Higher-level support and policy. For evidence-based care to dramatically increase, higher-level support is required. Improving Access to Psychological Therapies (IAPT) is a systematic way of organizing the delivery of evidence-based psychological treatment, according to the NICE guidelines, within England’s National Health Service. IAPT services are characterized by use of evidence-based treatments, routine outcome monitoring, and regular and outcomes-focused supervision.20 Routine outcome monitoring not only provides the patient and therapist with valuable information on symptom improvement, but it also provides information on whether this is a cost-effective approach. In the US, the Veterans Health Administration (VHA) is actively implementing a national initiative to disseminate and implement evidence-based treatments.21
IAPT and the VHA models involve centralized control of money from the top and their implementation is mandated. Such initiatives have a much greater likelihood of success in changing therapist behavior relative to relying on individual therapists to voluntarily receive training and modify their behavior.
Conclusion and future directions
The establishment of several evidence-based psychological treatments for EDs, including family-based treatment, CBT, and interpersonal psychotherapy, represent an enormous advance. However, only a minority of patients with EDs who access care receive one of these treatments. To address the research-practice gap and ensure that more people obtain high-quality, evidence-based care, the use of novel approaches are required.
What will be most effective in terms of meaningfully addressing the research-practice gap is higher-level support and policy, which has the greatest likelihood of generating widespread change. It is important to work with policy makers to develop research questions that will answer important policy-related questions. Such an approach may dramatically increase access to evidence-based care for patients with EDs.
There is an enormous treatment gap in the field of EDs, whereby the vast majority of patients with EDs (≥ 80%) receive no clinical care whatsoever.17 Moving forward, in addition to continuing to improve the quality of treatment for the minority of individuals with EDs who receive services, increased attention needs to be devoted to finding novel approaches to delivering treatment that can reach the vast number of individuals in need of care who currently receive no services at all.
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.
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.