Not Horsing Around: Using Equine Therapy For Eating Disorders

It’s possible that some of you are already rolling your eyes: I know my audience. In the calls for evidence-based treatment, alternative therapies are often sidelined, deemed less important or less effective. While I certainly see that side of the argument, and would advocate for a continued search for treatment efficacy, I’m not ready to abandon the search for alternative approaches. Especially when used in concert with other treatments, I find alternative therapies very intriguing, partially for what they tell us about the complexity of treating eating disorders.

In a recent study, Lac, Marble & Boie (2013) explored the use of equine-assisted psychotherapy (EAP) for eating disorders. Keep in mind that as is the case with many alternative therapies, the article is based on a case study, rather than a large-scale clinical trial. To me, the point of these types of articles is to get … Continue reading →

Walking a Mile in Your Shoes: Treating Eating Disorders with a Personal History of Eating Problems

A big topic at ICED, and one that seems to continually resurface, is treatment professionals in recovery. One the one hand, many see healthcare professionals with a history of eating disorders as possessing a kind of empathy that may be inaccessible to those who have not “been there.” On the other, some argue that this history complicates the patient-professional relationship in potentially detrimental ways.

You’ll find proponents of both sides of this debate from both professional and patient communities, and there are compelling arguments to be made on both sides of the coin. As an eating disorder researcher with a history of eating disorders, I don’t think you will be surprised that I lean toward the “it’s totally fine” side of the debate.

One thing that stood out to me about the larger discussion on this topic at the conference, however, was how we need to be careful about not … Continue reading →

The Sobering Reality (and the Silver Lining) of Treating Anorexia Nervosa in Adults: A Randomised Controlled Trial

The challenges of treating anorexia nervosa are plenty; some of these challenges — like low prevalence rate and high treatment dropout rate —  make conducting randomised controlled trials aimed at identifying effective treatment methods really hard as well.

So I was pretty excited about the recently published randomised controlled trial comparing focal psychodynamic therapy (FPT), cognitive behaviour therapy (CBT), and optimised treatment as usual in adult (a harder to treat demographic than adolescents) anorexia nervosa patients.

Reading the paper, I was pretty impressed with how good the study design was; I’m not going to go into all the nitty-gritty details, but if you have access to and the chance to read the paper, do it. You’ll appreciate, I think, the amount of effort that went into this.

THE STUDY

Patients were recruited from ten universities across Germany. They had to be adult females with a BMI between 15-18 and with … Continue reading →

Cognitive-Behavioural Therapy for Bulimia Nervosa in the “Real World”: What's the Evidence?

Cognitive-behavioural therapy (CBT) is commonly described as the evidence-based treatment for bulimia nervosa. But do the findings from nearly perfectly crafted trials, with stringently followed protocols and “ideal” participants apply to the “real world”? How generalizable are the findings from carefully selected participants to clinical populations where, for one, the prevalence of psychiatric comorbidities is relatively high?

In other words, CBT has been shown to be efficacious (i.e., it works in a controlled experimental research trial setting) but is it effective (i.e., does it work in a clinical setting where clients might have multiple diagnoses and complex needs)?

This is precisely the question that Glenn Waller and colleagues sought to answer. They wanted to see whether CBT would work in a “routine clinical setting, where none of the exclusion-and protocol-based constraints […] apply.”

PARTICIPANTS

Participants were recruited from a publicly-funded outpatient ED service in the UK. The only exclusion criteria … Continue reading →

Comorbid PTSD and Eating Disorders: Can Treating One Improve The Other?

Women with bulimia nervosa are three times more likely to struggle with PTSD than women without eating disorders, according to a study by Dansky and colleagues (1997). In that study, 37% of individuals with bulimia nervosa had lifetime PTSD, compared to 12% of women without eating disorders. That’s almost two in five.

Treating eating disorders is hard, but treating eating disorders with comorbid conditions is way harder. There is no consensus, it seems, as to what disorder(s) to treat first, or whether they should be treated simultaneously:

Brewerton (2004) suggests that eating problems should be addressed prior to treating PTSD because bingeing and purging contribute to a state of physical and emotional dysregulation. Fairburn (2008), however, suggests that significant comorbid disorders be treated prior to beginning CBT for eating disorders.

