Meta‐Analysis of Anorexia Nervosa Counseling Outcome Studies From 1990 to 2015

This meta‐analysis of 92 anorexia nervosa counseling articles examined the effectiveness of counseling in reducing symptoms of anorexia nervosa at termination and the longest follow‐up assessments. Treatment‐as‐usual studies showed no effect to small effects at both posttest and follow‐up assessments, wait‐list studies showed small effects at posttest and medium effects at follow‐up, and single‐group uncontrolled studies showed medium to large effects at posttest and medium effects at follow‐up. Implications for research and practice are discussed.     

Pathological Conflict Avoidance in Anorexia Nervosa: Family Perspectives

Conflict avoidance is a common pattern in families of patients with anorexia nervosa (AN), but little systematic controlled research has been conducted to elucidate the formal mechanics of such interaction. Forty family triads with daughters suffering from AN were compared to 40 matched control (CON) triads, on five measures of conflictual family situations. Results revealed that the AN group had significantly more difficulty in choosing the topic of discussion, adhering to the topic, developing and exploring the chosen topic, and reaching a solution—all within a family setting. Findings empirically support previous clinical and research evidence on the pathological avoidance of conflict in families with a member who has AN. Therapeutic implications are discussed.     

神经性厌食症的家庭治疗--西方关于神经性厌食症心理治疗的新进展

弗洛伊德关于家庭和心理性别发展的论述给神经性厌食症的理解、分析与治疗带来了新的关注焦点,在其之后的学者将他的思想进一步继承和发展,创造出了以家庭为关注对象的且在当代得到广泛应用的系统家庭疗法,并将该疗法应用到了神经性厌食症的诊断与治疗中,取得了开创性的成果.     

Femininity, Mental Weakness, and Difference: Male Students Account for Anorexia Nervosa in Men

The purpose of this study was to examine how men account for the diagnosis in men of anorexia nervosa (AN), a condition commonly associated with women. Male students participated in focus group discussions of topics related to AN. Discussions were tape-recorded with participants' consent, transcribed, and then analyzed using discourse analysis. The participants spontaneously constructed AN as a female-specific condition. When asked to account for AN in men, they distanced AN from hegemonic masculinities in ways that sustained both dominant masculine identities and gender-specific constructions of AN. These findings show how issues of health and gender are interlinked in everyday understandings of AN. Future researchers might usefully consider how the construction of gender-specific illness implicates wider notions of both feminine and masculine gender identities.     

The Psychological Battle for Control: A Qualitative Study of Health-care Professionals' Understandings of the Treatment of Anorexia Nervosa

This paper reports a qualitative, idiographic study, which intensively examines a multidisciplinary team of clinicians' subjective understandings and experiences of treating young people with anorexia nervosa. The study employs semi-structured interviews and interpretative phenomenological analysis, these methods enabling individual clinicians' perspectives to be explored in depth and retained within the analysis. The analysis focuses on the salient higher-order theme of control which emerges as central to understanding the treatment of the anorexic child. Three control-related themes are used to illustrate the multiplicity of meanings and experiences which are relevant to this team of health-care professionals. It is suggested that this paper makes three important contributions to the current eating disorder literature: illuminating the multi-faceted nature of the construct control; highlighting the importance of therapists' subjective understandings and experiences; and illustrating the value of qualitative methods for clinically relevant research. © 1997 John Wiley & Sons, Ltd.     

The Cognitive‐Behavioural Theory and Treatment of Bulimia Nervosa: An Examination of Treatment Mechanisms and Future Directions

Enhanced cognitive‐behavioural therapy (CBT‐E) is the current treatment of choice for bulimia nervosa. While the cognitive‐behavioural theory and treatment of bulimia nervosa have made a substantial contribution to our understanding of the disorder, approximately half of patients treated with CBT‐E fail to achieve remission of binge eating and purging. There is evidence showing that mechanisms proposed by the CBT‐E model are associated with binge eating and purging symptoms, and therefore likely important targets for treatment. To identify future directions in improving the efficacy of this treatment, and informed by a model of the client change process, we review the evidence for the hypothesised treatment mechanisms of CBT‐E. We conclude that while the proposed treatment mechanisms of CBT‐E largely change over the course of treatment, there is limited evidence that the treatment manipulations of CBT‐E are responsible for the specific changes in the proposed treatment mechanisms. In addition, given a lack of research in this area, we could find no evidence that changes in the additional treatment mechanisms outlined in CBT‐E are associated with changes in the core symptomatology of binge eating and purging. Based on these findings, we recommend that future efforts are directed towards understanding the client change process in CBT‐E and outline three clear directions for research.     

