Eating Disorder Treatment Center Research Articles

Stephanie Knatz Peck: Novel and innovative treatment for eating disorders

Dr. Stephanie Knatz Peck, Ph.D., is a practicing clinical psychologist and Associate Clinical Professor of Psychiatry at the University of California, San Diego (UCSD). Her career uniquely bridges clinical practice with innovative research, focusing on developing and evaluating novel psychiatric interventions, particularly for eating disorders. Dr. Knatz Peck's research journey began at the UCSD Eating Disorder Treatment and Research Center, where she skillfully translated complex neuroimaging and genetic findings into practical, innovative treatment approaches for anorexia nervosa (AN). This work culminated in the development and manualization of Temperament-Based Treatment with Supports (TBT-S), a groundbreaking behavioral intervention for AN. In recent years, Dr. Knatz Peck has expanded her research into the promising field of psychedelic-assisted therapies. She served as co-investigator on the first clinical trial evaluating psilocybin treatment for AN, marking a significant milestone in eating disorder research. Additionally, she contributes her expertise as a senior clinical consultant for Compass Pathways, where she leads training initiatives and plays a crucial role in developing psychological support models for psilocybin therapy across various psychiatric conditions. Beyond her academic pursuits, Dr. Knatz Peck founded and directs BrightMind Therapy, an outpatient practice providing evidence-based therapy for children and adolescents. Her comprehensive approach seamlessly integrates clinical practice with rigorous research, utilizing neuroimaging data, genetic findings, and hands-on clinical observations to develop targeted interventions for treatment-resistant psychiatric conditions. We are privileged to have Dr. Knatz Peck share her invaluable insights and experiences with our readers in this Genomic Press Interview.

Vitamin D Status and Behavioral Impulsivity in Anorexia Nervosa: Insights from a Longitudinal Study.

Anorexia nervosa (AN) is a severe psychiatric disorder marked by extreme weight control behaviors and significant impacts on physical and psychosocial health. This study explores the relationship between vitamin D (Vit-D) levels and impulsivity in women with AN. Forty-six cisgender White women participants were assessed upon admission and before discharge from a specialized eating disorder treatment center, with an average duration of 2.5 ± 0.10 months. Methods included self-reported questionnaires and behavioral tasks to measure impulsivity, alongside serum Vit-D levels. Our results showed significant improvements in Vit-D levels and certain impulsivity measures, such as faster reaction times and fewer errors on the go/no-go task, correlating with higher Vit-D levels. However, no significant correlations were found between Vit-D levels and self-reported impulsivity. These findings suggest that adequate Vit-D levels may enhance cognitive functions related to impulse control in AN. Given this study's limitations, including its exclusive focus on women and small sample size, future research should involve larger, more diverse populations and randomized clinical trials to better understand the causal relationships and therapeutic potential of Vit-D in managing AN-related impulsivity.

Adapting a mobile app to support patients with anorexia nervosa following post-acute care: perspectives from eating disorder treatment center stakeholders.

Anorexia nervosa (AN) is a harmful, life-threatening illness. Patients with severe AN often receive acute treatment but, upon discharge, experience high relapse rates. Evidence-based, outpatient treatment following acute care is critical to preventing relapse; however, numerous barriers (e.g., location, financial limitations, low availability of providers) preclude individuals from accessing treatment. mHealth technologies may help to address these barriers, but research on such digital approaches for those with AN is limited. Further, such technologies should be developed with all relevant stakeholder input considered from the outset. As such, the present study aimed to garner feedback from eating disorder (ED) treatment center providers on (1) the process of discharging patients to outpatient services, (2) their experiences with technology as a treatment tool, and (3) how future mHealth technologies may be harnessed to offer the most benefit to patients in the post-acute period. Participants (N = 11, from 7 ED treatment centers across the United States) were interviewed. To analyze the data for this study, each interview was manually transcribed and analyzed using components of Braun and Clarke's six-phase thematic analysis framework (Braun & Clarke, 2006). Participants indicated proactively securing outpatient care for their patients, but mentioned several barriers their patients face in accessing evidence-based ED treatment. All participants had some experience using various technologies for treatment (e.g., teletherapy, self-monitoring apps), and mentioned a high level of interest in the development of a new app to be used by patients recently discharged from acute treatment for AN. Participants also offered suggestions of effective and relevant content for a potential app and adjunctive social networking component for post-acute care of AN. Overall, participants expressed positive attitudes toward the integration of an app into the care flow, suggesting the high potential benefit of harnessing technology to support individuals recovering from AN.