The issue is quite complex,

For example, the presence of severe depression, of which hopelessness and difficulty

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Family-Based Treatment for Adolescents with Anorexia Nervosa: Hype or Hope?

When it comes to eating disorder treatment, few (if any) approaches are as divisive as Family-Based Treatment, also known as the Maudsley Method (I’ll use the terms interchangeably) . When I first heard about Maudsley, sometime during my mid-teens, I thought it was scaaary. But, as I’ve learned more about it, I began to realize it is not as scary as I originally thought.

As a side-note: I know many people reading this post know more about Maudsley than I ever will, so your feedback will be very much appreciated, especially if I get something wrong. I should also mention that I never did FBT or any kind-of family treatment/therapy as part of my ED recovery. (I have done family therapy, but it was unrelated to my ED; it was a component of a family member’s treatment for an unrelated mental health issue.)

In this post, I want to … Continue reading →

A Study Without a Control Group? Evidence for Enhanced Cognitive Behavioural Therapy for Adults with Anorexia Nervosa

Here’s a quick tip: when a study that purports to find evidence of treatment effectiveness–preliminary or not–doesn’t have a control group (a group that doesn’t undergo treatment but is otherwise similar to the group that does), you should raise your eyebrows. Or shake your head. Or roll your eyes. Whichever you prefer.

Why do we need a control group? If the treatment works, we will see improvement in the patients, so isn’t that evidence enough? Well, no.

[T]he whole idea of an experiment is to identify two identical groups of people and then to manipulate something. One group gets an experimental treatment, and one does not. If the group that gets the treatment (e.g., a drug, exposure to a violent video game) behaves differently than the control group that did not get the treatment, we can attribute the difference to the treatment – but only if we can rest

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Doing It Together: Uniting Couples in the Treatment of Eating Disorders

Eating disorders don’t discriminate against gender, age, sexual orientation or race. Veteran men in their 50’s can struggle with eating disorders, as can trans men and women of all ages and backgrounds, and so can congenitally blind (and deaf) individuals.

Besides the barriers that many of these patients face in simply getting diagnosed with an eating disorder, yes, even if they’ve passed that hurdle, many face an even bigger problem: getting appropriate treatment.

Naturally, no one treatment method will work for everyone, especially when the patient population is so diverse. What works for a 13-year-old female may not work for a man in his 40’s or 50’s.  Unfortunately, treatment options (at least those that have some empirical evidence) are limited. As I’ve recently blogged, new treatments are being developed and utilized in treating adults and/or patients with with long-standing eating disorders – sub-populations that have largely been … Continue reading →

How Can We Treat Chronic and Severe Anorexia Nervosa? (On the Need for New Approaches)

Treating anorexia nervosa is hard. Treating chronic and severe anorexia nervosa is a lot harder. Although the situation seems to be improving, there are really no evidence-based treatments for anorexia nervosa – particularly for those who have been sick for a long time.

Patients with severe and enduring anorexia nervosa have one of the most challenging disorders in mental health care  (Strober, 2010).They have the highest mortality rate of any mental illness with markedly reduced life expectancy (Harbottle et al., 2008). At 20 years the mortality rate is 20%, and given the young age of onset this results in many young adults dying in their 30s, and a further 5–10% every decade thereafter (Steinhausen, 2002)… Patients are often under- or unemployed, on sickness benefits, suffer multiple medical complications… have repeated admissions to general and specialist medical facilities, and are frequent users of primary care services (Birmingham and Treasure, 2010;

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The Research-Practice Gap in Eating Disorder Treatment

The approaches used in clinical practice to treat patients often lag behind the most up-to-date developments in research. It can take a long time to integrate scientific findings into clinical practice. This, of course, is not limited to eating disorders or even mental health issues. This so-called “science-practice gap” exists for many reasons, which vary depending on the medical discipline.

This issue, though, seems particularly bad when it comes to eating disorder treatment.

There’s the issue of conducting good studies – how do we determine what is efficacious? That’s a complicated task. What is “recovery” and how long is long-enough for follow-up? Is what we consider to be efficacious really efficacious or just slightly better than the rest?

Then there’s the training: mental health seems to be undervalued in medical school curricula for one, but even more importantly: “Clinicians tend to give more weight to their personal experiences than … Continue reading →