Psychological Interventions For Adults Research Articles

A pilot brief therapy intervention for Functional Neurological Disorder (FND) and Non-Epileptic Attack Disorder (NEAD): A service evaluation

This service evaluation examined the feasibility and service user reported experience of a brief psychological intervention for adults with Non-Epileptic Attack Disorder (NEAD). 15 participants attended an individual six-session Acceptance and Commitment therapy (ACT)-informed intervention comprising of psychoeducation and grounding techniques. Participant experience of the intervention was assessed using outcome measures and an online focus group which indicated their satisfaction. Participants fed back that longer therapy intervention; education of other health professionals (having reported previous negative experiences); and group/family support sessions would enhance future care.

Preliminary data that psychological treatment and baseline anxiety are associated with a decrease in postprandial fullness and early satiation for individuals with bulimia nervosa and related other specified feeding or eating disorder.

Gastrointestinal symptoms, particularly postprandial fullness, are frequently reported in eating disorders. Limited data exist evaluating how these symptoms change in response to outpatient psychological treatment. The current study sought to describe the course of postprandial fullness and early satiation across psychological treatment for adults with bulimia nervosa and related other specified feeding or eating disorders and to test if anxiety moderates treatment response. Secondary data analysis was conducted on questionnaire data provided by 30 individuals (80% white, M(SD)age = 31.43(13.44) years; 90% female) throughout treatment and six-month follow-up in a pilot trial comparing mindfulness and acceptance-based treatment with cognitive-behavioral therapy for bulimia nervosa. Participants completed items from the Rome IV Diagnostic Questionnaire for Adult Functional Gastrointestinal Disorders and the State Trait Anxiety Inventory. Postprandial fullness and early satiation both significantly decreased over time (ds = 1.23-1.54; p's < .001). Baseline trait anxiety moderated this outcome, such that greater decreases were observed for those with higher baseline anxiety (p = .02). Results extend prior work in inpatient samples by providing preliminary data that postprandial fullness and early satiation decrease with outpatient psychological treatment for bulimia nervosa. Baseline anxiety moderated this effect for postprandial fullness. Future work should replicate findings in a larger sample and test anxiety as a mechanism underlying postprandial fullness in eating disorders. The current study found that common gastrointestinal symptoms (postprandial fullness and early satiation) decrease over the course of outpatient psychotherapy for adults with full and subthreshold bulimia nervosa. Postprandial fullness decreased more across time for those high in anxiety.

A systematic review of psychological interventions in adults with pulmonary hypertension: Is the evidence-base disproportionate to the problem?

Our understanding of the psychological impact of living with pulmonary hypertension (PH) is growing, particularly for how anxiety and depression present in this group. There is evidence for the use of psychological interventions in other chronic lung conditions; however, trials focusing on adults with PH have yet to be subject to a systematic review. We systematically searched four databases for evidence examining the effectiveness of psychological interventions for adults with PH. A narrative approach has been used to present findings. Overall, 186 unique articles were identified of which four were suitable. Data was gathered from 143 individuals. Cognitive behavioural therapy (CBT), metacognitive therapy (MCT) or counselling were investigated. All three studies reported a significant reduction in anxiety and depression, and some secondary outcomes were also associated with change. The evidence supporting the use of psychological therapies for adults with PH is promising, although limited. There is an urgent need for more research in this area to better understand how we can support this clinical group.

Specific learning disorders in young adults: Investigating pragmatic abilities and their relationship with theory of mind, executive functions and quality of life.

BackgroundSpecific Learning Disorders (SLD) are lifelong conditions often associated with language difficulties, executive dysfunctions, and psychological problems. Previous research has shown that communicative-pragmatic ability may be impaired in SLD. However, the role of other cognitive abilities in explaining pragmatic difficulties has still not been fully investigated. The relationship between pragmatics and quality of life is not yet clear, as well. AimsFirstly, the study assessed pragmatic comprehension abilities in adults with SLD. Secondly, we examined the relationship between pragmatics, theory of mind, executive functions and quality of life. Method and proceduresWe enrolled 26 adults with SLD and 30 adults without SLD. Standardized tests assessing pragmatic comprehension, theory of mind and executive functions were used. The quality of life was investigated with a self-reported questionnaire. Outcomes and resultsPragmatic comprehension abilities were compromised in young adults with SLD. In this clinical population we also found a link between pragmatic comprehension and visual theory of mind. Finally, independently from the presence of SLD, pragmatics abilities were in relationship with quality of life. Conclusions and implicationsOverall, these data highlight the importance of including pragmatic abilities both in the clinical evaluation, as well as in psychological intervention for adults with SLD.

