Caring for a child with an eating disorder: Understanding differences among mothers and fathers of adolescent and adult children.

OBJECTIVE: This study investigated treatment-engagement fears, self-efficacy, and accommodating and enabling in mothers and fathers of adolescent and adult children with eating disorders. METHODS: This study involved a secondary analysis of pre-treatment data from a subsample of 143 parents (95 mothers; 48 fathers) from a Canada-wide multi-site study. Parents completed the Caregiver Traps Scale, Parents Versus Anorexia Scale, and the Accommodation and Enabling Scale for Eating Disorders. Data were analysed using factorial Multivariate Analysis of Variance and mediation via multiple regression. RESULTS: Mothers reported higher levels of treatment-engagement fears than fathers. Among mothers, higher fear predicted lower self-efficacy and more accommodating and enabling behaviours. Among fathers, neither fear nor self-efficacy predicted accommodating and enabling. No differences in treatment-engagement fear or self-efficacy between parents of adolescent child and adult children were found at pre-treatment. CONCLUSIONS: Mothers' and fathers' experience different levels of fear related to their involvement in their ill-child's treatment at pre-treatment, and that fear is uniquely related to variables that impact treatment outcomes. There is a need to support parents even when their child is an adult. This study can inform family-based treatments vis-a-vis tailoring interventions for mothers and fathers and providing support to parents of children with eating disorders across the lifespan.

Treatment-engagement fears in family-oriented interventions: validation of the caregiver traps scale for eating disorders.

As more caregivers of children (of any age) struggling with an eating disorder are recruited as partners in care, it is important to identify potential barriers to such involvement. The Caregiver Traps Scale for Eating Disorders (CTS-ED) was developed as a measure of caregiver fears with respect to treatment-engagement. The purpose of this study was to evaluate its psychometric properties. One hundred and twenty four parents of children with ED participated in the validation of this instrument. Data were analyzed through exploratory factor analysis. The exploratory factor analysis revealed one factor, accounting for 39% of the variance, with a mean of 3.99 (scale from 1 to 7), indicating that caregivers endorsed clinically significant fears relating to their involvement in their child's treatment. The scale yielded high internal consistency (α = .89). As expected, the CTS-ED was significantly positively correlated with a measure of accommodating and enabling of ED symptoms, and negatively correlated with a measure of parental self-efficacy. This scale shows promise as a measure for clinicians and researchers to identify parental fears that could potentially fuel accommodating, enabling or treatment-interfering behaviors. Suggestions for its utility as a clinical and supervision tool are also provided.Clinical SignificanceDevelopment of an assessment tool to identify caregiver fears with respect to therapy engagement in the context of family-oriented interventions for eating disordersTool has the potential to increase the positive involvement of caregivers to support their child (of any age) with an eating disorderTool can be used clinically and to support self-reflective practices to improve compassionate clinician engagement of caregivers struggling to support their child.

Processes and outcomes of an emotion-focused family therapy two-chair intervention for transforming problematic parenting patterns.

Emotion-focused family therapy (EFFT) is a therapy model which includes a two-chair intervention aimed at facilitating awareness and an interruption of problematic patterns of parenting as well as a reconnection to healthy caregiving instincts. The present study employed a task analysis to examine the process of this intervention with parents in a therapeutic setting and report on preliminary outcomes. Four trained EFFT therapists conducted chair work interventions with four parents (total of 16) and parents completed questionnaires directly following the intervention. Results indicated that most parents experienced significant emotional resolution of their love-based fears and an increase in confidence in supporting their children struggling with mental health issues. Use of the intervention in clinical settings is an effective and efficient way to support parents in responding to their children's mental health challenges.

Primary Substance Use Prevention Programs for Children and Youth: A Systematic Review.

