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Experiencing eight psychotherapy approaches devoted to eating disorders in a single-day workshop increases insight and motivation to engage in care: a pilot study

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Abstract

Purpose

For patients with eating disorders (EDs), early engagement in care is usually considered a positive prognostic factor. The aim of the study was to investigate how a single-day intervention devoted to early, brief, experiential exposure to a variety of psychotherapy approaches might support commitment to change and the decision to engage in care in patients with EDs.

Methods

One hundred and sixty-nine adult outpatients newly diagnosed with an ED took part in a single-day workshop for groups of up to ten patients, where they experienced eight psychotherapeutic approaches. Motivation to change care and level of insight were assessed at baseline and 10 days after the intervention.

Results

Motivation and commitment to take active steps toward change (expressed by the “Committed Action” composite score) significantly improved after the intervention (p < 0.001), and a significant number of patients specifically moved from “contemplation” to “action” stage (p < 0.001). The improvement of motivation to change was significantly associated with an increase in insight capacity (p < 0.001), and this increase was observed for almost all related dimensions such as recognition of illness or awareness of need for psychological treatment.

Conclusion

A single-day session devoted to experiencing a range of group psychotherapies increased patients’ insight and motivation to actively engage in care. To confirm potential longer-term benefits of this intervention, further studies are needed to explore the contribution of each approach and process specifically involved in patients' increased motivation for care, as well as the clinical characteristics of patients associated with better outcomes.

Level of evidence

V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

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Availability of data and material

The datasets analysed during the current study and support its findings are available from the corresponding author on reasonable request.

References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington

    Book  Google Scholar 

  2. Danielsen M, Bjørnelv S, Weider S et al (2020) The outcome at follow-up after inpatient eating disorder treatment: a naturalistic study. J Eat Disord 8:67

    Article  PubMed  PubMed Central  Google Scholar 

  3. Franko DL, Keshaviah A, Eddy KT et al (2013) A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. Am J Psychiatry 170:917–925

    Article  PubMed  PubMed Central  Google Scholar 

  4. Iwajomo T, Bondy SJ, de Oliveira C, Colton P, Trottier K, Kurdyak P (2021) Excess mortality associated with eating disorders: population-based cohort study. Br J Psychiatry 219(3):487–493. https://doi.org/10.1192/bjp.2020.197

    Article  PubMed  Google Scholar 

  5. Keel PK, Brown TA (2010) Update on course and outcome in eating disorders. Int J Eat Disord 43:195–204

    PubMed  Google Scholar 

  6. Striegel Weissman R, Rosselli F (2017) Reducing the burden of suffering from eating disorders: unmet treatment needs, cost of illness, and the quest for cost-effectiveness. Behav Res Ther 88:49–64

    Article  PubMed  Google Scholar 

  7. Abbate-Daga G, Amianto F, Delsedime N et al (2013) Resistance to treatment and change in anorexia nervosa: a clinical overview. BMC Psychiatry 13:294

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rieger E, Touyz SW, Beumont PJV (2002) The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ): information regarding its psychometric properties. Int J Eat Disord 32:24–38

    Article  PubMed  Google Scholar 

  9. Rosenvinge JH, Klusmeier AK (2000) Treatment for eating disorders from a patient satisfaction perspective: a Norwegian replication of a British study. Eur Eat Disord Rev 8:293–300

    Article  Google Scholar 

  10. Steiner H, Mazer C, Litt IF (1990) Compliance and outcome in anorexia nervosa. West J Med 153:133–139

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Treasure J, Russell G (2011) The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. Br J Psychiatry J Ment Sci 199:5–7

    Article  Google Scholar 

  12. Fursland A, Erceg-Hurn DM, Byrne SM et al (2018) A single session assessment and psychoeducational intervention for eating disorders: impact on treatment waitlists and eating disorder symptoms. Int J Eat Disord 51:1373–1377

    Article  PubMed  Google Scholar 

  13. Vitousek K, Watson S, Wilson GT (1998) Enhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev 18:391–420

    Article  CAS  PubMed  Google Scholar 

  14. Ali K, Farrer L, Fassnacht DB et al (2017) Perceived barriers and facilitators towards help-seeking for eating disorders: a systematic review. Int J Eat Disord 50:9–21