P289 The effectiveness of interventions to reduce psychological distress in patients with autoimmune rheumatic conditions: a systematic review of effectiveness

Abstract Background/Aims Autoimmune rheumatic conditions are multisystem chronic disorders associated with increased psychological distress. Consequences include poor medication adherence and high levels of disease activity. Psychological interventions may reduce distress and change health behaviours. We aimed to determine the effectiveness of interventions for psychological distress in patients with autoimmune rheumatic conditions. Methods This was a systematic review of effectiveness which included randomised controlled trials of psychological interventions in adults with autoimmune rheumatic conditions. We searched MEDLINE, BNI, CINAHL, EMBASE, EMCARE, PsycINFO, NICE Evidence and The Cochrane Library. Two reviewers screened titles and abstracts and assessed the methodological quality of the included studies using Cochrane Risk of Bias 2 tool. Data were extracted by one reviewer and checked by a second. In each study, the effectiveness data were determined by extracting the reported means (and standard deviation) for each group and calculating the standardised mean differences using RevMan 5.4 software (The Cochrane Collaboration, 2020). The data on primary outcomes (anxiety and depression) are reported here. Results The search identified 96 studies. The process of screening and assessing for eligibility resulted in 20 studies for inclusion. Of these, one study had an overall low risk of bias and 19 had ‘some concerns’, mainly due to inadequate blinding and no information on pre-specified analysis plan. Only eight studies reported the effects on anxiety and 10 studies reported on depression. These studies included 919 patients in total. Most interventions were based on cognitive behavioural therapy and the context of delivery ranged from face-to-face individualised treatment to online group therapy. They often included education on topics such as stress and fatigue. Interventions often trained participants to develop skills in relaxation, problem-solving, and thought reframing. Goal setting and action planning were common to help participants make behaviour changes and apply their learning. Table 1 summarises disease group, type of intervention, comparator, outcome measure, and effects. Conclusion Conclusion: Most interventions were effective in reducing anxiety and depression in autoimmune rheumatic conditions. However, given the clinical heterogeneity and ‘some concerns’ about the included quality of studies, more work is needed to understand the mechanisms of the intervention effectiveness. Disclosure J. Hulley-Mills: None. C. Sliverthorne: None. B. Jones: None. J. Hooper: None. J. Robson: None. E. Dures: None. J. Daniels: None. M. Thompson: None. M. Ndosi: None.

The feasibility and acceptability of a brief psychological intervention for adults with long-term health conditions and subthreshold depression delivered via community pharmacies: a mixed methods evaluation\u2014the Community Pharmacies Mood Intervention Study (CHEMIST)

BackgroundAdults with long-term health conditions (LTCs) are more likely to experience depressive symptoms which can worsen health outcomes and quality of life, and increase healthcare costs. Subthreshold depression may go undetected and/or untreated.The Community Pharmacies Mood Intervention Study (CHEMIST) explored whether community pharmacies represent a suitable setting to offer brief psychological support to people with LTCs and comorbid subthreshold depression.MethodsA feasibility intervention study with a nested mixed methods evaluation was employed. Adults with subthreshold depression and a minimum of one LTC were recruited from community pharmacies/local general practices and offered a brief psychological support intervention (‘Enhanced Support Intervention’ (ESI)), based on behavioural activation within a Collaborative Care framework. The intervention included up to six sessions supported by pharmacy staff (‘ESI facilitators’) trained to deliver the ESI within the community pharmacy setting.Recruitment, retention rates and engagement with the ESI were assessed. Semi-structured, one-to-one interviews with pharmacy staff and study participants, and a focus group with pharmacy staff, explored experiences and acceptability of the study and the ESI. Themes were mapped onto constructs of the Theoretical Framework of Acceptability.ResultsRecruitment of ESI participants was challenging and slower than anticipated despite the varied methods of recruitment employed; although, this was useful in identifying barriers and enabling factors for participation. Engagament with the ESI was good with n=17 (71%) recruited participants commencing the ESI. The ESI was found to be acceptable to participants and ESI facilitators. Retention rate at 4 months was good n=20 (87.0%).The main barriers to identifying potential participants for pharmacy staff were lack of time, resources and limited experience in research. The ESI training and support manual were acceptable to ESI facilitators. The ESI and supporting patient workbook were acceptable to people with LTCs and subthreshold depression.ConclusionsCommunity pharmacies were viewed as an acceptable setting in which to deliver preventative brief psychological support to people with LTCs at risk of depression.This feasibility study provided important data to inform the design of a pilot randomised controlled trial in this setting and highlighted important considerations for future pharmacy-based research.Trial registrationISRCTN11290592

