The recruitment and acceptability of a project ECHO® eating disorders clinic: a pilot study of telementoring for primary medical and behavioral health care practitioners.

Early identification and intervention are critical to prevent physical and mental health complications, chronicity, and premature death associated with eating disorders. However, primary medical and behavioral health care clinicians often do not feel confident or competent to diagnose and manage patients with eating disorders. This pilot study describes an innovative telementoring project (Project ECHO® Eating Disorders) that builds a geographically defined collaborative learning community to bridge the knowledge gap between eating disorder specialists located in eating disorder service sites and community-based practitioners, often living in remote areas. We describe the program and recruitment strategies and review baseline participant evaluation findings. Continuing Medical Education (CME) evaluation findings are presented as a measure of practitioner acceptability and satisfaction. Content analysis of CME participant evaluation comments provides an understanding of the impact of the program on participant knowledge and intended practice changes. We end with implications for training, practice, and research.

Disordered Eating, Eating Disorders, and Body Image in Midlife and Older Women.

PURPOSE OF REVIEW: We review the evidence for the reported increase in disordered eating and body image disturbance occurring in women in middle age and later life. We describe the contributing factors that relate to the unique experience of eating disorders (EDs) at midlife and beyond. We review evidence for several key factors in this observation, specifically the bio-psycho-social and relational components of later life EDs. We present treatment considerations, screening tools for evaluation, and treatment recommendations for this special population suffering with EDs. RECENT FINDINGS: Eating disorder symptoms and body image preoccupation have been identified in increasing numbers of women over age 50. Reports indicate that women are seeking treatment for chronic, recurrent, or late onset EDs. However, health care providers generally have not screened for these conditions, and often pursue other medical diagnoses. Age does not immunize women from body image preoccupation, weight and shape concerns, disordered eating, and eating disorders.

A pilot study of multifamily therapy group for young adults with anorexia nervosa: Reconnecting for recovery.

OBJECTIVE: We tested the feasibility, acceptability, and preliminary effect sizes on outcome measures of Reconnecting for Recovery (R4R) Multifamily Therapy Group for young adults with anorexia nervosa (AN). METHOD: Ten participants (mean age = 23 years, SD = 3.6) meeting Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for a restrictive eating disorder (AN or other specified feeding and eating disorder) and 14 family members received 16 R4R outpatient sessions over 26 weeks. Feasibility and acceptability were evaluated by recruitment and retention rates and patient/family member suitability scores. Outcomes were determined utilizing the Eating Disorder Examination (EDE), weight (body mass index), and Difficulties in Emotion Regulation Scale. RESULTS: All participants and 12 family members were retained, and the majority found R4R acceptable. EDE global score and lack of emotional awareness improved significantly from baseline (BL) to end-of-treatment (EOT) and BL to 6-month follow-up (6MFU) with moderate to large effect sizes (0.47-1.41). Limited access to emotion regulation strategies (LAERS) improved significantly from BL to 6MFU (moderate effect size; 0.57). Improvements in LAERS from BL to EOT (0.32) and weight from BL to EOT and BL to 6MFU were not significant (effect sizes 0.16-0.22). DISCUSSION: Findings provide preliminary evidence that R4R is feasible, acceptable, and produces clinically significant changes in targeted outcomes.

Creating a Nursing Student Center for Academic and Professional Success.

BACKGROUND: The purpose of this article is to describe the development of an innovative broad-based initiative supportive of academic and professional success, the Center for Academic and Professional Success (CAPS) at the University of Rochester School of Nursing. While CAPS was founded to support all nursing students, it was also carefully developed to meet the special needs of students in the accelerated program for non-nurses (APNN) due to their diversity and the intensity and rapidity of the APNN program. METHOD: Faculty discussion, literature review, and student needs assessment findings informed program development. Outcome data obtained during the past 4 years are presented. RESULTS: Data revealed a correspondence between identified student needs and use of program services, as well as high satisfaction ratings. CONCLUSION: Findings supported the provision of both traditional academic support, as well as other critical supports to address the academic and social stressors associated with the transitions experienced by nontraditional, working, and graduate nursing students. [J Nurs Educ. 2017;56(4):235-239.].

Measuring perceived mutuality in women with eating disorders: the development of the connection-disconnection scale.

This article describes the development and psychometric testing of the Connection-Disconnection Scale (CDS), the only self-report measure designed to assess perceived mutuality experienced in close relationships by women with eating disorders. Item development was informed by relational-cultural theory and focus groups with patients and recovered individuals. Content and construct validity, test-retest reliability, and internal consistency were examined in samples of female outpatient (n = 131) and partial hospitalization (n = 85) patients. Factor analysis with promax rotation for each version of the CDS in outpatients resulted in a single-factor model explaining 77.53% of the variance for CDS-Mother, 71.86% for CDS-Father, 77.79% for CDS-Partner, and 67.67% for CDS-Friend. Cronbach's alphas ranged from .97 to .99 for both samples. Overall, the CDS demonstrated good discriminant and convergent validity with moderate to strong correlations between CDS parent forms and the Parental Attachment Questionnaire, Dyadic Adjustment Scale, and the Social Support Questionnaire. Regression equations revealed that scores on CDS parent forms were inversely related to several subscale scores on the Eating Disorders Inventory-2. The CDS is a reliable and valid measure of perceived mutuality that can enrich relational understanding of the etiology and treatment of eating disorders in women.

