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Closing the Research-Practice Gap in Eating Disorders

research on eating disorders

©AltagraciaArt/Shutterstock

  • Ellen E. Fitzsimmons-Craft, PhD
  • Denise E. Wilfley, PhD
September 30, 2019
Volume: 
36
Issue: 
9
  • Special Reports, Eating Disorders
Significance for Practicing Psychiatrists - Eating Disorders
Significance for Practicing Psychiatrists
Key characteristics of approaches for addressing the research-practice gap
Table. Key characteristics of approaches for addressing the research-practice gap

Disseminating Evidence-Based Psychological Treatment

 

Eating disorders (EDs) affect individuals from every socioeconomic status, race, ethnicity, and gender, with approximately 10% of the population affected by an ED at some point in their lifetime.1 EDs are associated with high medical and psychiatric comorbidity, poor quality of life, and high mortality, and mortality from anorexia nervosa (AN) is the highest of all mental disorders.2 Fortunately, there are a number of evidence-based psychological treatment approaches for EDs. Three well-established treatments have emerged for patients who are medically and psychiatrically stable enough for outpatient care.3

Family-based treatment

The basic tenets of family-based treatment—often referred to as the Maudsley method—for adolescents with anorexia nervosa include4:

1) The family is not blamed as the cause of the illness.

2) The adolescent’s acceptance of family and parent involvement in therapy is crucially important; thus, parents are tasked with taking charge of weight gain in their malnourished child.

3) The entire family is an important part of treatment success.

4) Normal adolescent development is seen as having been interrupted by the illness.

The treatment typically consists of 10 to 20 sessions over the course of 6 to 12 months. Full nutrition is viewed as a critical first step toward recovery, and the early part of treatment is focused on the therapist coaching the parents to provide this nutrition by actively feeding their child.

Cognitive-behavioral therapy

Cognitive behavioral therapy (CBT) is a treatment for bulimia nervosa and binge eating disorder. According to the cognitive-behavioral theory of EDs, the over-evaluation and control of shape and weight is central to ED maintenance, with most of the other clinical features understood as directly resulting from this psychopathology, including extreme weight-control behavior and preoccupation with thoughts about eating, shape, and weight.

The core components of CBT are designed to be delivered in 20 sessions over 5 months. Key strategies include establishing control over eating with behavioral techniques, such as self-monitoring and establishing a regular pattern of eating and addressing maintaining factors (eg, control and over-evaluation of shape and weight, dietary restraint). In the enhanced version of CBT for EDs (CBT-E), modules can be added to address one or more external processes that may be maintaining the ED, including perfectionism, low self-esteem, and interpersonal problems.

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Disclosures: 

Dr Fitzsimmons-Craft is Assistant Professor of Psychiatry, and Dr Wilfley is the Scott Rudolph University Professor of Psychiatry, Medicine, Pediatrics, and Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO. The authors report no conflicts of interest concerning the subject matter of this article.

References: 

1. Schaumberg K, Welch E, Breithaupt L, et al. The science behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders. Eur Eat Disord Rev. 2017;25:432-450.

2. Klump KL, Bulik CM, Kaye WH, et al. Academy for Eating Disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord. 2009;42:97-103.

3. Lock J. An update on evidence-based psychological treatments for eating disorders in children and adolescents. J Clin Child Adolesc. 2015;44:707-721.

4. Lock J, Le Grange D. Treatment Manual for Anorexia Nervosa: A Family-Based Approach. New York: Guilford Press; 2015.

5. Wilson GT, Zandberg LJ. Cognitive–behavioral guided self-help for eating disorders: Effectiveness and scalability. Clin Psychol Rev. 2012;32:343-357.

6. National Institute for Health and Care Excellence. Eating Disorders: Recognition and Treatment. May 2017.

7. Wilfley DE, Eichen DM. Interpersonal psychotherapy. Brownell KD, Walsh BT, Eds. Eating Disorders and Obesity, 3rd ed. New York: Guilford; 2017:290-295.

8. Waller G. Treatment protocols for eating disorders: clinicians’ attitudes, concerns, adherence and difficulties delivering evidence-based psychological interventions. Curr Psychiatry Rep. 2016;18:1-8.

9. von Ranson KM, Wallace LM, Stevenson A. Psychotherapies provided for eating disorders by community clinicians: infrequent use of evidence-based treatment. Psychother Res. 2013;23:333-343.

10. Insel TR. Translating scientific opportunity into public health impact: A strategic plan for research on mental illness. Arch Gen Psychiatry. 2009;66:128-133.

11. Beidas RS, Kendall PC. Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clin Psychol-Sci Pr. 2010;17:1-30.

12. Zandberg LJ, Wilson GT. Train-the-trainer: implementation of cognitive behavioural guided self-help for recurrent binge eating in a naturalistic setting. Eur Eat Disord Rev. 2013;21:230-237.

13. Wilfley DE, Fitzsimmons-Craft EE, Eichen DM, et al. Training models for implementing evidence-based psychological treatment for college mental health. Contemp Clin Trials. 2018;72:117-125.

14. Cooper Z, Bailey-Straebler S, Morgan KE, et al. Using the Internet to train therapists: randomized comparison of two scalable methods. J Med Internet Res. 2017;19:e355.

15. Fairburn CG, Allen E, Bailey-Straebler S, et al. Scaling up psychological treatments: a countrywide test of the online training of therapists. J Med Internet Res. 2017;19:e214.

16. Wilfley DE. Harnessing Technology for Training Clinicians to Deliver Interpersonal Psychotherapy (IPT). Paper presented at the National Eating Disorders Association Conference. San Diego, CA; October 2015.

17. Kazdin AE, Fitzsimmons-Craft EE, Wilfley DE. Addressing critical gaps in the treatment of eating disorders. Int J Eat Disord. 2017;50:170-189.

18. Cuijpers P, Donker T, Weissman MM, et al. Interpersonal psychotherapy for mental health problems: a comprehensive meta-analysis. Am J Psychiatry. 2016;173:680-687.

19. Knaup C, Koesters M, Schoefer D, et al. Effect of feedback of treatment outcome in specialist mental healthcare: meta-analysis. Br J Psychiatry. 2009;195:15-22.

20. Layard R, Clark DM. Thrive: How Better Mental Health Care Transforms Lives and Saves Money. New York: Princeton University Press; 2015.

21. Karlin BE, Cross G. From the laboratory to the therapy room: national dissemination and implementation of evidence-based psychotherapies in the US Department of Veterans Affairs Health Care System. Am Psychol. 2014;69:19-33.

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