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Why Research Matters
Contributor: Randy Flanery PHD and Kim McCallum MD, CEDS, FAPA of McCallum Place
Despite decades of concerted effort to disseminate information about treatments found to be most effective in clinical trials, there are still barriers that make it difficult for clinicians and institutions to commit to evidence based treatments (EBTs).
Recent research (Kimber, 2014) suggests that an organizational culture that fosters innovation, the capacity to allocate resources to support the change effort and garnering “buy in” from both therapists and administrators are critical to the adoption of new procedures; these attitudes are even more important than the strength of the evidence for the effectiveness of treatment.
The Role of Genes and Temperament
Most psychotherapy research suggests that if a patient or family hasn’t responded in the first 6 to 8 weeks, response is unlikely. Therapists should reevaluate their treatment at regular intervals. Research has helped us understand that genes and temperament contribute significantly to the risk for developing an eating disorder. Families report that awareness of these factors has helped them understand their loved ones and reduced stigma, shame and self-blame that can interfere with recovery.
We would like to describe how a growing body of empirical evidence persuaded us to modify our clinical practice.
Increasing Awareness and Reducing Risk
When we began to treat individuals with eating disorders we wanted to have an impact, increase awareness and reduce the risk. We accepted many offers to speak to community groups and schools, emphasizing how eating disorders were serious mental illnesses with significant harmful medical complications. We wanted to facilitate early interventions.
Psycho Educational Programs
Efforts to raise awareness in students however seemed less effective. Although referrals for treatment did increase, suggesting that these talks might help providers of care refer to treatment, it was not clear that these efforts were in fact effective prevention measures.
In fact, research suggested that psycho educational programs were not effective in reducing the incidence of eating disorders, and in some cases might promote many of the attitudes that lead to developing an eating disorder.
Cognitive Dissonance Principles
Based on this evidence, we stopped giving these types of talks and focused on awareness of resources for parents and educators, even when pressured by administrators, school nurses and health teachers. Instead, we recommended incorporating cognitive dissonance principles that have been articulated in the Body Project (Stice & Presnell, Becker).
This type of intervention builds skills to enable the individual to resist cultural pressures to adopt the thin ideal and increase body acceptance. In this way a growing body of rigorous research helped us to fine tune efforts and abandon well intentioned practice that might not have been helpful.
Family Based Treatment
Family based treatment for teen age patients with Anorexia Nervosa is an empirically supported effective initial intervention for most patients. When we began treating eating disorders in the 1980s, most parents were relegated to a secondary role while the clinicians refed the child in the hospital.
In the Past, Parents were the Enemy
Parents would be advised to be less controlling, avoid being the food police, and to be less intrusive. Parents were sometimes made to feel that they had caused the eating disorder.
Putting the Parents in the Center
In the 1990s, the psychological care of children and adolescents shifted to empower parents, increased awareness of adolescent brain function and how brain circuitry was still developing began to shift how we involved parents in care. Lock and LaGrange, concerned that treatments that did not actively include parents, decided to test a model that puts parents in the center of treatment.
It took us several exposures to the model to be convinced that this strategy could work for low weight patients who traditionally needed hospital care to achieve weight restoration. Once convinced, it was easy to recommend FBT as the first choice treatment for most teenagers with anorexia.
Dealing with Gaps in Evidence
There are many significant gaps in evidence and not all clinical practice is supported by empirical data. Our patients and families understand this. On the other hand, they do expect us to provide evidence based treatments when available, describe our understanding of the biologic and environmental contributions of their illness and refer to a clinician with the skills to provide the best treatment.
We were lucky that our institution has supported our efforts to train therapists in evidence based practice and are committed to following outcomes with patients who complete treatments in PHP or Residential care. It is important that we remain mindful of the difference between traditional best practice and EBTs so that we are open to change and able to incorporate new and better treatments as they emerge with the goal of enhancing patient outcomes.
Community Discussion – Share your thoughts here!
What impact has research made on your recovery? What types of evidence have you researched in your recovery and why?
References:
- Kimber, M., Couturier, J., Jack, S., Niccols, A., Van Blyderveen, S., McVey, G. (2014). Decision-making processes for the uptake and implementation of Family-based Therapy by eating disorders teams: a qualitative study. Int J Eat Disord; 47:32-39.
- Lock, J. & Le Grange, D. (2012). Treatment Manual for Anorexia Nervosa, Second Edition. New York, Guilford Press.
- Stice & Presnell, (2007). The Body Project: Promoting Body Acceptance and Preventing Eating Disorders. New York, New York, Oxford University Press.
- Stice & Shaw, (2004). Eating disorder prevention programs: a meta-analytic review. Psych Bull; 130:206-227.
- The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on July 22nd, 2015
Published on EatingDisorderHope.com