Cognitive-behavioral group therapy for ADHD predominantly inattentive presentation: A feasibility study of a new treatment protocol

Attention-deficit/hyperactivity disorder (ADHD) is a highly impairing condition with varying clinical presentations. Psychological treatments for ADHD are often similar, irrespective of predominant symptomatology. However, because inattention and hyperactivity/impulsivity are associated with different challenges in daily life more presentation-specific treatments are warranted. The purpose of the present study was to evaluate the feasibility and explore the preliminary effects of a novel group-based cognitive-behavioral therapy (CBT) protocol for ADHD predominantly inattentive presentation (ADHD-I), with the aim to reduce symptoms of inattention and associated problems. Materials and Methods. Using an open trial design, 39 adult patients with ADHD-I were included. Participants underwent 14 sessions of the new CBT for ADHD-I (CADDI) protocol, which includes skills training in organizing and initiating activity and coping with procrastination and passivity. In addition, mindfulness meditation is practiced throughout treatment. Results. The CADDI protocol proved feasible in terms of session completion and treatment acceptability. However, home assignment completion was moderate and attrition was high. Inattentive symptoms, assessed by clinicians and self-report, were reduced of a medium effect size, (Cohen’s d = 0.65 and d = 0.55, respectively) and symptoms of depression of a small effect size (d = 0.48). An increase of a large effect size was observed for mindfulness meditation (d = 0.91). No effects were seen in functional impairment, nor in quality of life. Conclusions. The CADDI protocol is a potentially valuable new psychological treatment for adults with ADHD-I, although treatment effects need to be further evaluated and participant retention secured in randomized controlled trials.

Cochrane systematic review and meta-analysis of the impact of psychological treatment on health-related quality of life in people with epilepsy: an update by the ILAE Psychology Task Force, highlighting methodological changes.

Clinical interest in using psychological interventions for people with epilepsy (PWE) aiming at decreasing mental health difficulties, improving health-related quality of life (HRQOL) and seizure-related outcomes, continues to grow. This article summarizes the 2020 update of the 2017 Cochrane Review and meta-analysis of psychological interventions for PWE, highlighting the reasons for major methodological modifications such as the recategorization of interventions and expanded risk of bias assessment. A 2020 literature search yielded 36 RCTs (n=3526) investigating psychological treatments for PWE with a validated HRQOL measure as an outcome. Twenty-seven trials were skills-based psychological interventions, whilst nine studies were education-only interventions. Among skills-based psychological interventions, 11 studies (n=643) used the Quality of Life in Epilepsy-31 (QOLIE-31) or other QOLIE inventories convertible to QOLIE-31 as an outcome measure and were pooled for meta-analysis. Significant mean changes were observed for the QOLIE-31 total score (mean improvement of 5.23 points; p< 0.001) and in six out of seven subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication and cognitive functioning). The mean changes in the QOLIE-31 total score and the overall QoL subscale exceeded the threshold of minimally important change (MIC), indicating clinically meaningful post-intervention improvement. These results provide moderate evidence that psychological treatments for adults and adolescents with epilepsy enhance HRQOL. In addition to the summary of the Cochrane review, we provide a detailed characterization of the interventions and patient populations of the meta-analyzed studies.