Adapting a mobile app to support patients with anorexia nervosa following post-acute care: perspectives from eating disorder treatment center stakeholders

Adapting a mobile app to support patients with anorexia nervosa following post-acute care: perspectives from eating disorder treatment center stakeholders

Sensory processing in children and adolescents shortly after the onset of anorexia nervosa: a pilot study

BackgroundAlterations in sensory processing, such as vision, taste, and interoceptive sensation, have been reported in adult anorexia nervosa (AN). Whether these symptoms are traits, states, or “scars” due to chronic starvation has not been fully established. Based on the hypothesis that alterations in sensory processing also occur in adolescent AN in the early stages of the disease, the present study was conducted using both self-administered and parent-administered sensory processing questionnaires.MethodsChildren and adolescents with anorexia nervosa treated at a single tertiary eating disorder treatment center in Japan (AN group) and female junior high school students attending a public junior high school in Saitama Prefecture, Japan (healthy control group: HC group) were included in the study. The Sensory Profile (SP) and Adult/Adolescent Sensory Profile (AASP) were administered to the participants and their caregivers. In addition, we collected demographic data and administered the Children’s Eating Attitude Test and Autism-Spectrum Quotient Children’s version.ResultsSeventeen children and adolescents were enrolled in the AN group, and 63 were enrolled in the HC group. There was no statistically significant difference between the AN and HC groups in the quadrant scores of the AASP. In the SP, the Sensory Avoiding score and the Emotional/Social response score were higher in the AN group than in the HC group.ConclusionFrom the parents’ point of view, the patient avoids unexpected sensory stimuli, but the patients are unaware of their own avoiding behavior in the early stages of the disease. The results suggest that sensory sensitivity in AN may be a “scar” symptom due to chronic starvation and a state symptom. Longitudinal studies from shortly after the onset with larger sample sizes are needed to gain insight into the dynamic relation between sensory processing and eating disorder pathology.

The importance of an eating disorder treatment support center in Japan: A survey from 2017 to 2020

We investigated the impact of medical collaboration between the Chiba Eating Disorder (ED) Treatment Support Center (CSC) in Chiba Prefecture and the ED treatment center at Kohnodai Hospital. We calculated the number of consultations performed by the CSC and referral rate to other medical facilities from October 2017 to March 2020, as well as the clinical characteristics of the patients treated at our hospital from April 2016 to March 2020. Data on duration of hospitalization and increase in body mass index (BMI) during hospitalization were recorded. Patients were divided into all of the Japan and Chiba Prefecture groups. Data were evaluated by Poisson's regression analysis or one-way analysis of variance. A p-value < 0.05 was considered significant. The 2019 data served as reference values. Our data demonstrated that while the number of CSC consultations increased (2017:201, 2018:547, 2019:552) annually, the number of hospitalizations for EDs decreased (197, 194, 134, respectively). In comparison, the number of outpatient consultations for EDs across all of Japan peaked in 2018 and decreased significantly thereafter (2016:110, 2017:139, 2018:193, 2019:142). After the CSC was established, the number of patients treated in our department decreased as expected. Patients with anorexia nervosa (AN) who were treated on an outpatient basis across all of Japan were younger in 2019 (27.0 ± 1.2) than in 2018 (31.9 ± 1.2). Severe cases had better outcomes, and there was a significant increase in BMI of inpatients with AN in both groups. Overall, the activities of such ED treatment support center promoted successful treatment of severe ED cases.

