Getting Well Is More Than Gaining Weight – Patients’ Experiences of a Treatment Program for Anorexia Nervosa Including Ear Acupuncture

Abstract

This study illuminates how 25 in-patients who were treated for anorexia nervosa in a highly specialized clinic for eating disturbances in Sweden experienced the treatment program. The program included structured eating, medication, restrictions in physical activity and supportive dialogues. Patients were also offered semi-standardized NADA ear acupuncture as a complement to relieve stress, anxiety and tension. In total, 46 interviews were analysed qualitatively using latent content analysis. The results showed how participants strived with their slow transition towards recovery. The novelty of integrating acupuncture in psychiatric treatment makes this study interesting. Acupuncture was experienced to relieve anxiety and somatic symptoms through the whole process. Further research is needed to evaluate the effect of acupuncture on the patient's subjective sense of well-being when used as an adjunct to usual care. Background Anorexia nervosa (AN) is a serious illness with significant comorbidity and high mortality. AN can be described as a destructive way of dealing with emotions, and anxiety is very common among persons with AN (Wildes, Ringham, & Marcus, 2010). Several other psychiatric symptoms such as depression and sleep problems, and physical symptoms like gastrointestinal issues (Fairburn & Harrison, 2003), cardiac arrhythmia and osteoporosis (NICE, 2017) co-occur in eating disorders. Recovery from AN is a long process (NICE, 2017). The evidence for psychological and pharmacological treatment in AN is weak and recommendations in national guidelines are conflicting (NICE, 2017; WFSBP, 2011). CBT is effective but expensive, in short supply and could not be offered to persons who do not want to cooperate. Medication should not be used as the sole treatment (NICE, 2017) and there is an increased risk for side effects of pharmacologic therapies in persons with AN due to the somatic comorbidities (NICE, 2017; Strober & Johnson, 2012). National guidelines recommend outpatient care as a first-line therapy setting (Hilbert, Hoek, & Schmidt, 2017). When outpatient care is not sufficient a higher level of care is needed. Sometimes even involuntary commitment and forced feeding is necessary in order to prevent starvation to death (Hilbert et al., 2017; NICE, 2017). Environmental stress, for example from being in a hospital setting and locked in, increases anxiety (Strober & Johnson, 2012). A recent systematic review (Murray, Quintana, Loeb, Griffiths, & Le Grange, 2019) including 35 RCTs evaluating a variety of treatments for AN, concluded that the interventions had a short-term effect on weight but not at follow-up, and that specialized treatments brought no advantage over comparator interventions in psychological symptoms. The findings in a meta-synthesis of 14 qualitative studies on experienced recovery from AN (Stockford, Stenfert Kroese, Beesley, & Leung, 2019) indicates that recovery is a complex psychological process. Identified themes were having a fragmented sense of self, making an active decision towards rec...

Patient and clinician perspectives on supported mealtimes as part of anorexia nervosa treatment: A systematic review and qualitative synthesis

“…This theme appears in 17 papers and includes patients' views on the organisational aspects of mealtime from a practical standpoint. Generally, mealtime support was regarded as a necessary intervention by patients (Matthews, Gordon, van Beusekom, Sheffield, & Patterson, 2019), however, excessive focus on food intake was seen as unhelpful for long‐term recovery as it prevented clinicians from addressing the underlying psychological aspects of AN (Colton & Pistrang, 2004; Escobar‐Koch et al., 2010; Mitrofan et al., 2019; Olsson & Landgren, 2020; Rance et al., 2017; Thabrew et al., 2019).…”

“…Patients also explored that the post-meal period was associated with heightened anxiety and ED cognitions, highlighting the need for effective post-meal support et al, 2012b;Olsson & Landgren, 2020;Smith et al, 2014;Thabrew et al, 2019 Attribution to ED Holmes et al, 2021;Long et al, 2012b;Smith et al, 2014;Ramjan et al, 2012 Sense of normality Kezelman et al, 2016;Long et al, 2012b;Monaghan & Doyle, 2022;Offord et al, 2006;Zugai et al, 2013 Restrictions and punishment Colton & Pistrang, 2004;Escobar-Koch et al, 2010;Holmes et al, 2021;Long et al, 2012b;Matthews et al, 2019;Offord et al, 2006;Olsson & Landgren, 2020;Ramjan et al, 2012;Smith et al, 2014;Thabrew et al, 2019;Zugai et al, 2013Flexibility Babb et al, 2021Escobar-Koch et al, 2010;Long et al, 2012b;Offord et al, 2006;Zugai et al, 2013 Clinician conduct Kezelman et al, 2016;Long et al, 2012b;Matthews et al, 2019;Mitrofan et al, 2019;Monaghan & Doyle, 2022;Offord et al, 2006;Olsson et al, 2020;Smith et al, 2014;Thabrew et al, 2019;van Ommen et al, 2009;Zugai et al, 2013 Consistency of care Long et al, 2012b;…”

“…Long et al, 2012b;Matthews et al, 2019;Monaghan & Doyle, 2022;Nilsen et al, 2021;Offord et al, 2006;Thabrew et al, 2019ED behaviours Long et al, 2012bMatthews et al, 2019;Monaghan & Doyle, 2022;Nilsen et al, 2021;Offord et al, 2006;Smith et al, 2014;Thabrew et al, 2019 Peer support Monaghan & Doyle, 2022;Offord et al, 2006;Olsson & Landgren, 2020;Smith et al, 2014;van Ommen et al, 2009. (Monaghan & Doyle, 2022).…”

Ear acupuncture as an adjunct in a treatment protocol for anorexia nervosa: utilization rate and nurses’ experience

“…19 Safe, non-pharmacological treatments are warranted to relieve symptoms during stressful inpatient stays. 17,18 Relaxation reduces anxiety, which is beneficial for recovery from AN, and activities that help patients to relax should be included in treatment programmes. 19 If acupuncture is proven to reduce anxiety and stress in this population it could be recommended as an adjunct.…”

“…7 These studies, using body acupuncture, indicated that patients with AN appreciated acupuncture and that comorbidities such as depression and anxiety were improved. 15,16 In qualitative studies, patients with AN perceived that body acupuncture 16 and ear acupuncture 17,18 reduced anxiety and gave them an opportunity to rest and reflect, which are essential elements of care during the long recovery period. 19 As in another study of patients’ experience of ear acupuncture in a psychiatric context, 20 positive experiences of calmness, wellbeing, increased energy, improved sleep and better concentration were reported, in line with quantitative results.…”