Associations between therapy experiences and perceived helpfulness of treatment for people with eating disorders

Abstract

Background Although eating disorders cause significant impairment to an individual’s function, many people disengage from treatment. There is a paucity of literature that focuses on both positive and negative aspects of eating disorder treatment experiences as perceived by the experiencing person. This study aimed to identify the associations between features of therapy with perceived treatment helpfulness across individuals’ most and least helpful treatment experiences. Methods An online cross-sectional survey was developed and disseminated, with the data of participants (n = 235) being utilised for statistical analyses, including multiple linear regressions. Results As predicted, factors in the therapeutic relationship such as the therapist’s ability to instil a sense of hope, provide freedom of choice, understand the person, and address participant concerns had significant explanatory value in perceived treatment helpfulness. Contrary to our hypothesis, change being retrospectively identified as important or possible by the participant did not have a high degree of relation. These outcomes highlighted the significance of the therapeutic relationship in governing positive treatment experiences and responses. The results also suggested motivation to change when commencing treatment may not be strongly related to perceived treatment helpfulness and support further exploration.

One Sheet Does Not Fit All: The Dietetic Treatment Experiences of Individuals with High Eating Disorder Symptomatology Attending a Metabolic and Bariatric Clinic; an Exploratory Mixed-Methods Study

“…Participants valued feeling understood by the dietitian and desired treatment that took into consideration their treatment preferences (including their readiness to change) and that was tailored to their circumstances (e.g., lifestyle and co-morbidities). In this way, the findings of this study are consistent with the existing literature and reinforce the significance of a strong therapeutic alliance in predicting positive treatment responses and experiences [20,[33][34][35][36]. Integral to this was the use of a collaborative approach to treatment that centred around the participants' autonomy.…”

“…These questions used a sliding scale (0 to 100, Range: 100) where 0 was associated with negative perceptions and 100 was associated with positive perceptions. The criterion validity and internal consistency of the original measures in the EDTES have been demonstrated by Mital et al [20]. In the present sample, internal consistency was high for the adapted most helpful (Cronbach's alpha = 0.954, n = 14, 12 items) and least helpful (Cronbach's alpha = 0.940, n = 14, 12 items) dietitian treatment items.…”

“…The online survey used was based on the Eating Disorders Treatment Experience Survey (EDTES) and was adapted for the current population [20]. Eating disorder symptomatology was assessed using the Eating Disorder Examination Questionnaire-Short (EDE-QS).…”

“…Responses for each dietitian (i.e., most helpful dietitian and least helpful dietitian) were entered as two separate values. As was conducted in the Mital et al paper [20], ratings relating to participants' treatment preferences and choices being taken into consideration were also averaged to produce an additional variable. Due to the small sample size of participants who had seen more than one dietitian (n = 14), adjustments for multiple testing were not made, and differences between groups were tested with the conservative Wilcoxon signed ranks test, with p set at ≤0.05.…”

Therapist ratings of technique and alliance among adults with eating disorders: Support for integrative treatment.

“…AN inpatient patients are less likely to prematurely terminate treatment when alliance is stronger (Sly et al, 2013), and a stronger alliance at discharge was significantly correlated with improved body mass index and quality of life in another inpatient AN sample (Marzola et al, 2019). Apart from formal outcome measures, patients perceive treatment to have been more helpful when factors such as therapists providing freedom of choice and understanding their patients, related to alliance formation, were a part of treatment (Mital et al, 2022). Thus, a strong therapeutic alliance is critical to achieving successful treatment outcomes with adult ED patients.…”