Knowledge and Beliefs about Bulimia Nervosa and its Treatment: A Comparative Study of Three Disciplines

Poor Mental Health Literacy (MHL), i.e. knowledge and beliefs about bulimia nervosa (BN), among health professionals may contribute to low rates of recognition and less optimal management. The aim of this study was to investigate the BN-MHL of health professionals. A total of 534 professionals selected randomly from Internet based lists were surveyed with a MHL questionnaire regarding a fictional vignette of a woman with BN. One hundred and thirty-six dieticians, 68 psychologists and 97 counselors, total 56% (n = 301) responded. The majority of respondents indicated the woman in the vignette suffered from BN (49%) or an eating disorder (20%) and endorsed evidenced based approaches. On post hoc between group analyses there was a trend (p = .02) for dieticians and psychologists to be more likely than counselors to accurately identify the diagnosis of BN. Dieticians and psychologists were also more likely than counselors to endorse a psychologist as the most helpful treatment provider (p<.001) and to be more likely to endorse cognitive behavioral therapy as the most helpful treatment (p<.001). These results indicate a need for greater training and support for non specialist primary care health professionals.     

Counseling and Guided Self‐Help Outcomes for Clients With Bulimia Nervosa: A Meta‐Analysis of Clinical Trials From 1980 to 2010

This meta‐analysis included 111 clinical trials exploring the effectiveness of counseling/psychotherapy and guided self‐help approaches in the treatment of bulimia nervosa. In general, single‐group studies supported higher efficacy of counseling/psychotherapy, whereas wait‐list, treatment‐as‐usual, and placebo studies indicated both approaches were equally effective at termination (posttest) and follow‐up in altering binging, purging, laxative use, and self‐reported bulimia or body dissatisfaction perceptions in nearly all comparisons.     

Applications of Collaborative Helping Maps: Supporting Professional Development,Supervision and Work Teams in Family‐Centered Practice

Collaborative, family‐centered practice has become an influential approach in helping efforts across a broad spectrum of human services. This article draws from previous work that presented a principle‐based, practice framework of Collaborative Helping and highlighted the use of Collaborative Helping maps as a tool both to help workers think their way through complex situations and to provide a guideline for constructive conversations between families and helpers about challenging issues. It builds on that work to examine ways to utilize Collaborative Helping maps at worker, supervisory, and organizational levels to enhance and sustain collaborative, family‐centered practice and weave its core values and principles into the everyday fabric of organizational cultures in human service agencies and government agencies that serve poor and marginalized families and communities.     

Integrated,Family‐based,Partial Hospital Treatment for Complex Pediatric Illness

This paper describes a unique treatment program for complex pediatric illness. The Hasbro Children's Partial Hospital Program uses a family systems orientation, integrated care, and a partial hospital setting to treat children with a wide range of pediatric illnesses that have failed outpatient and inpatient treatments. We have treated more than 2000 children with at least 80 different ICD‐9 diagnoses. The multidisciplinary treatment team functions as a meta‐family for children and their families who present with illness and family beliefs that impede successful outcomes with standard care. The three features: family systems orientation, integrated care, and partial hospital setting, hopefully interact to create an environment that helps families expand and modify their explanatory models regarding participating in effective medical care. The goal of treatment is for both children and their parents to feel empowered to take control of the illness. Parents completing standardized measures at intake describe their children and families as experiencing significant emotional distress, low levels of general family functioning, and poor quality of life. Although the children are described as having distinct behavioral differences, the families are described as responding to the experience of a seriously ill child in similar ways. A treatment program that addresses the noncategorical aspects of how families respond to illness while addressing the specific diseases of the children can allow children and their families to respond favorably to treatment.     