    Article  PubMed  Google Scholar 

  15. Geller J, Zaitsoff SL, Srikameswaran S (2005) Tracking readiness and motivation for change in individuals with eating disorders over the course of treatment. Cogn Ther Res 29:611–625

    Article  Google Scholar 

  16. Serpell L, Treasure J, Teasdale J et al (1999) Anorexia nervosa: friend or foe? Int J Eat Disord 25:177–186

    Article  CAS  PubMed  Google Scholar 

  17. Denison-Day J, Appleton KM, Newell C et al (2018) Improving motivation to change amongst individuals with eating disorders: a systematic review. Int J Eat Disord 51:1033–1050

    Article  PubMed  Google Scholar 

  18. Reyes-Rodríguez ML, Ramírez J, Davis K et al (2013) Exploring barriers and facilitators in eating disorders treatment among Latinas in the United States. J Lat Psychol 1:112–131

    PubMed  PubMed Central  Google Scholar 

  19. Byrne SM, Fursland A, Allen KL et al (2011) The effectiveness of enhanced cognitive behavioural therapy for eating disorders: an open trial. Behav Res Ther 49:219–226

    Article  PubMed  Google Scholar 

  20. Carter O, Pannekoek L, Fursland A et al (2012) Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Behav Res Ther 50:487–492

    Article  PubMed  Google Scholar 

  21. Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 41:509–528

    Article  PubMed  Google Scholar 

  22. Geller J, Drab-Hudson D, Whisenhunt B et al (2004) Readiness to change dietary restriction predicts outcomes in the eating disorders. Eat Disord 12:209–224

    Article  PubMed  Google Scholar 

  23. Nordbø RHS, Espeset EMS, Gulliksen KS et al (2012) Reluctance to recover in anorexia nervosa. Eur Eat Disord Rev 20:60–67

    Article  PubMed  Google Scholar 

  24. Schmidt U, Brown A, McClelland J et al (2016) Will a comprehensive, person-centered, team-based early intervention approach to first episode illness improve outcomes in eating disorders? Int J Eat Disord 49:374–377

    Article  PubMed  Google Scholar 

  25. Treasure J, Stein D, Maguire S (2015) Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Interv Psychiatry 9:173–184

    Article  PubMed  Google Scholar 

  26. Waller G, Schmidt U, Treasure J et al (2009) Problems across care pathways in specialist adult eating disorder services. Psychiatr Bull 33:26–29

    Article  Google Scholar 

  27. Beat (2015) The costs of eating disorders: Social, health and economic impacts. http://www.basw.co.uk, https://www.basw.co.uk/resources/costs-eating-disorders-social-health-and-economic-impacts. Accessed 20 Sept 2021

  28. Agras WS, Walsh T, Fairburn CG et al (2000) A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Arch Gen Psychiatry 57:459–466

    Article  CAS  PubMed  Google Scholar 

  29. Solmi M, Wade TD, Byrne S et al (2021) Comparative efficacy and acceptability of psychological interventions for the treatment of adult outpatients with anorexia nervosa: a systematic review and network meta-analysis. Lancet Psychiatry 8:215–224

    Article  CAS  PubMed  Google Scholar 

  30. Castro-Fornieles J, Casulà V, Saura B et al (2007) Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa. Int J Eat Disord 40:129–135

    Article  PubMed  Google Scholar 

  31. Fairburn CG, Cooper Z, Doll HA et al (2013) Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK–Italy study. Behav Res Ther 51:R2–R8

    Article  PubMed  PubMed Central  Google Scholar 

  32. Murphy R, Straebler S, Cooper Z et al (2010) Cognitive behavioral therapy for eating disorders. Psychiatr Clin N Am 33:611–627

    Article  Google Scholar 

  33. Barney JL, Murray HB, Manasse SM et al (2019) Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: a systematic review. Eur Eat Disord Rev 27:352–380

    Article  PubMed  PubMed Central  Google Scholar 

  34. Juarascio AS, Manasse SM, Schumacher L et al (2017) Developing an acceptance-based behavioral treatment for binge eating disorder: rationale and challenges. Cogn Behav Pract 24:1–13

    Article  PubMed  Google Scholar 

  35. Katterman SN, Kleinman BM, Hood MM et al (2014) Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eat Behav 15:197–204

    Article  PubMed  Google Scholar 

  36. Linardon J, Gleeson J, Yap K et al (2019) Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention. Cogn Behav Ther 48:15–38

