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Recent studies completed in association with North West Centre for Eating Disorders
Contact us if you would like a copy of any paper listed below
Guided self-help for binge eating disorder and bulimia: A practice-based studyA measure of control: an exploration of the meaning of self-induced vomiting to clients with eating disorders
The therapeutic relationship from an attachment theory perspective
The embodied self: the expression of psychological conflict through the body in clients with eating disorders
Counsellors' conceptualisation of humour in the counselling relationship
Managing severe anorexia: Can community-based intensive outpatient programming reduce hospital (re-) admissions and overall cost of care whilst maintaining patient safety? A Stockport pilot
Guided self-help for binge eating disorder and bulimia: A practice-based study
By Caroline Vermes, M.Ed, University of Manchester, September 2010
Abstract
Objective: To investigate the effectiveness and cost per participant in remission (CPPR) of a 12 week guided self-help (GSH) cognitive behavioural therapy course, with professionally-led group support for adults with bulimia (BN) and binge eating disorder (BED), in comparison to one-to one integrative psychotherapy (IP) of individualised duration.
Method:A controlled, non-randomised treatment trial study. Pre-treatment data were gathered on 66 participants who were assigned by their own choice to either treatment condition. End of treatment data were gathered for treatment completers. GSH offered treatment in less than 10 weeks whereas IP had standard waiting times of 10-20 weeks. The primary outcome variable was remission of binge eating per participant's self-report. Additional variables included psychological features associated with eating disorders. Measures included CORE, PHQ-9, GAD-7 and Sterling Eating Disorder Scales.
Results: 56.2% (n=18) of GSH completers achieved remission at end of the course. GSH CPPR was £1,151.90, which includes the cost for 5 participants who went on for further treatment. IP CPPR was £1,950.00 which included resources spent on those who dropped out (DO) or did not return after assessment (DNR). The GSH course produced statistically significant improvement on all psychological variables except low assertiveness and perceived external control. Those who did not achieve remission in 12 weeks had significantly higher baseline anxiety scores, and 76.9% had a concurrent mood disorder. The GSH group had 7.9% attrition, whereas 46.4% of the IP group were DO/DNR. The DO/DNR's were characterised by waiting longer than 10 weeks to be offered treatment; bulimia; lower body mass index; and less severe bulimic dietary behaviour by self-report.
Conclusion: Guided self-help for BN and BED can offer rapid-access, cost-effective treatment that achieves good patient satisfaction. Within a stepped care treatment model for eating disorders, pure and guided self-help can be situated as an elemental step for a substantial proportion of patients referred to secondary care. More research on cost-effectiveness and in particular, quality adjusted life years (QALY) for eating disorders treatments is required.
Back to topA measure of control: an exploration of the meaning of self-induced vomiting to clients with eating disorders.
by Deborah Withers, University of Wolverhampton, September 2008
Abstract
This study involved analysis of the transcripts of three participants who purge by vomiting in the context of an eating disorder. The aim was to explore the meaning of the lived experience of this form of purging. Interpretative Phenomenological Analysis was applied to the primary data from which the following four themes emerged: 1) Gaining and losing control; 2) Focussing on process and measurement; 3) Experiencing conflict and 4) Connectedness. Implications for eating disorder related therapy and training were discussed in light of the emerging themes. Suggestions for further research were made particularly in relation to the apparent need for more effective treatments.
Back to topThe therapeutic relationship from an attachment theory perspective
by Marina Christina Skourteli, University of Manchester, December 2007.
Abstract
This study examined the notion of the therapist as an attachment figure and the relationship between client adult attachment in close relationships and client attachment to the therapist. Participants (clients in ongoing therapy) were asked to complete measures of adult attachment in close relationships and client attachment to their therapists. In addition, participants were interviewed with regard to their perceptions of their therapist and their therapeutic relationship. Results indicated strong support for the notion that therapists serve as attachment figures for their clients. Further, there was some evidence suggesting that client adult attachment orientation may be activated or re-enacted within the therapeutic relationship and in particular with regard the ways clients relate to their therapist. The importance of the therapeutic relationship and implications for the practice of counselling psychology are discussed.
