Predictors of therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa.

BACKGROUND: Therapeutic alliance (TA) has been found to be a significant predictor of outcome for patients with severe and enduring anorexia nervosa (SE-AN), accounting for more variance than treatment type. To better understand how to promote TA for this population, the aim of the current study was to investigate predictors of TA in adults with SE-AN. METHODS: Participants were 63 adult females with SE-AN presenting to an outpatient, multi-site randomized controlled trial conducted at two clinical sites. Participants' perception of the quality of their therapeutic relationship, demographic information, and eating disorder symptomatology were assessed via interview and questionnaire measures. RESULTS: Baseline ratings of how successful participants believed treatment would be for them was the only variable to significantly predict early (p = .01), mid (p = .009), and late treatment alliance (p = .03). No other variables investigated predicted the quality of patient rated TA at any point in treatment (ps > .57). CONCLUSIONS: Results suggest instilling hope in treatment outcome may enhance TA, and in turn, outcomes for patients with SE-AN in outpatient therapy.

Body checking and avoidance in low weight and weight restored individuals with anorexia nervosa and non-clinical females.

Body dissatisfaction (BD) is central to the development, maintenance and relapse of anorexia nervosa (AN). BD has been conceptualized as a multi-dimensional construct incorporating behaviours, cognitions and affect, yet little is known about the impact of weight and disordered eating on these aspects. 56 'below DSM-IV weight criteria for AN' (BMI 17.5 kg/m(2)) individuals currently receiving treatment for an eating disorder, and 60 non-eating disordered females completed the Body Checking Scale, Body Image Avoidance Questionnaire and the Body Image Anxiety Questionnaire. As expected, females diagnosed with AN showed significantly more behavioural and affective body dissatisfaction than the control group. Patients at lower weights showed significantly more avoidance behaviours and less body image anxiety than those with anorexia at higher weights. No difference was seen in checking behaviours between these groups. Weight based differences in avoidance behaviours continued to exist even when the effects of anxiety were controlled for. Affective and behavioural aspects of BD should be considered in clinical practice at all stages of treatment.

Cognitive behavioural therapy for individuals with longstanding anorexia nervosa: adaptations, clinician survival and system issues.

Despite recent advances in the treatment of anorexia nervosa, some individuals will progress to a severe and enduring illness, with associated physical, psychological and social consequences. Working with these patients, however, may leave clinicians feeling overwhelmed, risking difficulties in the therapeutic relationship including disengagement or despair. Cognitive behaviour therapy has shown some promise in the treatment of eating disorders, yet some features may not be appropriate for this group. In this paper, we outline the ways in which we have adapted cognitive behaviour therapy to best meet the complex and challenging needs of this group. We stress the importance of maintaining a reassuring, accepting and motivational approach in combination with clear goal setting and boundaries.

Assessing quality of life in the eating disorders: the HeRQoLED-S.

EVALUATION OF: Las Hayas C, Quintana JM, Padierna JA, Bilbao A, Muñoz P. Use of Rasch methodology to develop a short version of the Health Related Quality of Life for Eating Disorders questionnaire: a prospective study. Health Qual. Life Outcomes 8, 29 (2010). Quality of life has become of increasing interest for health professionals since the 1980s and is now incorporated into assessment, treatment and evaluation of many health interventions. Within the arena of eating disorders, adequate consideration of quality of life within treatment and research has been slower, but is now coming into line with wider physical and mental health fields. A number of eating disorder-specific measures have been developed that aim to assess perceived quality of life while also minimizing response bias, which can be attributable to the ego-syntonicity of the eating disorders. While these measures are of great importance, further work is still required to assess the reliability and validity of these scales and to adapt the current available measures to increase their suitability for incorporation into clinical and research protocols. The current discussed paper by Las Hayas et al. aims to evaluate the Health Related Quality of Life for the Eating Disorders - version 2 (HeRQoLEDv2) for reliability and validity, to develop a short form of this questionnaire, the Health Related Quality of Life for the Eating disorders - Short form (HeRQoLED-S) using Rasch methodology and to further assess the HeRQoLED-S for reliability and validity. The authors confirm their hypothesized internal structure of the scales and present evidence for the reliability of the short scale. However, the short measure should be subject to more rigorous analysis of its reliability and construct validity in order to provide evidence as to its relationship to quality of life as perceived by eating disorder individuals.