    Article  PubMed  Google Scholar 

  37. Downs KJ, Blow AJ (2013) A substantive and methodological review of family-based treatment for eating disorders: the last 25 years of research. J Fam Ther 35:3–28

    Article  Google Scholar 

  38. Lock J, le Grange D (2005) Family-based treatment of eating disorders. Int J Eat Disord 37:S64–S67

    Article  PubMed  Google Scholar 

  39. Meneguzzo P, Tenconi E, Todisco P et al (2021) Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: data from a longitudinal study in an eating disorders specialized inpatient unit. Eur Eat Disord Rev. https://doi.org/10.1002/erv.2848 (Epub ahead of print 2021)

    Article  PubMed  PubMed Central  Google Scholar 

  40. Tchanturia K, Giombini L, Leppanen J et al (2017) Evidence for cognitive remediation therapy in young people with anorexia nervosa: systematic review and meta-analysis of the literature. Eur Eat Disord Rev 25:227–236

    Article  PubMed  Google Scholar 

  41. Casasnovas C, Fernández-Aranda F, Granero R et al (2007) Motivation to change in eating disorders: clinical and therapeutic implications. Eur Eat Disord Rev Prof J Eat Disord Assoc 15:449–456

    Article  CAS  Google Scholar 

  42. Fernàndez-Aranda F, Álvarez-Moya EM, Martínez-Viana C et al (2009) Predictors of early change in bulimia nervosa after a brief psychoeducational therapy. Appetite 52:805–808

    Article  PubMed  Google Scholar 

  43. Abbate-Daga G, Marzola E, Amianto F et al (2016) A comprehensive review of psychodynamic treatments for eating disorders. Eat Weight Disord. https://doi.org/10.1007/s40519-016-0265-9 (Epub ahead of print 1 December 2016)

    Article  PubMed  Google Scholar 

  44. Pantalon MV, Nich C, Franckforter T et al (2002) The URICA as a measure of motivation to change among treatment-seeking individuals with concurrent alcohol and cocaine problems. Psychol Addict Behav 16:299–307

    Article  PubMed  Google Scholar 

  45. Mander J, Wittorf A, Teufel M et al (2012) Patients with depression, somatoform disorders, and eating disorders on the stages of change: validation of a short version of the URICA. Psychotherapy. https://doi.org/10.1037/a0029563 (Epub ahead of print 22 October 2012)

    Article  PubMed  Google Scholar 

  46. Blanchard KA, Morgenstern J, Morgan TJ et al (2003) Motivational subtypes and continuous measures of readiness for change: concurrent and predictive validity. Psychol Addict Behav 17:56–65

    Article  PubMed  Google Scholar 

  47. DiClemente CC, Hughes SO (1990) Stages of change profiles in outpatient alcoholism treatment. J Subst Abuse 2:217–235

    Article  CAS  PubMed  Google Scholar 

  48. McConnaughy EA, Prochaska J, Velicer W (1983) Stages of change in psychotherapy: measurement and sample profiles. Psychotherapy 20:368–375

    Article  Google Scholar 

  49. Lecompte C, Savard R (2006) Les effets d’une intervention de counseling sur la réadaptation de travailleurs accidentés à risque de chronicité. Institut de recherche Robert-Sauvé en santé et en sécurité du travail

  50. Prochaska JO, Norcross JC (1994) Systems of psychotherapy: a transtheoretical analysis. Brooks, Pacific Grove

    Google Scholar 

  51. Prochaska JO, DiClemente CC, Norcross JC (1992) In search of how people change. Applications to addictive behaviors. Am Psychol 47(9):1102–1114. https://doi.org/10.1037//0003-066x.47.9.1102

    Article  CAS  PubMed  Google Scholar 

  52. Prochaska JO, Velicer WF, Rossi JS et al (1994) Stages of change and decisional balance for 12 problem behaviors. Health Psychol 13:39–46

    Article  CAS  PubMed  Google Scholar 

  53. Hasler G, Delsignore A, Milos G et al (2004) Application of Prochaska’s transtheoretical model of change to patients with eating disorders. J Psychosom Res 57:67–72

    Article  PubMed  Google Scholar 

  54. Treasure JL, Katzman M, Schmidt U, Troop N, Todd G, de Silva P (1999) Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy. Behav Res Ther 37(5):405–418. https://doi.org/10.1016/s0005-7967(98)00149-1

