Modified metacognitive therapy for anorexia nervosa: An open trial in an outpatient setting.

OBJECTIVE: Current evidence indicates treatment for adults with anorexia nervosa (AN) requires improvement given recovery rates are low to moderate, and relapse rates are high. Metacognitive therapy (MCT) is an effective treatment for anxiety and depressive disorders. This study evaluates if MCT can be successfully modified to treat AN in a naturalistic clinical setting. METHOD: Twenty-four patients with AN participated in an open trial of modified metacognitive therapy (MCT-AN). Twelve of the 24 patients (50%) completed treatment. MCT was modified to include components specific to eating disorders. The MCT-AN was delivered by clinical psychologists who had undertaken training in MCT in a specialist outpatient service. Group and single participant data analyses were undertaken on those who completed treatment. RESULTS: As well as statistically significant differences from pre- to posttreatment in the group data there were also clinically significant improvements at the individual patient level for eating disorder and depressive symptoms, as well as weight. The mean number of therapy sessions was 18. DISCUSSION: These findings indicate that MCT-AN may be a promising intervention in the treatment of AN, warranting further investigation. PUBLIC SIGNIFICANCE: Treatment for anorexia nervosa in adults requires improvement. Research indicates that Metacognitive therapy (MCT) is an effective treatment for anxiety and depression and may be applicable to the eating disorders. This small open trial suggests that MCT can be modified successfully to treat patients with anorexia nervosa (AN). The results are preliminary and require further research to provide more evidence on the effectiveness of this treatment for AN.

Quality of life impairment and the attitudinal and behavioral features of eating disorders.

We examined the relative contribution of different forms of eating disorder (ED) pathology to impairment in mental and physical health-related quality of life (QOL) in women with a wide range of ED symptoms. Female participants from an outpatient ED clinic (n = 53) and the local community (n = 214) completed measures of ED features and mental and physical health-related QOL. Across the sample, ED features were significantly associated with most mental and physical domains of QOL. In multiple regression analyses controlling for age and body mass index, ED features significantly predicted impairment in mental and physical QOL. Extreme shape and weight concern significantly and independently predicted most QOL subscales (ß range = 0.19-0.44). The prominent contribution of shape and weight concern to both mental and physical QOL impairment underlines the importance of addressing body dissatisfaction in the treatment and prevention of EDs.

Body checking and avoidance in women: associations with mental and physical health-related quality of life.

Body checking and body avoidance have demonstrated clinical significance in a number of populations. However, the associations between these behaviors and mental and physical health-related quality of life have not been examined. This study investigated the associations between body checking and avoidance and quality of life in 214 community women. Body checking and body avoidance were significantly correlated with mental and physical quality of life, as well as with eating disturbances. Frequency of body checking significantly predicted impairment in mental quality of life, and frequency of body avoidance significantly predicted impairment in physical quality of life, over and above the contributions of depressive symptoms and related demographic characteristics. Targeting checking and avoidance in prevention and treatment programs may improve quality of life and reduce health-related functional impairment.

The relationship between eating disorder psychopathology and health-related quality of life within a community sample.

PURPOSE: Recent research has begun investigating the impact of eating disorders on health-related quality of life (QOL). The present study examined the impact of eating disorder psychopathology on QOL within a community sample. METHODS: Two hundred and fourteen women completed questionnaires assessing eating disorder symptoms, body dissatisfaction, body checking and body avoidance behaviors, and general psychopathology. RESULTS: Eating disturbance and body image dissatisfaction were associated with poorer QOL. In addition, eating disorder psychopathology uniquely predicted QOL above and beyond the variance accounted for by general psychopathology. Both subjective bulimic episodes and objective bulimic episodes were associated with impairments in QOL. CONCLUSIONS: These results indicate that eating disorder psychopathology may adversely affect the lives of women within the community. Early intervention and detection could reduce the negative impact of eating disorder psychopathology on women's lives and protect individuals with mild eating disorder symptoms from a further reduction in QOL.

Health-related quality of life in women with eating disorders: association with subjective and objective binge eating.

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.