Norfolk Community
Eating Disorders
Service
Research Updates
Dr MadeleineTatham
Consultant Clinical
Psychologist
Julie Dodd...
Overview
•CBT-T
•Keeping Myself Safe Group
•Attitudes and concerns regarding CBT
manuals
Background
• Vikki Mountford
• Hannah Turner
• Madeleine Tatham
• Glenn Waller
1. CBT-T
• Need for cost effective, faster, evidence-based
treatments
• Delivered by wide range of (non-specialist) mental...
Pilot Project
• 10 week CBT protocol
• 2 x Band 5s
• 2 day training delivered by lead author
• Weekly supervision by lead ...
Broad
structure of
CBT-T
Psychoeducation and cognitive restructuring
Changing eating - exposure
Changing eating – Behaviou...
Measures
•EDE-Q
•GAD7
•PHQ9
•WAI-SR
•PBQ
•and ED10
ED10 – development of a new measure
• Session by session measure
• 10 core attitudinal and behavioural items
• Good intern...
And beyond......
• Is it effective and if so, who for?
• Mediators and moderators of change
• Therapeutic alliance
• Long-...
2. Keeping Myself Safe Group
•Move away from MET
•Psychoeducation and therapeutic
stance
Rationale and aims
• Manage RTT targets
• Fostering early engagement following assessment
• Reducing isolation and shame
•...
Group Format
•4 Group Sessions and an
individual follow up
•Our stance
•Overview
•Keeping myself safer plan and GP
summary...
Impact....?
• Self-reported increases in likelihood of attending
physical monitoring.
• Increased belief ratings re the im...
I.e. symptom change
2012 - 2013 2013-2014
0
1
2
3
4
5
6
No.ofsymptomsperweek
Eating Disorder Symptomatology
Binges Vomitti...
And BMI.....
2012-2013 2013-2014
16.6
16.21
15.8
17.8
17.95
Diagnostic
cut off
14.5
15
15.5
16
16.5
17
17.5
18
18.5
Assess...
Research in progress......
• Impact of psychoeduational group on symptoms
whilst awaiting treatment?
• Impact of KMS group...
Previous research
Concerns delivering CBT Attitudes to manuals
Attitudes to manuals – key findings
• Low uptake and implementation of ED evidence-based
treatment (e.g. Von Ranson, Walla...
Attitudes to manuals
• Variation in use - situational and demographic
factors
• Beliefs about their impact upon therapeuti...
Method
Participants
• 125 qualified therapists in UK
Measures
• Attitudes to Treatment Manuals Questionnaire
• Brief Sympt...
Findings
• Majority aware of manuals
• Only half using them often or always
• Those who did tended to be
- Older
- Less ne...
Implications
1. Address therapist concerns about impact upon
therapeutic process in manuals (e.g.
emphasising need for goo...
Clinicians’ concerns delivering CBT
• Evidence-based interventions under-used in ED
? Unaware of evidence base? (Meehl, 19...
Method
Participant
• 113 clinicians
Measures
• 14 elements of CBT
• Intolerance of Uncertainty Scale
Findings
• 4 distinct concerns
1. Process
2. Education
3. Cognitive
4. Exposure
• Most worrying:
• Body image work
• Endin...
Findings cont....
Clinician traits:
• Older , more experienced clinicians less worried
• No general link between trait anx...
Implications
• Importance of clinician’s own cognitions and
emotions and their impact upon treatment:
• Prospective anxiet...
And finally, ideas for the future.....?
• Patients’ views of (CPA) motivational assessment
letters
• Development of an ED ...
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Norfolk Community Eating Disorders Research Updates

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The third presentation was by Dr MadeleineTatham (Consultant Clinical
Psychologist, Norfolk CEDS) and Julie Dodd (Assistant Psychologist) which gave an overview about current research activities and projects including an exciting pilot project on Cognitive Behavioral Therapy (CBT-T) in eating disorders, group therapy (Keeping Myself Safe) and an interesting research on clinicians’ attitude towards using CBT manuals.

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Norfolk Community Eating Disorders Research Updates