    Article  CAS  PubMed  Google Scholar 

  55. Turnbull S, Ward A, Treasure J et al (1996) The demand for eating disorder care. An epidemiological study using the general practice research database. Br J Psychiatry J Ment Sci 169:705–712

    Article  CAS  Google Scholar 

  56. Wade TD, Frayne A, Edwards S-A et al (2009) Motivational change in an inpatient anorexia nervosa population and implications for treatment. Aust N Z J Psychiatry 43:235–243

    Article  PubMed  Google Scholar 

  57. Dray J, Wade TD (2012) Is the transtheoretical model and motivational interviewing approach applicable to the treatment of eating disorders? A review. Clin Psychol Rev 32:558–565

    Article  PubMed  Google Scholar 

  58. Soler J, Trujols J, Pascual JC et al (2008) Stages of change in dialectical behaviour therapy for borderline personality disorder. Br J Clin Psychol 47:417–426

    Article  PubMed  Google Scholar 

  59. Konstantakopoulos G, Tchanturia K, Surguladze SA et al (2011) Insight in eating disorders: clinical and cognitive correlates. Psychol Med 41:1951–1961

    Article  CAS  PubMed  Google Scholar 

  60. Saccomani L, Savoini M, Cirrincione M et al (1998) Long-term outcome of children and adolescents with anorexia nervosa: study of comorbidity. J Psychosom Res 44:565–571

    Article  CAS  PubMed  Google Scholar 

  61. Gorwood P, Duriez P, Lengvenyte A et al (2019) Clinical insight in anorexia nervosa: associated and predictive factors. Psychiatry Res 281:112561

    Article  PubMed  Google Scholar 

  62. Konstantakopoulos G, Georgantopoulos G, Gonidakis F et al (2020) Development and validation of the schedule for the assessment of insight in eating disorders (SAI-ED). Psychiatry Res 292:113308

    Article  PubMed  Google Scholar 

  63. Clausen L, Lübeck M, Jones A (2013) Motivation to change in the eating disorders: a systematic review. Int J Eat Disord 46:755–763

    Article  PubMed  Google Scholar 

  64. Bachner-Melman R, Lev-Ari L, Zohar AH et al (2021) The Eating Disorders Recovery Questionnaire: psychometric properties and validity. Eat Weight Disord Stud Anorex Bulim Obes. https://doi.org/10.1007/s40519-021-01139-y (Epub ahead of print 13 February 2021)

    Article  Google Scholar 

  65. Bardone-Cone AM, Hunt RA, Watson HJ (2018) An overview of conceptualizations of eating disorder recovery, recent findings, and future directions. Curr Psychiatry Rep 20:79

    Article  PubMed  Google Scholar 

  66. Green J, Philipou A, Castle D et al (2017) An evaluation of the predictive validity of the URICA and ANSOCQ scales for weight gain in adults with AN in an outpatient eating disorders program: a prospective cohort study. J Eat Disord 5:50

    Article  PubMed  PubMed Central  Google Scholar 

  67. Heider K, Dempfle A, Altdorf S et al (2021) Motivation to change in the course of a pilot study of a step-down treatment approach of inpatient and anorexia nervosa-specific home treatment and its effects on treatment outcome. Front Psychiatry 12:693103

    Article  PubMed  PubMed Central  Google Scholar 

  68. Gregertsen EC, Mandy W, Kanakam N et al (2019) Pre-treatment patient characteristics as predictors of drop-out and treatment outcome in individual and family therapy for adolescents and adults with anorexia nervosa: a systematic review and meta-analysis. Psychiatry Res 271:484–501

    Article  PubMed  Google Scholar 

  69. Johnson W (2007) Genetic and environmental influences on behavior: capturing all the interplay. Psychol Rev 114:423–440

    Article  PubMed  Google Scholar 

  70. Klump KL, Wonderlich S, Lehoux P et al (2002) Does environment matter? A review of nonshared environment and eating disorders. Int J Eat Disord 31:118–135

    Article  PubMed  Google Scholar 

  71. Mazzeo SE, Bulik CM (2009) Environmental and genetic risk factors for eating disorders: what the clinician needs to know. Child Adolesc Psychiatr Clin N Am 18:67–82

    Article  PubMed  PubMed Central  Google Scholar 

  72. Treasure J, Ward A (1997) A practical guide to the use of motivational interviewing in anorexia nervosa. Eur Eat Disord Rev 5(2):102–114

