Community Eating Disorders Service Research Articles

Evidence of effectiveness of specialist supportive clinical management for anorexia nervosa in routine clinical practice: Outcomes from a clinical case series.

This study provides a preliminary report on the effectiveness of Specialist Supportive Clinical Management (SSCM) in a clinical case series of adults with anorexia nervosa, to supplement evidence of efficacy from controlled trials. Body mass index (BMI), eating disorder symptoms, mood and anxiety were measured at the start and end of treatment for 42 adults who received SSCM in a community eating disorders service. Significant improvements were observed on all outcome measures, with larger effect sizes for symptom change than BMI. Recovery rates appear similar to those in clinical trials. The study offers preliminary support for the effectiveness of SSCM in routine settings and identifies several areas for further research.

Primary Care Referrals of Suspected Eating Disorders in Children and Young People in Greater Manchester Audit

AimsCurrent NICE guidance states that Children and Young People (CYP) with suspected Eating Disorders (EDs) should be immediately referred to specialist services on their first presentation to primary care. This audit assessed whether these standards were being met across Greater Manchester and what general practitioners felt would be helpful in supporting them to correctly refer patients. Aim 1: Analyse information from referral forms on all patients referred to Manchester Foundation Trust Community Eating Disorders Service (MFT-CEDS) from primary care between 17th December 2020 – 17th June 2021. Aim 2: Gain insight into how confident GPs in Greater Manchester feel identifying suspected EDs in CYP, their knowledge of guidelines regarding referral, and how they would like to be supported to improve referrals of suspected CYP-ED.MethodsQuantitative data on all primary care referrals made between 17th December 2020–17th June 2021 were analysed. Referrals were classified as correct if they were made both immediately and directly to the correct service. Subgroup analysis of data by geographic region of Greater Manchester was also undertaken. Qualitative data were collected through a survey which was sent to General Practitioners across Greater Manchester. The survey assessed knowledge of current guidelines and views on what training materials could be helpful to improve the referral process.ResultsA total of 69 patients were referred to MFT-CEDS by their GP between 17th December 2020 and 17th June 2021. 35% of GP referrals to MFT-CEDS were documented as being made correctly as per current guidelines. 43.5% of all referrals were not initially made to MFT-CEDS. 58% of referrals were documented as being made immediately. North and South Manchester had the lowest rates of correct referrals of 10% and 8% respectively. There were 10 survey respondents, of which the majority did not know current referral guidelines and did not feel confident in identifying suspected Eating Disorders in CYP.ConclusionThe majority of primary care referrals of CYP with suspected eating disorders to MFT-CEDS were not made in line with current NICE guidance.The following recommendations were made based on the findings of this audit:1) Create an information document and video regarding identification and referral guidelines for suspected EDs in CYP, 2) Design an easy-to-use referral template for GPs, 3) Conduct interviews with GPs working in North and South Manchester to help identify what additional support they need, 4) Re-audit referral data once quality improvement measures have been in place for 6 months.

Effectiveness of a brief form of group dialectical behavior therapy for binge‐eating disorder: Case series in a routine clinical setting

While there is evidence to support the use of group dialectical behavior therapy (DBT) in the treatment of binge-eating disorder (BED), treatment is relatively long compared with other evidence-based treatments. This study explored the effectiveness of brief DBT groups for BED, delivered in a routine community setting. Eighty-four adults with BED entered 10-week DBT group treatment in a community eating disorders service. In total, 12 groups were conducted. Patients completed measures of eating disorder pathology, anxiety, depression, and emotional eating at the start and end of treatment, and at 1-month follow-up. Frequency of weekly binges was recorded. Outcomes were similar to those of longer versions of DBT, with an attrition rate of 26%, and significant reductions in eating disorder psychopathology and emotional eating by the end of treatment and at follow-up. Over 50% of patients were abstinent from binge eating by Session 4. Group DBT delivered in a 10-session format is clinically equivalent to longer versions of the same treatment. Future research is required to explore patterns of change and to demonstrate replicability under controlled conditions, but these findings are promising for the efficient delivery of effective treatment and reducing waiting times.

Patient expectations, eating disorder severity and personality features: Impact on eating pathology in psychological therapy for eating disorders

Many factors have been shown to impact treatment outcome in eating disorders, including illness related variables (e.g. symptom severity), and broader clinical features (e.g. personality pathology). Less is known about the potential impact of patient related variables, such as patients' views regarding treatment suitability and success. This study explored the impact of eating disorder severity, personality features and patient expectations regarding treatment suitability and success, on eating pathology at treatment end. Participants were 128 adults with diagnosed eating disorders who completed a course of evidence-based psychological therapy in a community eating disorders service in the UK. Patients completed measures of eating disorder psychopathology and personality features at treatment commencement, and a measure of patient expectations regarding change after session six. They repeated the measure of eating disorder psychopathology at treatment end. All patients had some level of positive expectations regarding the suitability and potential success of treatment after session six. Eating disorder severity significantly predicted eating pathology at treatment end. However, strength of positive expectations regarding treatment success significantly predicted eating pathology over and above baseline level of eating disorder severity. Personality features at baseline were not significantly related to treatment outcome. Findings suggest that patients' expectations regarding the likely success of therapy have a significant impact on treatment outcome. Patients who develop a strong belief that treatment will work may be more likely to actively engage in the process of therapy to achieve their recovery goals. These findings have important implications for the early phase of therapy and how patients are oriented towards treatment.

CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression

Whilst studies have consistently identified early symptom reduction as an important predictor of treatment outcome, the impact of early change on common comorbid features has not been investigated. This study of CBT for eating disorders explored patterns of early change in eating pathology and longer-term change in personality pathology, anxiety and depression. It also explored the impact of early change in eating pathology on overall change in personality pathology, anxiety and depression. Participants were 179 adults diagnosed with eating disorders who were offered a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment and following the 6th session. They also completed measures of personality disorder cognitions, anxiety and depression at the start and end of treatment. There were significant changes in eating pathology over the first six sessions of treatment. Significant improvements were also seen in personality disorder pathology, anxiety and depression by the end of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. Early changes in eating pathology were associated with later changes in common comorbid features, with early reduction in restraint being a key predictor. These findings demonstrate that early symptom change can be achieved in CBT for eating disorders when delivered in routine clinical practice. Such change has long-term benefits that go beyond the domain of eating pathology, enhancing change in personality pathology, anxiety and depression.

The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders

The present study explored the impact of early symptom change (cognitive and behavioural) and the early therapeutic alliance on treatment outcome in cognitive-behavioural therapy (CBT) for the eating disorders. Participants were 94 adults with diagnosed eating disorders who completed a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment, following the 6th session and at the end of treatment. They also completed a measure of therapeutic alliance following the 6th session. Greater early reduction in dietary restraint and eating concerns, and smaller levels of change in shape concern, significantly predicted later reduction in global eating pathology. The early therapeutic alliance was strong across the three domains of tasks, goals and bond. Early symptom reduction was a stronger predictor of later reduction in eating pathology than early therapeutic alliance. The early therapeutic alliance did not mediate the relationship between early symptom reduction and later reduction in global eating pathology. Instead, greater early symptom reduction predicted a strong early therapeutic alliance. Early clinical change was the strongest predictor of treatment outcome and this also facilitated the development of a strong early alliance. Clinicians should be encouraged to deliver all aspects of evidence-based CBT, including behavioural change. The findings suggest that this will have a positive impact on both the early therapeutic alliance and later change in eating pathology.

Telephone surveys and client satisfaction: Reflections from an adult community eating disorders service

Telephone surveys are fast, cost-effective, well received by participants, ensure high response rates and offer good data on client satisfaction. Satisfaction with the service was generally high and examples are given on how service development was influenced by feedback data.

Cognitive-behavioural therapy for outpatients with eating disorders: Effectiveness for a transdiagnostic group in a routine clinical setting

Whilst there is a growing evidence to support the impact of cognitive-behavioural therapy (CBT) in the treatment of adults with eating disorders, much of this evidence comes from tightly controlled efficacy trials. This study aimed to add to the evidence regarding the effectiveness of CBT when delivered in a routine clinical setting. The participants were 203 adults presenting with a range of eating disorder diagnoses, who were offered CBT in an out-patient community eating disorders service in the UK. Patients completed measures of eating disorder pathology at the start of treatment, following the sixth session, and at the end of treatment. Symptoms of anxiety, depression, and psychosocial functioning were measured pre- and post-treatment. Approximately 55% of patients completed treatment, and there were no factors that predicted attrition. There were significant improvements in eating disorder psychopathology, anxiety, depression and general functioning, with particular changes in eating attitudes in the early part of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. These findings confirm that evidence-based forms of CBT can be delivered with strong outcomes in routine clinical settings. Clinicians should be encouraged to deliver evidence-based treatments when working in these settings.

The quest to adhere to the NICE guidelines for eating disorders in an adult community eating disorders service

This article describes and reflects on a full audit cycle that was conducted in an adult community eating disorders service in search of compliance with the National Institute for Health and Clinical Excellence (NICE, 2004) guidelines for eating disorders.

Active Waiting List Management: Potential Usefulness in a Community Eating Disorders Service

We explored the usefulness of an initiative for managing a treatment waiting list in a community eating disorders service. We sent 108 patients awaiting treatment an opt-in letter and, if necessary, a reminder 3 weeks later. Those who opted in were compared with those who did not. Of those receiving the letter, 67.6% opted in and did not differ significantly from those who opted out on measures of eating disorder pathology and general functioning. However, they had waited less time. Opt-in letters may help to identify those who no longer want to access services, thereby allowing resources to be directed towards those who still want treatment.