A pilot investigation of the relation of perceived mutuality to eating disorders in women.

Relational theory predicts that lack of mutuality in important relationships leads to the development of psychological problems, including eating disorders. We sought to explore the association between perceived mutuality in relationships with partners and friends and eating disorders. Participants were 74 women, 35 with an eating disorder diagnosis and 39 non-psychiatric controls. The eating disorder group reported lower perceived mutuality than controls for both partners and friends. The negative aspects of perceived mutuality were particularly important in differentiating between groups. These findings held when depression was included as a covariate for friends only. Results suggest that the disconnecting aspects of relationships may play a powerful role in the phenomenology of eating disorders.

The therapist's use of self-disclosure in a relational therapy approach for eating disorders.

One of the critical aspects of Relational Therapy (RT) that distinguishes it from other treatments for eating disorders is the therapist's use of self-disclosure. Self-disclosure is one way the therapist authentically represents her- or himself in the therapeutic relationship to foster relational movement and growth. This article makes use of an initial clinical vignette to compare and contrast the use of therapist self-disclosure within an RT approach with views of therapist self-disclosure from other psychotherapy traditions. Advantages are discussed for using therapist disclosure with eating disordered patients. Criteria are outlined to help the RT therapist decide when to disclose. Additional clinical vignettes show different types of therapist self-disclosure, their therapeutic purposes, and their relational impact. The article ends with implications for future research, training, and practice related to the use of self-disclosure in the treatment of eating disordered patients.

Primary process and peer consultation: an experiential model to work through countertransference.

Various models exist for peer supervision and consultation of group therapy. This article documents the authors' experience using an experiential group consultation of group therapy model that relies on primary process to overcome countertransference dilemmas. A review of group therapy supervision and consultation models is followed by vignettes from the authors' experience. Discussion of the vignettes highlight critical issues in group consultation and expound upon the strengths and challenges of using an experiential model.

The relationship between perceived mutuality and bulimic symptoms, depression, and therapeutic change in group.

This pilot study examined (a) the effectiveness of short-term group relational therapy (RT) in comparison to short-term group cognitive-behavioral therapy (CBT), and (b) the relationship between perceived mutuality (PM) in relationships and severity of bulimic and depressive symptoms in women with bulimia nervosa (BN). Fifteen women ages 20-54 diagnosed with BN (n=11) or binge-eating disorder (BED, n=4) were randomly assigned to a 16-week manualized RT or CBT group. The following measures were administered at baseline, at 8 and 16 weeks, and at 6th- and 12th-month follow-ups: Eating Disorders Inventory-2 (EDI-2), Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), and the Mutual Psychological Development Questionnaire (MPDQ). A series of mixed design analyses of variance (ANOVA) were computed to examine group therapy effectiveness and outcomes related to PM and symptom severity. Both group RT and CBT treatment conditions showed significant improvement in reducing binge eating, vomiting, and depression at end of treatment and across follow-up assessment times. Low levels of PM with father at baseline were associated with high levels of bulimic and depressive symptoms across assessment times, whereas low PM with mother was only associated with high levels of depression. Pilot study findings supported the idea that group work focused primarily on PM and relational factors can be effective in treating women with bulimic and depressive symptoms. Findings also suggest that relationships with fathers play an important role in recovery.

The effects of exercise on children with attention-deficit hyperactivity disorder.

PURPOSE: The effects of exercise on children with attention-deficit hyperactivity disorder (ADHD) were evaluated by studying the rate of spontaneous eye blinks, the acoustic startle eye blink response (ASER), and motor impersistence among 8- to 12-yr-old children (10 boys and 8 girls) meeting DSM-III-R criteria for ADHD. METHODS: Children ceased methylphenidate medication 24 h before and during each of three daily conditions separated by 24-48 h. After a maximal treadmill walking test to determine cardiorespiratory fitness (VO(2peak)), each child was randomly assigned to counterbalanced conditions of treadmill walking at an intensity of 65-75% VO(2peak) or quiet rest. Responses were compared with a group of control participants (11 boys and 14 girls) equated with the ADHD group on several key variables. RESULTS: Boys with ADHD had increased spontaneous blink rate, decreased ASER latency, and decreased motor impersistence after maximal exercise. Girls with ADHD had increased ASER amplitude and decreased ASER latency after submaximal exercise. CONCLUSIONS: The findings suggest an interaction between sex and exercise intensity that is not explained by physical fitness, activity history, or selected personality attributes. The clinical meaning of the eye blink results is not clear, as improvements in motor impersistence occurred only for boys after maximal exercise. Nonetheless, these preliminary findings are sufficiently positive to encourage additional study to determine whether a session of vigorous exercise has efficacy as a dopaminergic adjuvant in the management of behavioral features of ADHD.