Perspectives of underweight people with eating disorders on receiving Imagery Rescripting trauma treatment: a qualitative study of their experiences

Abstract

Background The prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This qualitative study explores the experiences of trauma-focused Imagery Rescripting (ImRs) therapy of underweight inpatients being treated for an ED. Objective To test the feasibility and to improve ImRs by understanding the experiences and perspectives of people with an ED and PTSD who, when underweight, received ImRs as an adjunct to their inpatient ED treatment. Method To explore how underweight people with an ED experience and perceive ImRs, we used a qualitative study design involving semi-structured interviews with 12 participants. After analysis, the data were summarized and classified within a thematic framework that focused on experiences and improving the ImRs method. Results The thematic analysis resulted in the following 6 main themes; (1) Expectations of ImRs; (2) Ability to participate in ImRs; (3) Effect of ImRs; (4) Experience of ImRs technique; (5) Conditions under which ImRs is given; (6) In depth-analysis. The results show that despite the fear of disappointment the participants appreciate addressing the PTSD and ED symptoms simultaneously. Further, results showed that it had been possible for them to attend ImRs but that the effects of ImRs were not uniformly perceived. Also, participants indicated that a caring context is important and that ImRs should not be scheduled immediately before a meal. Finally, the treatment generated hope. Conclusions The findings of this study demonstrated the feasibility of the integration of ImRs trauma treatment for individuals who are being treated in an ED inpatient treatment setting, and are in contrast to standard practice where the focus of inpatient treatment has been ED-symptom improvement without comprehensively addressing past traumatic experiences during an underweight phase. Trial registration International Clinical Trials Registry Platform (ICTRP) (NTR6094). Date of registration 09/23/2016. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6094

Treatment of patients with anorexia nervosa and comorbid post-traumatic stress disorder; where do we stand? A systematic scoping review

“…During trauma treatment, adverse events did occur in three participants; all participants could continue both anorexia nervosa treatment as well as trauma-focused treatment despite the occurrence of adverse events. With regard to acceptability, participants reported that processing trauma interventions at the same time as receiving intensive eating disorder treatment was supportive and helped them with regaining weight ( 33 ). Next, they reported that being offered an integrated treatment gave them hope ( 33 ).…”

“…With regard to acceptability, participants reported that processing trauma interventions at the same time as receiving intensive eating disorder treatment was supportive and helped them with regaining weight ( 33 ). Next, they reported that being offered an integrated treatment gave them hope ( 33 ).…”

“…One might preliminarily hypothesize that the attention being given to PTSD symptomatology may help anorexia nervosa patients staying engaged in the offered eating disorder treatment, as is suggested elsewhere ( 18 ). This beneficial effect of offering trauma-focused treatment to patients with a history of unsuccessful, unsuitable treatments is described by the participants in the Ten Napel-Schutz study ( 33 ) as they reported that being offered a concurrent treatment gave them hope, an essential ingredient for motivation.…”