A case series of group-based ketamine-assisted psychotherapy for patients in residential treatment for eating disorders with comorbid depression and anxiety disorders.

BackgroundDepression and anxiety outcome measures, safety/tolerability, patient satisfaction, and ease of implementation of group-based ketamine-assisted psychotherapy (G-KAP) delivered to patients in intensive residential eating disorder (ED) treatment were assessed.Case presentationThis study reports on five participants with a diagnosis of an ED and comorbid mood and anxiety disorders who received weekly intramuscular ketamine injections in a group setting over 4 weeks. Measures of anxiety (GAD-7) and depression (PHQ-9) were administered pre-dose, 4-h post-dose, and 24-h post dose. Four of the 5 participants experienced clinically significant improvements on the PHQ-9 score (i.e., change greater than 5) while 2 of the 5 participants experienced clinically significant improvements on the GAD-7 score (i.e., change greater than 4) from pre-dose to 24-h post-dose after the last ketamine session. Dosing sessions were well tolerated, and no serious adverse events were reported. Clinical observations and participant reports corroborated improvements in depression and anxiety symptoms, good tolerability of ketamine treatment, and practical implementation of the G-KAP protocol in a residential ED treatment center.ConclusionsThis study suggests the potential utility of G-KAP as an adjunct to intensive, specialized ED treatment. Overall, this novel, cross-diagnostic intervention warrants future research to further explore its appropriateness in a treatment setting.

Parent and clinician perspectives on virtual guided self-help family-based treatment (GSH-FBT) for adolescents with anorexia nervosa.

PurposeGuided self-help (GSH) treatments have the capacity to expand access to care, decrease costs, and increase dissemination compared to traditional therapist-directed treatment approaches. However, little is known about parent and clinician perspectives about the acceptability of GSH for adolescents with eating disorders.MethodsThis study utilized a mixed methods approach to obtain qualitative and quantitative data regarding clinician and participants’ experiences with GSH. Parent participants were enrolled in a randomized trial comparing GSH family-based treatment (GSH-FBT) to family-based treatment delivered via videoconferencing (FBT-V) for adolescents (12–18 years old) with a DSM-5 diagnosis of anorexia nervosa (AN). Parent participants provided qualitative feedback using the Helping Alliances Questionnaire about their experience of treatment. Clinician participants were six master’s or PhD-level therapists. These clinicians were trained in and provided both treatments (GSH-FBT and FBT-V). They provided responses to questionnaires and participated in a 1-h focus group about their experience as treatment providers.ResultsRegardless of treatment condition, parents listed more improvement than worsening of symptoms in their child with AN. Clinicians reported lower scores on competency and comfort metrics with GSH-FBT compared to FBT-V. Qualitatively, clinicians reported both advantages and disadvantages of delivering GSH-FBT.ConclusionFurther studies are needed to better understand how GSH interventions can be disseminated to patients and families, particularly those with limited access to specialized eating disorder treatment centers.Level of evidence Level I, data collected as part of a randomized controlled trial.

Understanding non-routine discharge: Factors that are associated with premature termination from higher levels of care in adults with anorexia nervosa

ABSTRACT This study sought to replicate and extend associations between clinical and demographic features at admission and types of premature treatment termination for adults diagnosed with anorexia nervosa (AN) in higher-level-of-care settings. Secondary data analyses examined a study population comprised of adults with AN (N = 565) who were admitted to one of two United States eating disorder treatment centers (April 2015–April 2020) for intensive outpatient, partial hospitalization, residential, or inpatient services. There were no significant differences in the type of non-routine discharge according to level of care. At admission, those with lower BMI were more likely to discharge against medical advice, and those with lower cognitive restraint and elevated binge eating were more likely to discharge against medical advice or by staff-initiated request, respectively. Discharge by parent/patient request was more likely among those who were older or who reported lower baseline desire for muscularity. Overall older age, elevated binge eating, and lower weight, desire for muscularity, and cognitive restraint may be associated with less tolerance/acceptability for AN treatment. Increased understanding of how to better support patients who admit to higher levels of care with these clinical features will contribute to better odds of completion of a full course of treatment.

