A Pilot, Multicentre Pragmatic Randomised Trial to Explore the Impact of Carer Skills Training on Carer and Patient Behaviours: Testing the Cognitive Interpersonal Model in Adolescent Anorexia Nervosa

Hodsoll, John; Rhind, Charlotte; Micali, Nadia; Hibbs, Rebecca; Goddard, Elizabeth; Nazar, Bruno Palazzo; Schmidt, Ulrike; Gowers, Simon; Macdonald, Pamela; Todd, Gillian; Landau, Sabine; Treasure, Janet

doi:10.1002/erv.2540

Cited by 53 publications

(62 citation statements)

References 43 publications

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“…In regard to the effect of the interventions on patients, it is worth noting that ED symptoms and behaviours, psychological distress, and psychosocial impairment related to the domestic area significantly reduced after both interventions. Results were similar to those reported by Hodsoll et al () and Whitney et al (), where patients' improvement was maintained in a follow‐up period of 1 to 3 years. However, this is contrary to our study where improvement was only shown immediately following the intervention and was not maintained at the 3‐month follow‐up assessment.…”

Section: Discussionsupporting

confidence: 90%

A controlled study of the Collaborative Care Skills Workshops versus Psycho‐educational Workshops among Spanish caregivers of relatives with an eating disorder

Sepúlveda

Anastasiadou

Parks

et al. 2018

Euro Eating Disorders Rev

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The aim of this study was to test the hypothesis that a negative reaction to the illness would be reduced through the “Collaborative Care Skills Workshops” programme among Spanish caregivers of relatives with an eating disorder. Caregivers were randomly allocated to either the skill‐based workshops (n = 32) or psycho‐educational workshops (n = 31), and assessments were carried out over time (T0 vs. T1 vs. T2). There were no significant differences between interventions on primary or secondary caregiver outcomes or among the patients themselves. However, caregivers in both interventions showed greater improvement at T2 on accommodating and enabling behaviours and an improvement at T1 in terms of psychological distress and appraisals towards the caregiving experience. Eating pathology, psychological distress, and some indices of psychosocial adjustment were significantly lower among the patients following both interventions (T1). Overall, both interventions may be able to help caregivers and patients to decrease their psychological distress. Highlights Involvement of family members in the treatment could be the best resource for aiding in their relative's recovery. This is the first controlled study to test the effectiveness of the Collaborative Care Skills Workshops in Spanish caregivers. Both interventions could be implemented as both help Spanish caregivers and patients.

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Section: Discussionsupporting

confidence: 90%

A controlled study of the Collaborative Care Skills Workshops versus Psycho‐educational Workshops among Spanish caregivers of relatives with an eating disorder

Sepúlveda

Anastasiadou

Parks

et al. 2018

Euro Eating Disorders Rev

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“…In this latest iteration of the cognitive interpersonal model, we have described treatments targeting modifiable elements. Increasing social connection through encouraging a collaborative inclusive approach towards recovery, by increasing the knowledge and skills of family members, decreases the need for high-intensity care (day or inpatient) and reduces carer burden and patient isolation [49][50][51]136]. Treatment using MANTRA focuses on both inter and intrapersonal model elements [55,56].…”

Section: Resultsmentioning

confidence: 99%

“…An improved understanding about the illness reduces carer distress and burden [35,45,47,48]. Several studies have found that augmenting treatment with these resources for carers reduces both carer and service burden [49][50][51]. Often this has involved a 'train the trainer' approach whereby carers and patients deliver these interventions.…”

Section: Targeting Stressful Interpersonal Reactionsmentioning

confidence: 99%

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Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Treasure

Willmott

Ambwani

et al. 2020

JCM

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149

122

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The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.

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“…This targets some of interpersonal maintaining factors that arise as a consequence of the illness and aims to increase social connection (Treasure & Nazar, 2016). Augmenting both inpatient and adolescent outpatient treatment with ECHO for carers, not only reduces carer burden and distress but also reduces re-admission rates and symptoms in patients (Hibbs, Magill, et al, 2015;Hodsoll et al, 2017;Magill et al, 2016).…”

mentioning

confidence: 99%

Evaluation of a novel transition support intervention in an adult eating disorders service: ECHOMANTRA

Adamson

Cardi

Kan

et al. 2019

International Review of Psychiatry

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Background: Admissions and re-admissions for inpatient care for anorexia nervosa have been increasing. The aim of this study was to examine whether the transition from inpatient care to the community could be facilitated by supplementing usual treatment with ECHOMANTRA (transition interventions) for both patients and carers. Method: A case series study using a mixed-methods approach to measure the feasibility and efficacy of augmenting intensive hospital treatment with ECHOMANTRA. A consecutive series of consenting patients (n=31) and carers (n=21) were assessed on admission, discharge and at three months followup. These outcomes were compared with audit data (n=152) previously collected (2007-2017). Results: Length of stay for the ECHOMANTRA intervention group was 4.5 weeks less than the comparison group and weight gain was 0.11kg per week higher. Improvements in patient symptomology were sustained at follow-up. Thematic analysis of the feedback from both patients and carers suggests that the intervention is valued. Carer burden was reduced and their skills improved (both moderate size changes). Conclusion: Both the acceptability and efficiency of inpatient care for anorexia nervosa may be improved by augmenting treatment to prepare for transition from inpatient care by giving support to both patients and their carers.

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A Pilot, Multicentre Pragmatic Randomised Trial to Explore the Impact of Carer Skills Training on Carer and Patient Behaviours: Testing the Cognitive Interpersonal Model in Adolescent Anorexia Nervosa

Cited by 53 publications

References 43 publications

A controlled study of the Collaborative Care Skills Workshops versus Psycho‐educational Workshops among Spanish caregivers of relatives with an eating disorder

A controlled study of the Collaborative Care Skills Workshops versus Psycho‐educational Workshops among Spanish caregivers of relatives with an eating disorder

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Evaluation of a novel transition support intervention in an adult eating disorders service: ECHOMANTRA

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