lower levels of distress.
- [Show abstract] [Hide abstract]
ABSTRACT: Objectives Individuals with eating disorders are prone to depressive symptoms. This study examines whether depressive symptoms can change in women who complete intensive day treatment for anorexia and bulimia nervosa (BN), and whether these changes are associated with pre-treatment attachment insecurity.DesignParticipants were 141 women with anorexia nervosa restricting type (n = 24), anorexia nervosa binge purge type (n = 30), and BN (n = 87) who completed a day hospital treatment programme for eating disorders. They completed a pre-treatment self-report measure of attachment, and a pre-treatment and post-treatment self-report measure of depressive symptoms.ResultsParticipants experienced significant reductions in depressive symptoms at post-treatment. Eating disorder diagnosis was not related to these improvements. However, participants lower in attachment anxiety experienced significantly greater improvement in depressive symptoms than those who were higher in attachment anxiety.Conclusions These results suggest that clinicians may tailor eating disorders treatments to patients' attachment patterns and focus on their pre-occupation with relationships and affect regulation to improve depressive symptoms.Practitioner pointsThat depressive symptoms can decrease in women who complete day hospital treatment for anorexia and BN.That improvements in depressive symptoms do not vary according to eating disorder diagnosis in these women.That patients who complete treatment and who have higher attachment anxiety experience less improvements in depressive symptoms compared to those lower in attachment anxiety.That clinicians may attend to aspects of attachment anxiety, such as need for approval and up-regulation of emotions, to improve depressive symptoms in female patients with eating disorders.Psychology and Psychotherapy: Theory, Research and Practice. 04/2014;
- [Show abstract] [Hide abstract]
ABSTRACT: Abstract Psychological interventions and research for eating disorders tend to be complex, and outcomes on average are modest. Given the frequency and severity of eating disorders, these levels of outcomes are disconcerting. Adding to the current state of research is evidence that practicing clinicians do not tend to use evidence-based psychotherapies consistently for eating disorders. This is a problem not only of dissemination and uptake of research, but also one of knowledge translation. More practice-based research, in which clinicians are equal partners in developing interventions and designing research, may be necessary in order to solve the problems of modest outcomes and low research uptake. The psychotherapy research of eating disorders in this special section presents examples of research that takes place in real-world clinical contexts with complex patients and that can be more easily translated into clinical practice.Psychotherapy Research 05/2013; 23(3):247-251. · 1.75 Impact Factor