Has COVID-19 Complicated Eating Disorder Treatment? An Examination of Comorbidities and Treatment Response Before and During the COVID-19 Pandemic.

Objective: Recent evidence suggests psychosocial stressors stemming from coronavirus disease 2019 (COVID-19) exposure and public health recommendations and policies have exacerbated eating disorder symptoms. Consequentially, eating disorder acuity has increased during the COVID-19 pandemic. Currently, it is still unclear how the COVID-19 pandemic may be impacting individuals receiving treatment for eating disorders at higher levels of care. The purpose of this study was to examine the impact of COVID-19 on eating disorder symptoms and associated outcomes in a sample of individuals receiving eating disorder treatment compared to individuals receiving treatment in 2019. Methods: Blinded outcomes data from 272 adults who completed treatment at an eating disorder treatment center between April and October of 2019 (pre–COVID-19 group) and 2020 (COVID-19 group) were examined. Repeated measures analyses of variance with Bonferroni correction were used to examine differences in outcome variables and treatment response. Results: Fewer participants reported trauma in 2020, but symptoms were more severe when present. A significant interaction effect for treatment (eg, admission, discharge) and year (eg, pre–COVID-19, COVID-19) was found for eating disorder and trauma symptoms. Moreover, trauma symptom scores were higher in 2020 than in 2019. The interaction among year, trauma, and treatment was significant (F3,268 = 2.11, P = .027, η2 = 0.034), indicating that individuals with severe trauma in 2020 reported less eating disorder symptom score reduction. Conclusions: Results extend understanding of effects during the COVID-19 pandemic on treatment-seeking individuals with eating disorders. Clinical implications suggest that greater attention to trauma when screening eating disorder patients and selecting treatment approaches are needed, particularly during the COVID-19 pandemic.

Unsound sleep, wound-up mind: a longitudinal examination of acute suicidal affective disturbance features among an eating disorder sample.

Suicide is one of the most commonly reported causes of death in individuals with eating disorders. However, the mechanisms underlying the suicide and disordered eating link are largely unknown, and current assessments are still unable to accurately predict future suicidal thoughts and behaviors. The purpose of this study is to test the utility of two promising proximal risk factors, sleep quality and agitation, in predicting suicidal ideation in a sample of individuals with elevated suicidal thoughts and behaviors, namely those with eating disorders. Women (N = 97) receiving treatment at an eating disorder treatment center completed weekly questionnaires assessing suicidal ideation, agitation, and sleep. General linear mixed models examined whether agitation and/or sleep quality were concurrently or prospectively associated with suicidal ideation across 12 weeks of treatment. There was a significant interaction between within-person agitation and sleep quality on suicidal ideation [B(s.e.) = -0.02(0.01), p < 0.05], such that on weeks when an individual experienced both higher than their average agitation and lower than their average sleep quality, they also experienced their highest levels of suicidal ideation. However, neither agitation nor sleep quality prospectively predicted suicidal ideation. This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results suggest that ongoing assessment for overarousal symptoms, such as agitation and poor sleep quality, in individuals with eating disorders may be warranted in order to manage suicidal ideation among this vulnerable population.

The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers.