Back to topThe embodied self: the expression of psychological conflict through the body in clients with eating disorders
by Heather Sacco, University of Manchester, 2006.
Abstract
This study examined whether, and what kind, of mind-body connection was made by people with eating disorders. 'Mind/body connection' as used in this study meant the connections the participants made between their thoughts, feelings and bodies and the meaning or interpretations they made of their experiences. Four participants were interviewed and Interpretative Phenomenological Analysis (IPA) was used to analyse the data. The literature search spanned several domains: somatisation (Helman, 2002; Kirmayer & Young, 1998), eating disorders literature (Bruch, 1988; Orbach, 2006; Gilbert, 2002; Duker & Slade, 1994) psychology and the body (Stevens, 1997, 1999; MacSween, 1996; Kempen, 1998). Four mail findings were: 1) strong negative feelings and events before or around onset of the eating disorder; 2) a new, negative self-consciousness that developed after a shaming or shunning incident; 3) a circular pattern of mind affecting body and body affecting mind; 4) 'positive' aspects of the eating disorder - what it did for participants. Crucial elements of recovery were: developing a self-identity and keeping their bodies physically strong; and the ability to make meaning of their experiences. Most of the findings of this study corresponded with existing literature. A number of areas for further research were identified.
Back to topCounsellors' conceptualisation of humour in the counselling relationship
Jenny Ferguson, University of Manchester, 2009
Abstract
A review of the literature reveals discussion of the (largely anecdotal) uses and misuses of humour in the counselling relationship. Attempts to prove the effectiveness of humorous interventions in counselling relationships are lacking in methodological rigour. There is little research on counsellors' experience of the use of humour in their work. Consequently this study aimed to explore how counsellors encountered the experience and their reflections on the subject. Semi-structured interviews were conducted with eight qualified counsellors (five female, three male). Participants described their views on the development of their personal sense of humour, their experience of humour in practice and their concepts of the effects (if any) on the counselling relationship. The results were analysed using Interpretative Phenomenological Analysis. Five themes emerged from the analysis of the transcripts: 1) Humour as an active technique; 2)Experiencing the encounter of humour; 3) Evolving dynamics; 4) Therapist use of self; and 5) Perception of clients' use of humour. The findings are discussed with reference to existing literature, and extrapolated to include the notion of relational depth (Mearns & Cooper 2005). It is suggested that humorous interactions can play a role in facilitating and enriching the counsellor / client relationship, incorporating the values of 'acceptance' and 'congruence'. A precarious and subjective dimension emerges regarding the appropriateness of the use of humour in the counselling relationship, which argues for a broader understanding within the counselling community. Future research suggestions and implications for training and professional practice are also discussed.
Back to topManaging severe anorexia: Can community-based intensive outpatient programming reduce hospital (re-) admissions and overall cost of care whilst maintaining patient safety? A Stockport pilot
By James Bush, University of Manchester School of Medicine, July 2011.
Abstract
This study reviewed patient outcomes for standard Step 3 treatment at a community eating disorders service in Stockport using psychometric analysis before and after interventions which included one-to-one and group CBT and psychotherapy. Additionally, the financial impact of inpatient care for severe anorexia at a regional inpatient treatment centre in the North West of England was also evaluated. Finally, the results of an enhanced Step 3 intensive outpatient program (IOP) pilot including supported meals, carried out at the community eating disorder service were examined. Included in the IOP pilot were patients who had recently been discharged from inpatient care, plus those who were making insufficient progress in Step 3 treatment. BMI ranged between 13 – 19.
After standard Step 3 treatment at the community service, patients with anorexia, bulimia, binge eating disorder and EDNOS (n = 68) showed significant improvements in depression (82% improved, p<0.001), anxiety (62% improved, p<0.001) and psychosocial distress (80% improved, p=0.015). The financial impact of inpatient care was substantial, with the average cost per admission at £77, 159 based on average length of stay of 144.5 days (n=164). It was also found that around 32% of patients admitted to hospital in 2010 had had at least one previous inpatient admission. The IOP pilot had seven completions by the end of 2010. The average cost per engaged patient was £4,525 with average service use of 37 days. The details, implications and limitations of the IOP treatment results are discussed.