The Interplay of Self‐Certainty and Prosocial Development in the Transition from Late Adolescence to Emerging Adulthood

The transition from late adolescence to emerging adulthood is a period of the life span that offers young people the possibility to consolidate their self‐certainty and prosociality. Both aspects are of core importance for increasing personal and societal well‐being. The purpose of this longitudinal study was twofold: (i) to examine patterns of change and stability in self‐concept clarity and prosociality; and (ii) to unravel over time associations between these constructs in the transition from late adolescence to emerging adulthood. In addressing both aims, we explored the moderating effects of gender. Participants were 244 Dutch emerging adults (46% male; mean age at T1 = 16.73 years) who completed six waves of data collection (mean age at T6 = 22.7 years). Findings highlighted that (i) self‐concept clarity developed nonlinearly, with an initial decline from T1 to T2 followed by an increase thereafter, while prosociality increased linearly over time and both self‐concept clarity and prosociality were characterized by high rank‐order consistency; (ii) self‐concept clarity and prosociality were positively related over time, with the effect of prosociality on self‐concept clarity being stronger than the reciprocal effect of self‐concept clarity on prosociality. Gender differences were detected in mean levels of self‐concept clarity and prosociality (male participants reported higher self‐concept clarity and lower prosociality than female participants) but not in their developmental pathways nor in their reciprocal associations. Copyright © 2016 European Association of Personality Psychology     

The role of body image and self‐perception in anorexia nervosa: the neuroimaging perspective

Anorexia nervosa is a severe psychiatric illness characterized by intense fear of gaining weight, relentless pursuit of thinness, deep concerns about food and a pervasive disturbance of body image. Functional magnetic resonance imaging tries to shed light on the neurobiological underpinnings of anorexia nervosa. This review aims to evaluate the empirical neuroimaging literature about self‐perception in anorexia nervosa. This narrative review summarizes a number of task‐based and resting‐state functional magnetic resonance imaging studies in anorexia nervosa about body image and self‐perception. The articles listed in references were searched using electronic databases (PubMed and Google Scholar) from 1990 to February 2016 using specific key words. All studies were reviewed with regard to their quality and eligibility for the review. Differences in brain activity were observed using body image perception and body size estimation tasks showing significant modifications in activity of specific brain areas (extrastriate body area, fusiform body area, inferior parietal lobule). Recent studies highlighted the role of emotions and self‐perception in anorexia nervosa and their neural substrate involving resting‐state networks and particularly frontal and posterior midline cortical structures within default mode network and insula. These findings open new horizons to understand the neural substrate of anorexia nervosa.     

The design of the MBT‐G adherence and quality scale

Few group psychotherapy studies focus on therapists' interventions, and instruments that can measure group psychotherapy treatment fidelity are scarce. The aim of the present study was to evaluate the reliability of the Mentalization‐based Group Therapy Adherence and Quality Scale (MBT‐G‐AQS), which is a 19‐item scale developed to measure adherence and quality in mentalization‐based group therapy (MBT‐G). Eight MBT groups and eight psychodynamic groups (a total of 16 videotaped therapy sessions) were rated independently by five raters. All groups were long‐term, outpatient psychotherapy groups with 1.5 hours weekly sessions. Data were analysed by a Generalizability Study (G‐study and D‐study). The generalizability models included analyses of reliability for different numbers of raters. The global (overall) ratings for adherence and quality showed high to excellent reliability for all numbers of raters (the reliability by use of five raters was 0.97 for adherence and 0.96 for quality). The mean reliability for all 19 items for a single rater was 0.57 (item range 0.26–0.86) for adherence, and 0.62 (item range 0.26–0.83) for quality. The reliability for two raters obtained mean absolute G‐coefficients on 0.71 (item range 0.41–0.92 for the different items) for adherence and 0.76 (item range 0.42–0.91) for quality. With all five raters the mean absolute G‐coefficient for adherence was 0.86 (item range 0.63–0.97) and 0.88 for quality (item range 0.64–0.96). The study demonstrates high reliability of ratings of MBT‐G‐AQS. In models differentiating between different numbers of raters, reliability was particularly high when including several raters, but was also acceptable for two raters. For practical purposes, the MBT‐G‐AQS can be used for training, supervision and psychotherapy research.     