Traumatic events, posttraumatic stress disorder (PTSD) and related symptoms are commonly associated with eating disorders (ED). Several clinical features indicative of a more severe and complex course have been associated with traumatized ED patients, especially those with PTSD, who may be more likely admitted to residential treatment (RT). Research in this population is sparse but of increasing interest. Adult participants (96.7% female) with EDs entering RT (n = 642) at seven sites in the U.S. completed validated self-report assessments of ED, PTSD, major depression, state-trait anxiety, and quality of life. Presumptive diagnoses of DSM-5 PTSD (PTSD+) were made via the Life Events Checklist-5 and the PTSD Symptom Checklist for DSM-5. PTSD+ occurred in 49.3% of patients. PTSD+ patients had significantly higher scores on all assessment measures (p ≤ .001), including measures of ED psychopathology, depression, state-trait anxiety, and quality of life. Those with PTSD+ had significantly higher numbers of lifetime traumatic event types, higher rates of almost all lifetime traumatic events, and a greater propensity toward binge-type EDs. Results confirm that ED-PTSD+ patients in RT are more symptomatic and have worse quality of life than ED patients without PTSD+. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed.

A qualitative examination of adolescent and parent perspectives on early identification and early response to eating disorders

ABSTRACT This qualitative study examined adolescent and caregiver perspectives on identification and early response in emerging eating disorders. Fifteen female-identified adolescents with an eating disorder diagnosis (M age = 15.20 years; 93% White; 20% Hispanic) and 12 caregivers (all biological parents: 1 father, 11 mothers; M age = 51.56 years) participated in semi-structured interviews about their experience identifying and responding to the eating disorder, eventually seeking treatment. Participants were recruited from three eating disorder treatment centers in the United States. Interview responses were coded by three raters using inductive consensual qualitative methods. Results found that parents were typically the first to notice and confront the eating disorder, and weight loss and thinness usually were the earliest symptoms identified. The most common adolescent response to detection was mixed (e.g., relief and anger), and common parental reactions included seeking professional consultation and creating limitations on disordered behaviors (e.g., encouraging eating). Barriers to earlier detection were highlighted (e.g., parental hesitancy to act on suspicions), suggesting that parents need greater support for swift and confident responding. To combat this, parents recommended increasing knowledge of eating disorder symptoms. Parents and adolescents both recommended parent-led monitoring of eating and exercise behaviors to increase the chance of noticing changes and responding quickly with aggressive and supportive action. These experiences provide a framework for early identification and the role of caregiver response, highlighting the need for assertive yet compassionate efforts to combat emerging eating disorders.

A yoga-based therapy program designed to improve body image among an outpatient eating disordered population: program description and results from a mixed-methods pilot study

ABSTRACT Poor body image is a critical barrier to eating disorder recovery. This pilot project was designed as a feasibility study to examine a novel group-based, therapeutic yoga and body image program (YBI) for addressing negative body image in those clinically diagnosed with an eating disorder (anorexia, bulimia nervosa, and other specified feeding or eating disorder) receiving outpatient level treatment at an eating disorder treatment center located in Minneapolis–St. Paul, Minnesota. Self-administered questionnaires were completed by 67 participants at the beginning and end of the 8-week series, to better understand the acceptability of the YBI program and its potential effects on body image and self-worth during outpatient eating disorder treatment. Quantitative survey questions assessed participants’ body image concerns, while open-ended questions probed participants’ experiences and the perceived impact of the yoga program on their body image. After completion of the yoga program, mean item scores on the body image concern survey improved: increases ranged from 0.3 to 0.8 points on a 5-point scale. In open-ended questions, participants described many positive changes to their body image. Participants reported that the yoga program improved their self-acceptance, self-awareness, confidence, emotional and physical strength, and was a positive form of release. Participants also discussed physical and emotional challenges of the yoga program and how they contributed to self-judgment, vulnerability, and confrontation of uncomfortable feelings. The results of this pilot study are promising and warrant consideration of more rigorous study designs to explore the potential of a body image specific therapeutic yoga program to aid those in eating disorder treatment to improve body image disturbances.