CONTEXT: An updated synthesis of research on substance abuse prevention programs can promote enhanced uptake of programs with proven effectiveness, particularly when paired with information relevant to practitioners and policy makers. OBJECTIVE: To assess the strength of the scientific evidence for psychoactive substance abuse prevention programs for school-aged children and youth. DATA SOURCES: A systematic review was conducted of studies published up until March 31, 2020. STUDY SELECTION: Articles on substance abuse prevention programs for school-aged children and youth were independently screened and included if they met eligibility criteria: (1) the program was designed for a general population of children and youth (ie, not designed for particular target groups), (2) the program was delivered to a general population, (3) the program only targeted children and youth, and (4) the study included a control group. DATA EXTRACTION: Two reviewers independently evaluated study quality and extracted outcome data. RESULTS: Ninety studies met eligibility criteria, representing 16 programs. Programs evaluated with the largest combined sample sizes were Drug Abuse Resistance Education, Project Adolescent Learning Experiences Resistance Training, Life Skills Training (LST), the Adolescent Alcohol Prevention Trial, and Project Choice. LIMITATIONS: Given the heterogeneity of outcomes measured in the included studies, it was not possible to conduct a statistical meta-analysis of program effectiveness. CONCLUSIONS: The most research has been conducted on the LST program. However, as with other programs included in this review, studies of LST effectiveness varied in quality. With this review, we provide an updated summary of evidence for primary prevention program effectiveness.

Brief Emotion Focused Family Therapy: An Intervention for Parents of Children and Adolescents with Mental Health Issues.

This study evaluated the 2-day intensive modality of Emotion Focused Family Therapy (EFFT). The intervention attempts to prepare parents to take a primary role in their child's recovery from a range of mental health issues. One hundred and twenty-four parents completed the intervention and provided data a week prior to intervention, post-intervention and at 4-month follow-up. Results include significantly reduced parent blocks and increased parental self-efficacy in relation to involvement in their child's recovery, as well as significant improvement in child symptomatology. The findings confirm positive results from an earlier pilot study involving eating disorders and demonstrate the potential for EFFT as an intervention for a range of clinical problems in children and youth.

Parental Involvement and Child and Adolescent Eating Disorders: Perspectives from Residents in Psychiatry, Pediatrics, and Family Medicine.

OBJECTIVES: Best practice guidelines encourage the involvement of parents in the assessment and treatment of child/adolescent eating disorders (ED). This study investigated medical residents' perspectives regarding parental involvement as well as their expectations for future practice in the assessment and treatment of ED. METHOD: Five hundred and eighty-four medical residents from 17 Canadian residency programs specializing in family medicine, pediatrics, and psychiatry completed a web-based survey. Questions pertained to assessment and treatment practices for child/adolescent ED. Analyses included ANOVAs, paired t-tests, and, for residents who endorsed family involvement (N = 444), qualitative content analysis. RESULTS: Overall, residents reported that they "mostly" agreed with the involvement of family in the assessment and treatment of ED. Residents' endorsement of family involvement in both domains increased according to the extent of ED training received. Four major themes emerged from the content analysis of family involvement and included recommendations in line with evidence-based models and unspecified, passive involvement in the assessment and recovery process. CONCLUSIONS: Many residents endorse family involvement in both assessment and treatment; however, understanding of the nature of such involvement is often vague. Training in evidence-based protocols is necessary for residents planning to engage in multi-disciplinary assessment, referral, and/or treatment in their future practice.

OBJECTIFS: Les lignes directrices des pratiques exemplaires encouragent la participation des parents à l'évaluation et au traitement des troubles alimentaires (TA) des enfants/adolescents. Cette étude a sondé les points de vue des résidents en médecine à l'égard de la participation parentale et de leurs attentes à eux quant à la pratique future de l'évaluation et du traitement des TA. MÉTHODE: Cinq cent quatre-vingts résidents en médecine de 17 programmes de résidence canadiens se spécialisant en médecine familiale, en pédiatrie et en psychiatrie ont répondu à un sondage en ligne. Les questions portaient sur les pratiques d'évaluation et de traitement des TA pour les enfants/adolescents. Les analyses comprenaient des analyses de variance, des tests t jumelés, et, pour les résidents qui appuyaient la participation familiale (N = 444), une analyse qualitative de contenu. RÉSULTATS: En général, les résidents ont déclaré qu'ils étaient « majoritairement ¼ d'accord avec la participation de la famille à l'évaluation et au traitement des TA. L'appui des résidents à la participation familiale dans les deux domaines augmentait selon l'étendue de la formation reçue sur les TA. Quatre thèmes majeurs se sont dégagés de l'analyse de contenu de la participation familiale et ils incluaient des recommandations conformes aux modèles fondés sur des données probantes, et à la participation passive, indéterminée au processus d'évaluation et de traitement. CONCLUSIONS: De nombreux résidents appuient la participation familiale tant à l'évaluation qu'au traitement, cependant, la compréhension de la nature de cette participation est souvent vague. La formation en matière de protocoles fondés sur des données probantes est nécessaire pour les résidents qui prévoient exercer l'évaluation multidisciplinaire, l'aiguillage et/ou le traitement multidisciplinaire dans leur future pratique.