Brief videoconferencing psychological intervention for reducing COVID-19 related distress: study protocol for a randomized controlled trial

BackgroundGlobally COVID-19 has had a profound impact on the psychological wellbeing of millions of people, and there is an urgent imperative to address elevated levels of distress during the COVID-19 pandemic. The World Health Organization (WHO) has developed Problem Management Plus (PM+), a low intensity psychological intervention for adults experiencing psychological distress. This paper outlines the study protocol for a trial that tests the effectiveness of an adapted version of PM+ to reduce distress associated with COVID-19.MethodsA single-blind, parallel, randomized controlled trial will be carried out for distressed people across Australia. via video conferencing on a small group basis. Following informed consent, adults that screen positive for levels of psychological distress (General Health Questionnaire-12 (GHQ-12 score ≥ 3) and have access to videoconferencing platform will be randomised to an adapted version of gPM+ (n = 120) or enhanced treatment as usual (ETAU) (n = 120). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, sleep problems, anhedonia, social support, and stress in relation to COVID-19.DiscussionThe trial aims assess whether an adapted version of videoconferencing PM+ that is specifically designed to target COVI-19 related distress will result in reduced distress relative to enhanced usual care.Trial registrationThis trial was prospectively registered on the ANZCTR on 14/4/20 (ACTRN12620000468921).

Psychological therapies delivered remotely for the management of chronic pain (excluding headache) in adults

Psychological therapies delivered remotely for the management of chronic pain (excluding headache) in adults

Psychological interventions on fetal alcohol spectrum disorder across the life span

Fetal alcohol spectrum disorder (FASD) is the leading known and preventable cause of intellectual disability in the western world, affecting up to 1-5% of the population. It is considered an underdiagnosed and undertreated disorder, with few psychological interventions with empirical evidence. To review all the studies published to date on the psychological treatment of FASD throughout life. A bibliographic search was carried out using the MEDLINE, PsychINFO, PubMed and Cochrane Library databases using the terms 'fetal alcohol syndrome disorder' AND 'cognitive behavioral intervention' OR 'psychological intervention' OR 'psychological treatment' OR 'therapy' OR 'psychotherapy'. The review included published works which evaluate the efficacy of psychological treatments for these patients. Twenty published studies met the inclusion criteria. The treatments were classified according to the type of intervention: emotional and behavioral regulation, social skills training and family interventions for patients with FASD. The results indicate that psychological treatments focused on emotional and behavioral regulation, social skills training and family interventions are the most evidenced treatments for these patients. These treatments are based on cognitive-behavioral principles and include school-age children. However, more research is needed on psychological interventions for adults with FASD. Despite the progress in psychological interventions for FASD, the research still reflects highlighted limitations.

Mental health consequences of COVID-19 pandemic on adult population: a systematic review

Purpose The spread of novel coronavirus 2019 (COVID-19) has infected millions of people worldwide. Public health emergencies caused by COVID-19 affect not only people’s physical health but also mental health. This paper aims to summarize recent research findings on the mental health impact of COVID-19 experienced by the general adult population. Design/methodology/approach This paper used a systematic approach and aimed to review the literature on mental health problems faced by general adults during the COVID-19 pandemic. The PubMed database has been selected randomly from the Google Scholar, Cochrane Library, Embase and PubMed databases. Ten journal articles published between January and July 2020 were selected from the PubMed database for the final review. Findings There is growing evidence that COVID-19 may be an objective risk factor for mental distress among the general adult population. More psychological and social support should be provided to protect adult people’s mental health. Practical implications This review will help policymakers develop mental health interventions for the general adult population vulnerable to psychological distress because of COVID-19 pandemic. Originality/value This paper is original and contributes to the existing knowledge that the mental health challenges of COVID-19 are widespread. There is, therefore, a need for more psychological interventions for adults, older adults, in particular, to promote mental health and reduce the distress associated with public health emergencies caused by COVID-19.

Are Psychological Treatments for Adults With Histories of Violent Offending Associated With Change in Dynamic Risk Factors? A Meta-Analysis of Intermediate Treatment Outcomes

This meta-analysis examined whether psychological treatments delivered to adults with histories of violent offending in correctional and forensic mental health settings were related to change in dynamic risk factors. Twenty-two controlled studies (86% comprised male samples) were identified via a comprehensive search. Treatments had a significant effect overall, with small to moderate improvements in trait anger, social problem solving, impulsivity, and general social skill. The treatment effect for antisocial cognitions was nonsignificant. There were a small number of significant moderators, which provide preliminary indications of treatment features that may promote greater change. However, small sample sizes and difficulties disentangling moderating effects preclude drawing firm conclusions. While these results are useful and promising, the field remains limited by few high-quality outcome studies, disparate outcome/measure selection, inconsistent/incomplete reporting of evaluations, and limited information about whether change in dynamic risk factors predicts reductions in recidivism. Suggestions for advancing the field are provided.