Online cognitive behavioral therapy enhanced for binge eating disorder: study protocol for a randomized controlled trial

BackgroundBinge eating disorder is characterized by recurrent episodes of binge eating accompanied by a sense of lack of control. Of the different treatments available, Cognitive Behavioral Therapy-Enhanced and guided self-help treatment are recommended. As online treatment offers several additional advantages, we have developed a CBT-Enhanced online guided self-help intervention. The aim of this study is to determine whether this intervention reduces eating disorder pathology and increases the amount of binge free days in adults classified with binge eating disorder or other specified feeding or eating disorder- binge eating disorder, compared to an untreated waiting list condition. The experimental condition is hypothesized to be superior to the waiting list condition.MethodsThe efficacy of an online guided self-help intervention for binge eating disorder will be assessed by conducting a randomized controlled trial. The trial will target adult individuals classified with binge eating disorder or other specified feeding or eating disorder- binge eating disorder with a body mass index between 19.5 and 40, referred to an eating disorder treatment center. Dual arm allotment will be performed in a 1:1 ratio stratified for BMI above or below 30. Randomization will be blinded to the online intervention (n = 90), or to the control waiting list condition (n = 90). Assessors will be blinded and assessments will be administered at baseline, week 5, at end-of-treatment, and at 12 and 24 weeks follow-up. Primary outcome will be eating disorder pathology, operationalized as number of days on which binge eating occurred between the two conditions during the period of the intervention. Secondary outcome measures will be differences in other eating disorder pathology, clinical impairment and in quality of life, while therapeutic alliance, demographic characteristics and followed treatment module will serve as effect moderators. Several types of costs will be assessed.DiscussionThis paper presents an online guided self-help Cognitive Behavioral Therapy- Enhanced study protocol for individuals classified with binge eating disorder or other specified feeding or eating disorder. Efficacy will be examined through a Randomized Controlled Trial.Trial registrationThe study protocol is registered with the Netherlands Trial Registry NTR (NTR 7994) since 6 September 2019.

In Case You Haven't Heard…

To celebrate National Eating Disorders Awareness Week (Feb. 24–March 1), The Alliance for Eating Disorders Awareness launched its free findEDhelp app, which can be found on both Android and iOS platforms. The app comes on the heels of the previously launched eating disorders referral website www.findEDhelp.com, according to a press release. Both the app and the website help connect individuals experiencing an eating disorder with practitioners and treatment centers across the country. “In an effort to fill the void, increase access to care, and centralize information on eating disorder treatment centers and practitioners nationwide, we researched and created findEDhelp.com, our comprehensive and inclusive referral website,” said Johanna Kandel, CEO and founder of The Alliance for Eating Disorders Awareness. The goal of the findEDhelp app is to provide access to all levels of care and referrals to specialized treatment for those who are experiencing eating disorders. In an effort to make both the app and the website as inclusive and comprehensive as possible, there is no charge for treatment providers to be listed, and there will never be a cost to be included.

Behavioral inhibition moderates the association between overvaluation of shape and weight and noncompensatory purging in eating disorders.

The cognitive-behavioral therapy (CBT) model of eating disorders suggests that compensatory purging behaviors (e.g., self-induced vomiting, inappropriate laxative use) are primarily driven by binge eating. However, many individuals endorse purging in the absence of binge eating (i.e., noncompensatory purging [NCP]). Research is needed to understand why some individuals purge in the absence of objective or subjective binge-eating episodes. Given the importance of overvaluation of shape/weight in the CBT model, and the existing evidence linking temperamental characteristics like behavioral inhibition (i.e., the tendency to withdraw in response to threat cues) with purging in general, we tested whether behavioral inhibition moderated the relationship between overvaluation of shape/weight and NCP in a sample of individuals in a residential eating disorder treatment center (N = 143). Overvaluation was more strongly related to NCP in individuals with high (relative to low) levels of behavioral inhibition. Among individuals low in behavioral inhibition, overvaluation predicted engagement in NCP to a much weaker extent. For those high (relative to low) in behavioral inhibition, both emotional avoidance and overvaluation may be important targets in the treatment of NCP, particularly in the absence of binge eating.

