Treatment & Recovery

Yoga in the Treatment of Eating Disorders: A Randomized Controlled Trial

Tetyana 3 Comments

Exercise can be great for your body and for your mental health. It is well accepted that exercise can decrease anxiety, increase concentration, and generally improve mood. But too much exercise can be harmful, especially during recovery from a restrictive eating disorder. So is there a way to reap the benefits of exercise without the risks? And if yes, can this exercise actually help in the recovery process?

One form of exercise that has gained a lot of popularity is yoga. Initial studies on the use of yoga in treatment of anxiety and depression seem promising (though I haven’t checked them out in detail myself) (Mishra et al., 2001; Sahasi et al., 1989; Pilkington et al., 2005; Mitchell et al., 2007). So, can it be used as an adjunct with regular eating disorder treatment? Can it decrease eating disorder symptoms?

In this randomized controlled study (RCT – randomized controlled … Continue reading →

What Makes a Good Nurse? Perspectives of Anorexia Nervosa Patients

Tetyana

Nurses can play an important role in facilitating recovery from anorexia nervosa, particularly in an inpatient or residential treatment setting. But what makes a good nurse from the patient’s perspective? More specifically, what qualities do adolescents with anorexia nervosa consider important and helpful during recovery?

The answer may seem obvious: understanding, empathetic, supportive, non-judgemental, and the like. But those are sort of general characteristics that apply to good friends, family members, partners, doctors, other healthcare professionals, and even teachers.

Joyce von Ommen and colleagues wanted to dig a little deeper than that. They wanted to find out what components of nursing care helped patients restore normal eating and exercise patterns.

In order to find out, they collected interviews from 12 female adolescent patients (mean age of 15, range from 13-17), who were discharged from a specialized eating disorder treatment centre within three months of the interview. The patients were diagnosed … Continue reading →

A Study Without a Control Group? Evidence for Enhanced Cognitive Behavioural Therapy for Adults with Anorexia Nervosa

Tetyana 7 Comments

Here’s a quick tip: when a study that purports to find evidence of treatment effectiveness–preliminary or not–doesn’t have a control group (a group that doesn’t undergo treatment but is otherwise similar to the group that does), you should raise your eyebrows. Or shake your head. Or roll your eyes. Whichever you prefer.

Why do we need a control group? If the treatment works, we will see improvement in the patients, so isn’t that evidence enough? Well, no.

[T]he whole idea of an experiment is to identify two identical groups of people and then to manipulate something. One group gets an experimental treatment, and one does not. If the group that gets the treatment (e.g., a drug, exposure to a violent video game) behaves differently than the control group that did not get the treatment, we can attribute the difference to the treatment – but only if we can rest assured

… Continue reading →

Chronicity in Eating Disorders: How Do We Define It and What Do We Do About It?

Tetyana 5 Comments

It comes as no surprise that the earlier eating disordered individuals receive treatment, the higher the likelihood that they will make a full recovery. In other words, the duration of the illness is inversely proportional with the likelihood of full recovery.

The problem is that a lot of eating disorders are not caught early. That a lot of people don’t have access to the treatment they need. Insurance will not cover it, their doctors don’t think it is a problem or won’t treat it, or there is simply no space. And even if there is space, and insurance will  cover it, dropout rates are incredibly high and treatment success is meager. The end result? Sometimes it is a success story – a full or partial recovery. But other times, the stories make headlines across the world, and not for good reason.

So then, what can we do about … Continue reading →

Maintaining Change Following Intensive Eating Disorder Treatment

Gina 9 Comments

It is a relatively well known fact that eating disorders have a high relapse rate and many people, myself included, find themselves in multiple intensive – residential, inpatient, even partial hospitalization – treatments. One may ask if such intensive treatments really work or if long term intensive care is just a band-aid of sorts. I know I’ve had to ask myself, “why is this going to work this time when it hasn’t worked in the long run before.”

There is even debate in the field on whether residential treatment actually has evidence supporting its effectiveness (see Tetyana’s post here). I can speak from experience that the various intensive treatments I’ve personally done have saved my life and given me more perspective, skills training, and support than I could have had otherwise. However, despite having made significant changes, I’ve had more than my share of slips and relapses.