The effect of academic stress and attachment stress on stress-eaters and stress-undereaters.

It is well established that stress is related to changes in eating patterns. Some individuals are more likely to increase their overall food intake under conditions of stress, whereas others are more likely to consume less food when stressed. Attachment style has been linked to disordered eating and eating disorders; however, comparisons of eating behaviors under attachment versus other types of stress have yet to be explored. The present laboratory study examined the eating patterns in self-identified stress-undereaters and stress-eaters under various types of stress. More specifically, the study examined the effects of academic and attachment stress on calorie, carbohydrate and sugar consumption within these two groups. Under the guise of critiquing student films, university students viewed either one of two stress-inducing videos (academic stress or attachment stress, both designed to be emotionally arousing) or a control video (designed to be emotionally neutral), and their food intake was recorded. Results demonstrated that the video manipulations were effective in inducing stress. Differential patterns of eating were noted based on group and stress condition. Specifically, stress-undereaters ate fewer calories, carbohydrates and sugars than stress-eaters in the academic stress condition, but not in the attachment stress or control condition. Findings suggest that specific types of stressors may influence eating behaviors differently.

The influence of carer fear and self-blame when supporting a loved one with an eating disorder.

Carers often feel disempowered and engage in behaviours that inadvertently enable their loved one's ED symptoms and yet little is known regarding these processes. This study examined the relationships among fear, self-blame, self-efficacy, and accommodating and enabling behaviours in 137 carers of adolescents and adults with ED. The results revealed that fear and self-blame predicted low carer self-efficacy in supporting their loved one's recovery as well as the extent to which carers reported engaging in recovery-interfering behaviours. The relevance of these findings are discussed in the context of family-oriented ED therapies and highlight the importance for clinicians to attend to and help to process strong emotions in carers, in order to improve their supportive efforts and, ultimately, ED outcomes.

Emotion-Focused Family Therapy for Eating Disorders Across the Lifespan: A Pilot Study of a 2-Day Transdiagnostic Intervention for Parents.

UNLABELLED: Emotion-focused family therapy is a transdiagnostic approach that affords parents and caregivers a significant role in their loved one's recovery from an eating disorder. A 2-day intervention was developed on the basis of emotion-focused family therapy principles and delivered to 33 parents of adolescent and adult children. Data were collected pre- and post-intervention. Through education and skills practice, parents were taught strategies with respect to meal support and symptom interruption as well as emotion coaching. Parents were also supported to identify and work through their own emotional blocks that could interfere with their supportive efforts. Analyses revealed a significant increase in parental self-efficacy, a positive shift in parents' attitudes regarding their role as emotion coach and a reduction in the fears associated with their involvement in treatment, including a decrease in self-blame. Overall, this broad-based, low-cost intervention shows promise, and future research is warranted. Copyright © 2014 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: A low-cost, intensive emotion-focused family therapy intervention shows promise for parents of individuals with an eating disorder, regardless of their loved one's age, symptom profile or involvement in treatment. Working with parents' emotions and emotional reactions to their child's struggles has the potential to improve supportive efforts. An emotion-focused family therapy intervention for parents yields high satisfaction rates, improves parental self-efficacy and reduces fears regarding their involvement, including self-blame.