Guidelines for classifying evidence-based treatments in couple and family therapy

Guidelines for Evidence-Based Treatments in Family Therapy are intended to help guide clinicians, researchers, and policy makers in identifying specific clinical interventions and treatment programs for couples and families that have scientifically based evidence to support their efficacy. In contrast to criteria, which simply identify treatments that "work" and have been employed in the evaluation of other psychotherapies, these guidelines propose a three-tiered levels-of-evidence-based model that moves from "evidence-informed," to "evidence-based," to "evidence-based and ready for dissemination and transportation within diverse community settings." Each level reflects an interaction between the specificity of the intervention, the strength and readth of the outcomes, and the quality of the studies that form the evidence. These guidelines uniquely promote a clinically based "matrix" approach in which the empirical support is evaluated according to various dimensions including strength of the outcomes, the applicability across cultural contexts, and demonstration of specific change mechanisms. The guidelines are offered not only as a basis for understanding the evidence for diverse clinical approaches in couple and family therapy within the systemic tradition of the field, but also as an alternative aspirational model for evaluating all psychotherapies.     

Concordance Between Measures of Anxiety and Physiological Arousal Following Treatment of Panic Disorder in Adolescence

This study examined the concordance (or synchrony/desynchrony) between adolescents' self-reports of anxiety and physiological measures of arousal (heart rate) both prior to and after treatment for panic disorder. Results indicated a decline in reported subjective units of distress (SUDS) for the treatment group only at the post-treatment measurement for two of three tasks. Within the treatment group, heart rate changes during the Behavioral Approach Test (BAT) were observed following treatment for one task only. Implications of this apparent desynchrony between self-report and physiological measures in adolescent panic disorder are discussed, with cognitive changes in participants' perception of anxiety after treatment suggested as an important factor in recovery.     

Neurocognitive predictors of performance‐based functional capacity in bipolar disorder

Neurocognitive impairment can predict functional capacity in individuals with bipolar disorder, though little research has examined whether different neurocognitive domains impact specific types of tasks. This study examined the relationship between several neurocognitive variables and the UCSD Performance‐Based Skills Assessment (UPSA; Patterson et al., 2011) to identify the domains and tests that best predict the performance across the subscales. Forty‐seven euthymic participants who were diagnosed with either Bipolar I or Bipolar II were recruited and assessed on a battery of neuropsychological measures and the UPSA. Correlational and regression analyses were run to identify neurocognitive predictors of UPSA subscales. Per the literature, verbal learning and memory and executive function composites were first examined. Verbal learning and memory predicted the Communication subscale and Total score variables above and beyond the estimated FSIQ and symptom rating scales. In a secondary exploratory analysis, the Benton Judgment of Line Orientation subtest predicted the Finance subscale while the California Verbal Learning Test predicted the UPSA total score. Verbal learning and memory emerged as the strongest predictor of functional capacity, suggesting that this domain should be investigated in future mediational and longitudinal studies with the UPSA.     

Using the Reality Interview improves the accuracy of the Criteria‐Based Content Analysis and Reality Monitoring

Active interviewing approaches can exploit the verbal differences between truthtellers and liars, thus improving detecting deception. One such method is the Reality Interview (RI) aimed to facilitate recall from truthtellers, while increasing the difficulty for liars. This study investigated whether the RI could improve the diagnostic accuracy of the Reality Monitoring and the Criteria‐Based Content Analysis. Liars and truthtellers were either asked to freely recall an event or interviewed with the RI. As hypothesized, the RI improved the discriminability of Reality Monitoring and Criteria‐Based Content Analysis over Free Recall. Honest responses were longer, and the RI increased the word count difference between honest and false statements. However, after correcting for word count, results were no longer significant, showing its importance for deception detection. Nonetheless, the RI increased verbal differences between truthtellers and liars, demonstrating that using the RI with verbal credibility assessment tools is a powerful combination for investigative interviewing.     

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.