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 were recruited from a publicly-funded outpatient ED service in the UK. The only exclusion criteria … Continue reading →
I often hesitate to make broad, sweeping claims about the nature, cause, and experience of eating disorders and disordered eating. However, if there is one thing I feel absolutely certain saying about these disorders, it is that they are incredibly complex and multifaceted with no “one-size fits all” solution. So, I was quite excited when I came across a recent article by Michael Strober and Craig Johnson (2012) that explores the complexity of eating disorders and their treatment. Both authors have significant clinical experience treating eating disorders.
This article uses cases studies, literature, and the authors’ collective clinical experience to respond to some of the key controversies surrounding anorexia and its treatment. Among the major controversies that have come to light of late, they focus on two:
- Genetic/biological causation (Biologically-based mental illness – BBMI)
- Family-based treatment (FBT) as the best form of treatment for adolescents
The authors’ exploration of these … Continue reading →
Navigating health service systems can seem daunting, to say the least. Making phone calls, getting doctor appointments and referrals, attending intake appointments, and preparing oneself for treatment can be both mentally and physically draining. When children and adolescents develop eating disorders, their parents become the main navigators in this scenario, making decisions and arrangements for their under-18-year-olds. But what happens when these adolescents reach the age of 18, and still require and/or desire treatment?
A recent Canadian qualitative study by Gina Dimitropoulos and colleagues (2013) explored the transition between pediatric and adult treatment for eating disorders to identify ways to facilitate smooth and effective transitions. To explore the tensions surrounding transitions, the authors conducted focus groups with service providers from both pediatric and adult treatment programs, as well as interviews with community practitioners.
This study used grounded theory (more in-depth discussion here), a qualitative approach that … Continue reading →