Evidence‐based implementation practices applied to the intensive treatment of eating disorders: Summary of research and illustration of principles using a case example.

Abstract

Implementation of evidence-based practices (EBPs) in intensive treatment settings poses a major challenge in the field of psychology. This is particularly true for eating disorder (ED) treatment, where multidisciplinary care is provided to a severe and complex patient population; almost no data exist concerning best practices in these settings. We summarize the research on EBP implementation science organized by existing frameworks and illustrate how these practices may be applied using a case example. We describe the recent successful implementation of EBPs in a community-based intensive ED treatment network, which recently adapted and implemented transdiagnostic, empirically supported treatment for emotional disorders across its system of residential and day-hospital programs. The research summary, implementation frameworks, and case example may inform future efforts to implement evidence-based practice in intensive treatment settings.

Trajectories of interpersonal problems in residential eating disorder treatment: Exploring the influence of primary diagnosis

“…All program components followed a manualized transdiagnostic CBT approach (Thompson‐Brenner et al, 2021). Although treatment fidelity was not directly assessed in this specific study, adequate program‐level adherence and competence have been observed in multiple waves of fidelity assessment conducted over the same time period as participant data collection in this study (Abdulla et al, 2021; Oswald, 2020; Thompson‐Brenner et al, 2018).…”

“…Missingness varied by timepoint such that 11.9% were missing at discharge and 48.6% at 6‐month follow‐up; however, such missingness is commonplace for naturalistic treatment settings. Pattern mixture models in this context have consistently failed to indicate a systematic relationship between missingness and outcome (Scharff et al, 2021; Thompson‐Brenner et al, 2018). A missing data variable indicating the presence or absence of a missing 6‐month follow‐up score was included in a series of pattern mixture models to assess for any systematic relationship between missingness and IIP outcome in this sample.…”

“…Over the past decade, Renfrew has worked to de‐implement many longstanding treatment program components, while implementing a new transdiagnostic treatment program, largely informed by the Unified Protocol (UP; Barlow et al, 2017). The core of the manualized program includes a series of group and individual sessions, following an emotion‐focused, transdiagnostic CBT approach for EDs and comorbid conditions (Thompson‐Brenner et al, 2018, 2021).…”

Effectiveness of the massed delivery of unified protocol for emotional disorders within an intensive outpatient program for military service members and veterans.

“…First, Bentley et al (2017) implemented a highly modified 4-day UP for inpatients experiencing suicidal ideation (UP condition: n = 6) and reported that the approach was feasible and acceptable to patients. Second, Thompson-Brenner et al (2018) implemented an organization-wide UP approach within a large community-based health care system for patients with eating disorders, which included residential and partial hospitalization programs, and reported patients treated with UP ( n = 124) had lower levels of eating disorder symptom severity at 6-month follow-up when compared to patients from the same setting prior to UP implementation. Third, Kennedy et al (2023) implemented a version of UP for children and adolescents (modifications: age-appropriate exercises and additional caregiver content) in a 2-week partial hospitalization program and reported three case examples that illustrate feasibility.…”

“…Several studies have investigated the effectiveness of massed UP within the context of inpatient, residential, and partial hospitalization levels of care (Bentley et al, 2017; Kennedy et al, 2023; Thompson-Brenner et al, 2018), together demonstrating low dropout rates and an accelerated speed of symptom improvement. First, Bentley et al (2017) implemented a highly modified 4-day UP for inpatients experiencing suicidal ideation (UP condition: n = 6) and reported that the approach was feasible and acceptable to patients.…”