Psychological Interventions for People with Psychotic Experiences: A Systematic Review and Meta-Analysis of Effectiveness and Economic Studies

Background: Many people with psychotic experiences who seek help do not develop psychotic disorders, yet still demonstrate higher clinical complexity, suboptimal treatment response, and poor clinical and functional outcomes. Methods: We searched thirteen databases for studies concerning psychological interventions for adults with psychotic experiences, but not psychotic disorders. Our outcomes were the proportion of participants remitting/recovering from psychotic experiences (primary); changes in positive and negative psychotic symptoms, depression, anxiety, functioning, distress, or quality of life; and economic outcomes (secondary). We analysed results using random-effects meta-analysis and narrative synthesis. Findings: Twenty-seven reports from 21 studies met inclusion criteria. Five reported the proportion of participants remitting from psychotic experiences. Non-meta-analytic evidence suggested that cognitive behavioural therapy (CBT) may promote symptomatic recovery. For secondary outcomes, CBT demonstrated effectiveness over treatment as usual (TAU) and supportive treatments (ST) in improving distress (pooled standardised mean difference: -0.23 [-0.36 to -0.10]), but no other outcome. Individual reports indicated that CBT, mindfulness, sleep CBT, systemic therapy, cognitive remediation therapy, and supportive treatments improved some clinical and/or functional outcomes. Only four reports, using data from two studies, included economic evaluations, which suggested CBT may be cost-effective compared with TAU. Interpretation: Initial evidence suggests that CBT may promote recovery from psychotic experiences and reduce associated distress, although scarcity of studies, small sample sizes, and variable study quality limit our ability to make definitive conclusions. The paucity of consistent evidence for improving other non-psychotic clinical and functional outcomes highlights a need for further research into psychological treatments for this population. Funding: This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0616-20003). Declaration of Interest: The authors declare no competing interests. Ethical Approval: Not applicable.

Increasing access to psychological treatments for adults by improving uptake and equity: rationale and lessons from the UK

ObjectivesAccess to psychological treatments has been defined by Gulliford as comprising supply, effectiveness, equity and uptake. In the UK, a recent national programme “Improving Access to Psychological Treatments” has significantly increased supply and assessed effectiveness, but paid less attention to uptake and equity. The model developed by Gask et al. delineating processes relevant to improving access for ‘hard-to-engage’ groups in the UK, including black and minority groups seems relevant. This paper presents studies of a large-scale ‘community workshop’ intervention model developed by Brown to improve access for adults in the UK, designed to improve uptake and equity. We describe two ‘community workshop’ interventions for common mental health problems to which people have been able to self-refer and where uptake and equity have been high. Key components of this model are a ‘group-sensitive engagement’ ethos which includes self-referral, non-diagnostic titles of the intervention, a non-mental health setting, face-to-face presentation as well as a brief intervention and an acceptable format.ConclusionThe model of community workshops with its ‘group-sensitive engagement’ ethos to which adults can self-refer may be very relevant in providing access for people with mental health needs in national and international settings.Trial registration Classic ISRCTN26634837

Psychological treatments for adults and children with epilepsy: Evidence-based recommendations by the International League Against Epilepsy Psychology Task Force.

Given the significant impact that psychosocial factors and epilepsy treatments can have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is great clinical interest in the role of psychological evaluation and treatments to improve HRQOL and comorbidities. Therefore, the International League Against Epilepsy (ILAE) charged the Psychology Task Force with the development of recommendations for clinical care based on evaluation of the evidence from their recent Cochrane review of psychological treatments in individuals with epilepsy. The literature search for a recent Cochrane review of randomized controlled trials investigating psychological treatments for individuals with epilepsy constitutes the key source of evidence for this article. To provide practical guidance to service providers, we provide ratings on study research designs based on (1) the American Academy of Neurology's Level of Evidence system and (2) the Grading of Recommendations, Assessment, Development, and Evaluation system. This paper is the culmination of an international collaboration process involving pediatric and adult psychologists, neurologists, psychiatrists, and neuropsychiatrists. The process and conclusions were reviewed and approved by the ILAE Executive Committee. The strongest evidence for psychological interventions was identified for the most common mental health problems, including depression, neurocognitive disturbances, and medication adherence. Psychological interventions targeting the enhancement of HRQOL and adherence and a decrease in comorbidity symptoms (anxiety, depression) should be incorporated into comprehensive epilepsy care. There is a range of psychological strategies (ie, cognitive behavioral therapy and mindfulness-based therapies) that show promise for improving the lives of persons with epilepsy, and clinical recommendations are provided to assist epilepsy health care providers in treating the comorbidities and challenges associated with epilepsy and its treatments.