Keep Calm and Carry On? Grit Buffers Against Disordered Eating Unless Expressive Suppression is Used to Regulate Emotions

Introduction: Grit is a personality trait that affords individuals the ability to push through challenging circumstances, suggesting tolerance of negative affect. In contrast, individuals with disordered eating are motivated to avoid negative affect. We speculated whether grit would buffer against disordered eating attitudes and behaviors, and conducted two studies to address this query.Method: Study 1 (N = 137) had participants from eating disorder treatment centers (n = 52) and adults from the community (n = 85). Disordered eating was assessed using the Eating Disorder Inventory. In Study 2, we tested whether emotion regulation strategy (i.e., cognitive reappraisal and expressive suppression) as an individual differences variable influenced the relation between grit and disordered eating within a community sample (N = 212). Disordered eating was assessed via the Eating Disorder Examination Questionnaire. In both studies, Grit-Consistency and Grit-Perseverance were measured using the Short Grit Scale.Results: Study 1 revealed that Grit–Consistency, not Grit–Perseverance, was associated with lower bulimia and body dissatisfaction scores. Further, moderation analysis indicated that this relation was consistent for both the clinical and community samples. Findings from Study 2 demonstrated that Grit–Consistency was inversely correlated with shape and weight concerns. Moderation regression analysis showed that elevated levels of expressive suppression attenuated the relation between Grit-Consistency and disordered eating.Discussion: Our work provides evidence that Grit-Consistency buffers against disordered eating. But elevated use of expressive suppression, a maladaptive emotion regulation strategy, eliminates the benefits of grit.

Practice-research integration in the residential treatment of patients with severe eating and comorbid disorders.

Residential treatment involves a number of treatment components and modalities, and treatment staff come from diverse training backgrounds. These complexities present unique challenges for the implementation of standardized programming, training, and routine assessment to support practice and research aims. Implementation science highlights the critical role of clinician attitudes in successful adoption and sustainability. This article describes an ongoing real-world quality improvement effort to implement transdiagnostic evidence-based interventions for primary eating disorders, as well as routine data collection, in a residential eating disorder treatment center. We specifically focus on clinicians' subjective experience of, and attitudes toward, the implementation of new treatment strategies and data collection. Participating clinicians completed a semistructured interview based on constructs from the Consolidated Framework for Implementation Research, an organizing framework for implementation practice and research. Interviews were analyzed using consensual qualitative research. Results indicate that clinicians had positive overall implementation experiences, with available resources, leadership engagement, patient needs, relative advantage, and self-efficacy emerging as constructs that had the greatest impact on implementation. Clinicians also offered specific critiques and suggestions about the intervention and the implementation process. These results can inform internal sustainability efforts and can be integrated into future evidence-based intervention implementation and data collection efforts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Strength and Power Improvements in Athlete and Non-Athletes During Intensive Eating Disorder Treatment

Understanding the unique needs of athletes who undergo eating disorder (ED) treatment is sorely needed. This study explores changes of strength and power in athlete (n = 21) and non-athlete (n = 36) patients from intake to discharge. Maximal oxygen consumption, vertical jump, push-ups, hand grip strength, and body mass index (in anorexia nervosa; AN) were measured among treatment center patients. The number of push-ups and hand grip strength were significantly improved upon discharge in the full sample (ps &lt; .005) and in AN only (ps &lt; .001). Body mass index was also significantly higher in AN (p &lt; .001). Maximal oxygen consumption and vertical jump did not significantly improve between admission and discharge in either group (ps &gt; .40). This study is the first to investigate measures of strength in athletes engaged in intensive eating disorder treatment and indicates the need to address the psychological mindset around physical activity using exercise education as part of a comprehensive program. Recommendations for incorporating exercise into an intensive ED treatment center are also provided.