Evaluation of a novel transition support intervention in an adult eating disorders service: ECHOMANTRA.

Admissions and re-admissions for inpatient care for anorexia nervosa have been increasing. The aim of this study was to examine whether the transition from inpatient care to the community could be facilitated by supplementing usual treatment with ECHOMANTRA (transition interventions) for both patients and carers. A case series study was employed using a mixed-methods approach to measure the feasibility and efficacy of augmenting intensive hospital treatment with ECHOMANTRA. A consecutive series of consenting patients (n = 31) and carers (n = 21) were assessed on admission, discharge, and at 3 months follow-up. These outcomes were compared with audit data (n = 152) previously collected (2007-2017). The length of stay for the ECHOMANTRA intervention group was 4.5 weeks less than the comparison group, and weight gain was 0.11 kg per week higher. Improvements in patient symptomology were sustained at follow-up. Thematic analysis of the feedback from both patients and carers suggests that the intervention is valued. Carer burden was reduced and their skills improved (both moderate size changes). In conclusion, both the acceptability and efficiency of inpatient care for anorexia nervosa may be improved by augmenting treatment to prepare for transition from inpatient care by giving support to both patients and their carers.

Collaborative Care: The New Maudsley Model.

The aim of this article is to describe the rationale and practice of the New Maudsley collaborative care intervention for families of people with eating disorders. The intervention teaches carers the underpinning theory with practical examples on how to optimize their care giving, communication, and coping skills. This includes moderating high expressed emotion and reducing the tendency to accommodate and/or enable illness behaviors. Transcripts are used to give examples of this approach in action. The emerging evidence base indicates that this approach improves both carer and patient well-being and also is associated with a more efficient use of resources.

Carers' assessment, skills and information sharing (CASIS) trial: a qualitative study of the experiential perspective of caregivers and patients.

BACKGROUND: Families express a need for guidance in helping their loved ones with anorexia nervosa (AN). Guided self-help interventions can offer support to caregivers. METHODS: One hundred seventy-eight adult AN patients and their caregivers were recruited from 15 UK treatment centres. Families were randomized to carers' assessment, skills and information sharing (C) intervention + treatment as usual (TAU) or TAU alone. Feedback forms were sent at 6 months post-discharge and, if not returned, at 12 months. One hundred two (57%) patient forms (n = 50TAU; n = 52C) and 115 (65%) caregiver forms (n = 60TAU; n = 55C) were returned. Two researchers coded data blind, using thematic analysis. RESULTS: (i) Caregivers and patients express a need for post-discharge support. (ii) Patients identify helpful and unhelpful support strategies, useful for developing future interventions. (iii) Patients could identify positive caregiver behaviour changes targeted in intervention. (iv) Guided self-help may benefit caregiver and sufferer, post-discharge. CONCLUSION: Caregiver interventions can be a useful tool that will improve the cost effectiveness of inpatient treatment by enhancing the well-being of caregivers and patients.

The use of motivational interviewing in eating disorders: a systematic review.

This review examines the effectiveness of interventions that include the principles and techniques of motivational interviewing (MI) and its adaptations in the treatment of eating disorders. The aims are (1) to examine both the context and effectiveness of MI and Motivational Enhancement Therapy (MET) when used with either patients or carers of people with eating disorders, (2) to identify limitations and/or difficulties in this process and (3) to identify further research needs in this area. Electronic databases were searched up until April 2012. Articles were screened according to predetermined inclusion and exclusion criteria. Thirteen studies were finally selected for inclusion. A wide range of participants, interventions and outcomes were measured which made comparative analysis difficult. Promising results were found for interventions that included MI, particularly with regards to its use in increasing a readiness and motivation to change. Consequently, there is potential for using MI in the field of eating disorders, particularly with respect to 'readiness for change'. More homogeneity in study design and delivery of MI is needed along with some markers of treatment fidelity, including information as to how adherence to the intervention is assured.

Carer's experience and perceived effects of a skills based training programme for families of people with eating disorders: a qualitative study.

PURPOSE: The study examined the experience of carers of people with eating disorders after having participated in a skills-based training programme that incorporated five psycho-educational DVDs and book. Supplemental telephone coaching was also offered. METHOD: Nineteen interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA). RESULTS: (1) The transfer of specialist skills was highly valued in lessening carer stress and care-giving difficulties and, in some instances, appeared to have a positive effect on both carer and sufferer, (2) caregivers provided useful suggestions for building upon the current intervention, (3) future programmes would benefit from stronger fidelity to the principles of motivational interviewing, stricter monitoring of coaches and increased participation in male carers. CONCLUSION: This study has confirmed that skills-training can be beneficial in increasing carer self-efficacy and reducing psychological distress, anxiety and burden. They can be a cost-effective method of supporting carers who might otherwise struggle to find therapeutic family support.

Feasibility and acceptability of DVD and telephone coaching-based skills training for carers of people with an eating disorder.

OBJECTIVE: The aims of this study were (1) to describe the feasibility and acceptability of this skills-based training for carers of people with eating disorders and (2) to examine whether the anxiety, depression, and expressed emotion involved in the caregiving experience were reduced. METHOD: Sixteen carers participated in the study. Assessment measures including the General Health Questionnaire, the Hospital Anxiety and Depression Scale, the Experience of Caregiving Inventory, and the Family Questionnaire were taken before and after the intervention. Feedback and a measure of acceptability measure were also collected. RESULTS: Participants expressed high levels of satisfaction with most aspects of the training. Also most of the carers reported that the digital video devices (DVDs) provided sufficient training and were helpful for their stress levels. However, due to the small sample size, the lessening of psychological distress and depression after the intervention, did not reach formal levels of significance according the self-report measures. CONCLUSION: The DVDs appear to be an acceptable method of delivering information and skills-based training for carers.