    Article  Google Scholar 

  73. Duriez P, Lefèvre H, Lodovico L et al (2021) Increased cognitive flexibility mediates the improvement of eating disorders symptoms, depressive symptoms and level of daily life functioning in patients with anorexia nervosa treated in specialised centres. Eur Eat Disord Rev 29:600–610

    Article  PubMed  Google Scholar 

  74. Keski-Rahkonen A, Hoek HW, Susser ES et al (2007) Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 164:1259–1265

    Article  PubMed  Google Scholar 

  75. Giel KE, Martus P, Schag K et al (2021) Specialized post-inpatient psychotherapy for sustained recovery in anorexia nervosa via videoconference—study protocol of the randomized controlled SUSTAIN trial. J Eat Disord 9:61

    Article  PubMed  PubMed Central  Google Scholar 

  76. Mayoral M, Valencia F, Calvo A et al (2020) Development of an early intervention programme for adolescents with emotion dysregulation and their families: actions for the treatment of adolescent personality (ATraPA). Early Interv Psychiatry 14:619–624

    Article  PubMed  Google Scholar 

  77. McGowan NM, Syam N, McKenna D et al (2021) A service evaluation of short-term mentalisation based treatment for personality disorder. BJPsych Open 7:e140

    Article  PubMed  PubMed Central  Google Scholar 

  78. Fairburn CG, Rothwell ER (2015) Apps and eating disorders: a systematic clinical appraisal. Int J Eat Disord 48:1038–1046

    Article  PubMed  PubMed Central  Google Scholar 

  79. Yim SH, Spencer L, Gordon G et al (2021) Views on online self-help programmes from people with eating disorders and their carers in UK. Eur J Public Health 31:i88–i93

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank the “CMME Psychologists Group” (E. Bruel-Jungerman, A. Docteur, C. Drosdalski, E. Gauthier, F. Hollande, D. Justo, A. Laszcz, V. Leclerc, Z. Logak, I. Pouydesseau, A. Raust, L. Romo, E. Scanferla) and the department members who were actively involved in the design and implementation of the study intervention. They also wish to acknowledge Prof. Lucia Romo, for encouraging this manuscript, as well as Etienne Kimmel and Daphnée Poupon-Pourchot, CMME, GHU Paris psychiatry and neurosciences, who helped with management of data.

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Authors and Affiliations

  1. GHU Paris Psychiatry & Neurosciences, Clinic of Mental Illnesses & Brain Disorders (CMME), 100 rue de la Santé, 75014, Paris Cedex 14, France

    Elisabetta Scanferla & Philip Gorwood

  2. University of Paris, ED 450, Paris, France

    Elisabetta Scanferla & Bernard Pachoud

  3. Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, University of Paris, 75014, Paris, France

    Philip Gorwood

Authors
  1. Elisabetta Scanferla
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  2. Bernard Pachoud
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  3. Philip Gorwood
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Consortia

The CMME Psychologists Group

  • E Bruel-Jungerman
  • , A Docteur
  • , C Drosdalski
  • , E Gauthier
  • , F Hollande
  • , D Justo
  • , A Laszcz
  • , V Leclerc
  • , Z Logak
  • , I Pouydesseau
  • , A Raust
  • , L Romo
  •  & E Scanferl

Contributions

All authors were involved in the study design, had full access to all the data in the study, and provided clinical interpretation of the findings. Elisabetta Scanferla drafted the manuscript. All authors reviewed, edited and confirmed their acceptance of the final submitted version.

Corresponding author

Correspondence to Elisabetta Scanferla.

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Conflict of interest

The authors declare that they have no financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the Declaration of Helsinki and the French Public Health Code (Article L1121-1). It was registered in the national Health Data Hub (health-data-hub.fr) (D20-R048-J3 Psychotherapies).

Consent to participate

Each patient was informed of the objectives of the study and data anonymity prior to the signature of an informed consent form that systematically confirmed their participation.

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The members of the CMME Psychologists Group are listed in Acknowledgements.

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Scanferla, E., Pachoud, B., Gorwood, P. et al. Experiencing eight psychotherapy approaches devoted to eating disorders in a single-day workshop increases insight and motivation to engage in care: a pilot study. Eat Weight Disord 27, 2213–2222 (2022). https://doi.org/10.1007/s40519-022-01365-y

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