I … Continue reading →

Doing It Together: Uniting Couples in the Treatment of Eating Disorders

Tetyana

Eating disorders don’t discriminate against gender, age, sexual orientation or race. Veteran men in their 50’s can struggle with eating disorders, as can trans men and women of all ages and backgrounds, and so can congenitally blind (and deaf) individuals.

Besides the barriers that many of these patients face in simply getting diagnosed with an eating disorder, yes, even if they’ve passed that hurdle, many face an even bigger problem: getting appropriate treatment.

Naturally, no one treatment method will work for everyone, especially when the patient population is so diverse. What works for a 13-year-old female may not work for a man in his 40’s or 50’s.  Unfortunately, treatment options (at least those that have some empirical evidence) are limited. As I’ve recently blogged, new treatments are being developed and utilized in treating adults and/or patients with with long-standing eating disorders – sub-populations that have largely been … Continue reading →

Can Eating Disorders Be Contagious?

Tetyana 15 Comments

Treating a patient with an eating disorder can often feel like walking on eggshells; it is easy to say or do the wrong thing. I’ve covered this topic in my previous posts. In my first post, I wrote about negative attitudes that health care providers often have with regard to eating disorder patients and in my second post, I covered some ways in which caring clinicians that do work with ED patients may – usually inadvertently – negatively impact treatment, often by impairing the physician-patient/caregiver relationship.

But let’s forget about clinicians for a second, what if the treatment environment itself is damaging? Could treatment itself do more harm than good?

That’s the question that Walter Vandereycken explored in this commentary article. (This interesting paper was brought to my attention by a reader – you know who you are, so thanks!)

And just to be really clear Vandereycken doesn’t … Continue reading →

How Do Anorexia Nervosa Patients Define Recovery and Engage in Treatment? The Need for Individualized Treatment

Gina

One difficulty in measuring rates of recovery for patients with anorexia nervosa (AN) is coming up with a cohesive definition of “recovery” that most of us can agree on. Similarly, it is hard to identify whether a particular treatment course is working when the patient and the clinician have different goals in mind. A 2010 study by Alison Darcy and colleagues (article is freely available here) – in an attempt to understand the patients’ goals – aims to explore how patients define recovery and engage in treatment. This study differs from a lot of the literature on treatments and recovery in that all the data comes from individuals with a lifetime history of AN. The population sampled includes 20 women with a mean age of just slightly over 29 (range from 19-52). This is a small sample size, which can make it difficult to generalize responses, and the information gathered … Continue reading →

How Can We Treat Chronic and Severe Anorexia Nervosa? (On the Need for New Approaches)

Tetyana 27 Comments

Treating anorexia nervosa is hard. Treating chronic and severe anorexia nervosa is a lot harder. Although the situation seems to be improving, there are really no evidence-based treatments for anorexia nervosa – particularly for those who have been sick for a long time.

Patients with severe and enduring anorexia nervosa have one of the most challenging disorders in mental health care  (Strober, 2010).They have the highest mortality rate of any mental illness with markedly reduced life expectancy (Harbottle et al., 2008). At 20 years the mortality rate is 20%, and given the young age of onset this results in many young adults dying in their 30s, and a further 5–10% every decade thereafter (Steinhausen, 2002)… Patients are often under- or unemployed, on sickness benefits, suffer multiple medical complications… have repeated admissions to general and specialist medical facilities, and are frequent users of primary care services (Birmingham and Treasure, 2010;

… Continue reading →

When Clinicians Do More Harm Than Good – Part 2 (Risks Associated with Treatment)

Tetyana 6 Comments

My previous post on the effectiveness of residential treatment centers (RTCs) generated a lot of discussion. A point that was raised several times, on the blog, on Facebook and other forums was the fact that there are risks in choosing an RTC for treatment.

Laura Collins did a great job of articulating some of the risks in her comment:

Among the risks: delaying necessary changes at home, disempowering or alienating relationships at home that are necessary for longterm health, exposure to behaviors and habits that had not been an issue previously, exposure to unhealthy relationships with other clients, an artificial environment that can’t translate to life after RTC, and therapeutic methods or beliefs that are false or don’t apply.

There risks are not specific to RTCs. They hold true for inpatient treatment, partial hospitalization and to a lesser extent, outpatient treatment. I thought it would be nice to explore in … Continue reading →