The short term effectiveness of day treatment for eating disorders in reducing psychosocial impairment: utilizing the clinical impairment assessment in routine practice

Abstract

Purpose-The purpose of this paper is to investigate the effectiveness of a day treatment programme (DTP) in reducing psychosocial impairment, changing attitudes, restoring bodyweight and decreasing binge/vomit symptoms among 52 individuals (aged 16+) with eating disorders. It was hypothesized that day treatment would result in improvements across all variables measured. Design/methodology/approach-In a within-participants design, demographic, physiological and psychological measures were taken on admission to and at discharge from a DTP in the UK. Quantitative outcomes were analysed. Findings-In total, 40 participants were considered to have received an adequate dose of the DTP, having completed at least four weeks on the programme. Analyses supported all hypotheses, with all improvements being statistically significant. Large effect sizes were evident for all outcomes across the whole sample other than shape concern attitudes and weight concern attitudes, which reduced with moderate and moderate-tolarge effect sizes, respectively. Originality/value-This study provides new evidence of the effectiveness of day treatment in reducing psychosocial impairment resulting from eating disorder psychopathology. It remains for future research to determine whether these outcomes can be sustained over the longer term.

Intensive treatment program (ITP): A case series service evaluation of the effectiveness of day patient treatment for adolescents with a restrictive eating disorder

“…This increases opportunities for young people to practice new skills in their home environment and everyday life, as opposed to the more restricted environment of an inpatient or residential model of care. The vast majority of published literature on day treatments concerns adult populations (Abbate‐Daga et al, ; Zipfel et al, ) or mixed adult and adolescent populations (Dancyger et al, ; Green et al, ; Hepburn & Clark‐Stone, ) however, in recent years literature concerning adolescents is increasing (Bryson, Scipioni, Essayli, Mahoney, & Orstein, ; Goldstein et al, ; Herpertz‐Dahlmann et al, ; Hoste, ; Johnston, O'Gara, Koman, Baker, & Anderson, ; Ornstein, Essayli, Nicely, & Masciulli, ; Ornstein, Lane‐Loney, & Hollenbeak, ). For a review see Friedman et al ().…”

“…Similarly, there is variability in length of treatment, as well as the expected short and long term outcomes. Despite these variations, common findings indicate that day programs enhance treatment and improve physical and psychological outcomes for young people who are not progressing in outpatient treatment (Girz, Lafrance Robinson, Foroughe, Jasper, & Boachie, 2013;Goldstein et al, 2011;Green et al, 2015;Grewal, Jasper, Steinegger, Yu, & Boachie, 2013;Henderson et al, 2014;Hepburn & Clark-Stone, 2016;Hoste, 2015;Ornstein et al, 2012;Ornstein et al, 2017), are no less effective in this respect than inpatient care (Herpertz-Dahlmann et al, 2014) and have treatment gains maintained at follow up (Bryson et al, 2018). This paper reports on a chart review of young people referred to the Intensive Treatment Program (ITP) at the Maudsley Hospital in London in the first four and a half years of its operation.…”

Effectiveness of day treatment for eating disorders: are improvements maintained at 12-month follow-up?

“…This study aimed to build upon and extend findings from an earlier study (Hepburn and Clark-Stone, 2016) which was conducted at the same DTP during an overlapping timeframe. The former study found that among participants who were deemed to have completed the DTP, psychosocial impairment reduced, eating disorder attitudes improved, underweight participants increased their body mass index (BMI) and participants with binge/vomit symptoms reduced these behaviours between admission to and discharge from the DTP.…”

“…Evidence indicates that DTPs are effective at treating adults with anorexia nervosa and bulimia nervosa through reducing eating disorder psychopathology and disordered behaviours, restoring patients’ weight, and reducing anxiety and depression (Abbate-Daga et al , 2015; Beintner et al , 2019; Ben-Porath et al , 2010; Brown et al , 2018; Crino and Djokvucic, 2010; Fittig et al , 2008; Freudenberg et al , 2016; Garte et al , 2015; Hepburn and Clark-Stone, 2016; Jones et al , 2007; Kong, 2005; Olmsted et al , 2003, 2013; Reisch et al , 2001; Schaffner and Buchanan, 2008; Wade et al , 2019; Willinge et al , 2010; Zipfel et al , 2002). Although symptom frequencies often remain within the clinical parameters specified by the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) at the end of day treatment (Hepburn and Wilson, 2014), evidence suggests that treatment gains can be maintained or further improved at 3 months (Wade et al , 2019 ; Willinge et al , 2010), 6 months (Reisch et al , 2001), 12 months (Abbate-Daga et al , 2015), 18 months (Fittig et al , 2008), 24 months (Brown et al , 2018) and 26 months (Beintner et al , 2019).…”

Perceived Occupational Performance in Youth with Eating Disorders: Treatment-Related Changes

“…Day treatment programs can therefore potentially improve social and occupational domains, in addition to eating disorder and psychiatric symptomatology. For example, individuals ages 16 and above who attended a specialized eating disorder day treatment program reported significant improvements in psychosocial functioning, including work performance (Hepburn & Clark-Stone, 2016). Assessment of occupational performance, in addition to eating disorder symptomatology, is thus warranted as part of treatment outcome measurements.…”