  1. 1. Norfolk Community Eating Disorders Service Research Updates Dr MadeleineTatham Consultant Clinical Psychologist Julie Dodd Assistant Psychologist
  2. 2. Overview •CBT-T •Keeping Myself Safe Group •Attitudes and concerns regarding CBT manuals
  3. 3. Background • Vikki Mountford • Hannah Turner • Madeleine Tatham • Glenn Waller
  4. 4. 1. CBT-T • Need for cost effective, faster, evidence-based treatments • Delivered by wide range of (non-specialist) mental health providers?
  5. 5. Pilot Project • 10 week CBT protocol • 2 x Band 5s • 2 day training delivered by lead author • Weekly supervision by lead author to ensure fidelity • Case management by Consultant Clinical Psychologist
  6. 6. Broad structure of CBT-T Psychoeducation and cognitive restructuring Changing eating - exposure Changing eating – Behavioural experiments Maintaining alliance and motivation (reinforcement for change) Body image work (avoidance = exposure; checking and comparison = behavioural experiments; mind-reading = surveys) Reducing bingeing and purging - exposure work Reducing emotional triggers to bulimic behaviours Monitoring risks and safety Measurement of outcome, discussion with patient, response to no change Engage; assess maintaining factors Relapse prevention
  7. 7. Measures •EDE-Q •GAD7 •PHQ9 •WAI-SR •PBQ •and ED10
  8. 8. ED10 – development of a new measure • Session by session measure • 10 core attitudinal and behavioural items • Good internal consistency and test-retest reliability • r=.889 with EDE-Q • track changes to determine importance of early response to therapy
  9. 9. And beyond...... • Is it effective and if so, who for? • Mediators and moderators of change • Therapeutic alliance • Long-term follow up
  10. 10. 2. Keeping Myself Safe Group •Move away from MET •Psychoeducation and therapeutic stance
  11. 11. Rationale and aims • Manage RTT targets • Fostering early engagement following assessment • Reducing isolation and shame • Provide psychoeduation about ED symptoms and associated health risks • Promoting responsibility and autonomy for self-care • Developing an individualised self-care plan (including engaging with physical monitoring)
  12. 12. Group Format •4 Group Sessions and an individual follow up •Our stance •Overview •Keeping myself safer plan and GP summary •Overcoming obstacles •What has gone well?/ difficulties?
  13. 13. Impact....? • Self-reported increases in likelihood of attending physical monitoring. • Increased belief ratings re the importance of self- care • Increased confidence to engage in proactive self- care activities AND • Anecdotal observations regarding improvement in symptoms.........
  14. 14. I.e. symptom change 2012 - 2013 2013-2014 0 1 2 3 4 5 6 No.ofsymptomsperweek Eating Disorder Symptomatology Binges Vomitting Laxatives 0 1 2 3 4 5 6 No.ofsymptomsperweek Eating Disorder Symptomatology Binges Vomitting Laxatives
  15. 15. And BMI..... 2012-2013 2013-2014 16.6 16.21 15.8 17.8 17.95 Diagnostic cut off 14.5 15 15.5 16 16.5 17 17.5 18 18.5 Assessment Start Session 6 End Follow up BMI BMI (AN only) 16.3 17.3 16.7 17.01 17.4 Diagnostic cut off 14.5 15 15.5 16 16.5 17 17.5 18 18.5 Assessment Start Session 6 End FU 1 BMI BMI (AN only)
  16. 16. Research in progress...... • Impact of psychoeduational group on symptoms whilst awaiting treatment? • Impact of KMS group on retention in treatment? • Impact of KSM group on treatment outcome?
  17. 17. Previous research Concerns delivering CBT Attitudes to manuals
  18. 18. Attitudes to manuals – key findings • Low uptake and implementation of ED evidence-based treatment (e.g. Von Ranson, Wallace & Stevenson, 2013) • Key issue in delivery is the use of manualised methods • Use of CBT manuals enhances reported use of core techniques (Waller et al, 2012) • Little training in their use, limited use!
  19. 19. Attitudes to manuals • Variation in use - situational and demographic factors • Beliefs about their impact upon therapeutic process and outcomes • Attitudes towards manuals can effect outcomes (CBT for CFS; Wiborg et al, 2012) • In eating disorders?
  20. 20. Method Participants • 125 qualified therapists in UK Measures • Attitudes to Treatment Manuals Questionnaire • Brief Symptom Inventory
  21. 21. Findings • Majority aware of manuals • Only half using them often or always • Those who did tended to be - Older - Less negative about impact on process - Report positive outcomes / attitudes • Negative attitudes associated with less familiarity and lower mood level - Beliefs about impact of manuals on process
  22. 22. Implications 1. Address therapist concerns about impact upon therapeutic process in manuals (e.g. emphasising need for good alliance) 2. Ensure clinicians are familiar with manuals 3. Changing attitudes via supervision – encouraging experimentation to see whether their use results in positive attitudes to structured psychological treatment
  23. 23. Clinicians’ concerns delivering CBT • Evidence-based interventions under-used in ED ? Unaware of evidence base? (Meehl, 1986) ? Beliefs and attitudes about evidence-based treatments? (Shafran et al., 2009)? ? Level of training, competence and supervision ? (Fairburn & Wilson, 2013)
  24. 24. Method Participant • 113 clinicians Measures • 14 elements of CBT • Intolerance of Uncertainty Scale
  25. 25. Findings • 4 distinct concerns 1. Process 2. Education 3. Cognitive 4. Exposure • Most worrying: • Body image work • Ending treatment • Least worrying: • psychoeduation
  26. 26. Findings cont.... Clinician traits: • Older , more experienced clinicians less worried • No general link between trait anxiety and concerns about techniques but • Prospective anxiety = more concern re cognitive / exposure elements of change • P and Inhib anxiety = more concern process- related elements (motivation / endings)
  27. 27. Implications • Importance of clinician’s own cognitions and emotions and their impact upon treatment: • Prospective anxiety – less likely to use the impact laden interventions? - Cognitive restructuring - Behavioural experiments - Weighing & dietary change • Inhibitory anxiety – less likely to manage endings appropriately and extend treatment unnecessarily?
  28. 28. And finally, ideas for the future.....? • Patients’ views of (CPA) motivational assessment letters • Development of an ED / Diabetes measure • Supervisor competencies / development of a disorder specific CTRS?
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