A Description and Evaluation of the Treatment and Support Programs Provided by Two Eating Disorder Services in Brisbane

Miss Rachel Signorini (2014). A Description and Evaluation of the Treatment and Support Programs Provided by Two Eating Disorder Services in Brisbane Professional Doctorate, School of Psychology, The University of Queensland.

       
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Author Miss Rachel Signorini
Thesis Title A Description and Evaluation of the Treatment and Support Programs Provided by Two Eating Disorder Services in Brisbane
School, Centre or Institute School of Psychology
Institution The University of Queensland
Publication date 2014-09-04
Thesis type Professional Doctorate
Supervisor Jeanie Sheffield
Total pages 243
Total black and white pages 243
Language eng
Subjects 170106 Health, Clinical and Counselling Psychology
Abstract/Summary Abstract Eating disorders, such as Anorexia Nervosa and Bulimia Nervosa, are associated with significant mortality and physical and psychological morbidity (Hay & Mond, 2005). It is estimated that 15% of Australian women experience an eating disorder requiring clinical intervention during their lifetime (Wade, Bergin, Tiggemann, Bulik, & Fairburn, 2006). Amongst young women, eating disorders are the second leading cause of mental disorder disability, and the third most common chronic illness (Mathews, Hall, Vos, Patton, & Degenhardt, 2011; Yeo & Hughes, 2011). Most individuals with eating disorders receive treatment within outpatient and community settings (Dalle Grave, Calugi, Conti, Doll, & Fairburn, 2013). In this context, it is critical that effective treatment and support approaches for eating disorders within outpatient and community settings be identified. Comprised of two studies, the current research aimed to describe and evaluate the treatment and support programs provided by two eating disorder services located in Brisbane, Queensland, Australia. Study 1 evaluated two key programs provided by the Eating Disorders Outreach Service (EDOS), an outpatient hospital service which offers Enhanced Cognitive Behavioural Therapy (CBT-E) to adult outpatients with a diagnosed eating disorder, as well as Family Skills Training (FST) to family members and carers who have a relative with an eating disorder. Study 2 examined the 18-week and 10-week feminist group work programs provided by the community-based service, Isis – The Eating Issues Centre (Isis). Both studies utilised a mixed-method design. Through the use of quantitative methodology, the outcomes of adult clients accessing these programs were investigated by examining change over time on relevant psychometric measures. Clients’ perceptions and experiences of the programs were also explored through semi-structured interviews conducted by the researcher, with qualitative data analysed using Interpretative Phenomenological Analysis (IPA).   Study 1 described and evaluated the CBT-E and FST programs provided by EDOS. The data of 114 past CBT-E clients (Mage = 26.06 years, SD = 8.35) were extracted from the archival EDOS data base, and 12 FST clients (Mage = 48.25 years, SD = 9.56) completed psychometric measures administered by the researcher. In addition, three past CBT-E clients and 13 past FST clients were interviewed. Findings from the quantitative analyses revealed that CBT-E resulted in statistically and clinically significant improvements in eating disorder features and general psychopathology amongst adult clients with all eating disorders, which were maintained at the 20-week follow-up. However, only 50% of clients who commenced CBT-E completed treatment. In relation to the FST program, a statistically significant reduction in overall caregiving burden was observed but there were no significant improvements on measures of carers’ distress, expressed emotion, or accommodation and enabling of eating disorder behaviours. Qualitative findings revealed that CBT-E and FST clients who were interviewed were highly satisfied with the programs, regarded the programs as helpful, and reported numerous beneficial outcomes. Taken together, the quantitative and qualitative findings indicate that the CBT-E and FST programs provided by EDOS are beneficial and acceptable interventions for adult outpatients with eating disorders and their family members and carers. Study 2 examined the 18- and 10-week feminist group work programs provided by Isis. The pre- and post-treatment data of 25 18-Week Group clients (Mage = 30.52, SD = 9.95) and 33 10-Week Group clients (Mage = 34.06, SD = 11.06) previously collected by the service were analysed. The majority of these clients were accessing concurrent individual counselling. As part of the qualitative investigation, five past 18-Week Group clients and six past 10-Week Group clients were interviewed. Findings from the quantitative analyses revealed that participants of both programs experienced statistically and clinically significant improvements on the drive for thinness scale of the Eating Disorder Inventory-3 (EDI-3; Garner, 2004), as well as statistically (although not clinically) significant improvements on the bulimia, body dissatisfaction, interpersonal alienation, and interoceptive deficits scales. Despite these improvements, clients of both programs continued to experience clinically significant eating concerns and associated psychopathology at post-treatment. Qualitative findings revealed that 18- and 10-Week Group participants who were interviewed were highly satisfied with the programs, identified numerous positive aspects of group work, and reported experiencing various beneficial outcomes. Collectively, the qualitative and quantitative findings indicate that the 18- and 10-Week Group programs provided by Isis are helpful interventions for women with eating issues when accessed alongside individual support. Given that the programs provided by EDOS and Isis had not before been formally or externally evaluated, the research findings have informed the services’ understanding of the outcomes and experiences of clients accessing the programs. Beyond this, the findings provide further evidence that CBT-E is an effective and feasible treatment for adults with all eating disorders within outpatient settings. Likewise, the results align with those of previous studies and indicate that family skills training is a beneficial and acceptable intervention for family members and carers of relatives with an eating disorder. The results also offer some preliminary support for the use of feminist group work for women with eating issues when accessed in conjunction with individual support. Lastly, the findings provide much needed insight into consumers’ perspectives of these treatment and support approaches.

 
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Created: Wed, 11 Feb 2015, 11:38:21 EST by Miss Rachel Signorini on behalf of Faculty of Health and Behavioural Sciences