Psychological interventions for adults who are overweight or obese

Psychological interventions for adults who are overweight or obese

Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life.

Given the significant impact epilepsy can have on health-related quality of life (HRQoL) of individuals with this condition and their families, there is great clinical interest in evidence-based psychological treatments aimed at enhancing well-being in people with epilepsy (PWE). An evaluation of the current evidence is needed to assess the effects of psychological treatments for PWE on HRQoL outcomes to inform future therapeutic recommendations and research designs. The operational definition of psychological treatments included a broad range of interventions that use psychological or behavioral techniques designed to improve HRQoL, psychiatric comorbidities, and seizure frequency and severity for adults and children with epilepsy. A systematic literature search was conducted in line with Cochrane criteria for randomized controlled trials (RCTs) and quasi-RCTs investigating psychological treatments and using HRQoL outcome measures as primary or secondary outcome measures. Standard methodological procedures required by the Cochrane Collaboration were used for data collection and analysis. Twenty-four completed RCTs were included in this review (2439 participants). Based on satisfactory methodological homogeneity, data from 9 studies (468 participants) providing Quality of Life in Epilepsy-31 (QOLIE-31) outcomes were pooled for meta-analyses, showing significant mean changes for QOLIE-31 total score and 6 subscales. The significant mean changes of QOLIE-31 total score (mean improvement of 5.68 points; 95% confidence interval = 3.11-8.24, P<.0001) and 3 subscales (emotional well-being, energy/fatigue, overall quality of life [QoL]) exceeded the threshold of minimally important change, indicating a clinically meaningful postintervention improvement of QoL. Overall, the meta-analysis quality of evidence was characterized as "moderate" due to the risk of bias present in 8 of the 9 included studies (Handbook for Systematic Reviews of Interventions, Version 5.1.0, 2011, Chapters 8 and 12). A narrative synthesis was conducted for all trials and outcomes that were not entered in the meta-analysis. These results provide moderate-quality evidence that psychological treatments for adults with epilepsy may enhance HRQoL in people with epilepsy.

The role of evidence-based therapy relationships on treatment outcome for adults with trauma: A systematic review

ABSTRACTObjective: The purpose of this paper was to systematically review and synthesize the empirical literature on the effects of evidence-based therapy relationship (EBR) variables in the psychological treatment for adults who experienced trauma-related distress. Method: Studies were identified using comprehensive searches of PsycINFO, Medline, Published International Literature on Traumatic Stress, and Cumulative Index to Nursing and Allied Health Literature databases. Included in the review were articles published between 1980 and 2015, in English that reported on the impact of EBRs on treatment outcome in clinical samples of adult trauma survivors. Results: Nineteen unique studies met inclusion criteria. The bulk of the studies were on therapeutic alliance and the vast majority found that alliance was predictive of or associated with a reduction in various symptomotology. Methodological concerns included the use of small sample sizes, little information on EBRs beyond alliance as well as variability in its measurement, and non-randomized assignment to treatment conditions or the lack of a comparison group. Conclusions: More research is needed on the roles of client feedback, managing countertransference, and other therapist characteristics on treatment outcome with trauma survivors. Understanding the role of EBRs in the treatment of trauma survivors may assist researchers, clinicians, and psychotherapy educators to improve therapist training as well as client engagement and retention in treatment.

A randomised controlled trial of three psychological treatments for anorexia nervosa

There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy. A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25-40 sessions over a 10-month period. Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and psychosocial impairment. Treatment was completed by 60% of participants and 52.5% of the total sample completed 12-month follow-up. Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes; all resulted in clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission (mean = 28.3%) at 12-month follow-up. The findings add to the evidence base for these three psychological treatments for adults with AN, but the results underscore the need for continued efforts to improve outpatient treatments for this disorder. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN 12611000725965) http://www.anzctr.org.au/.