- Title
- CBT-E in an adult outpatient service: how effective is it in a real world setting?
- Creator
- Ryan, Lara Jane
- Resource Type
- thesis
- Date
- 2015
- Description
- Masters Research - Master of Clinical Psychology (MClinPsych)
- Description
- Background: Eating disorders are one of the most complex psychiatric illnesses and also amongst the most difficult to treat. They account for the highest rates of mortality among all psychiatric diagnoses (Galsworthy-Francis & Allan, 2014). Despite the seriousness of this mental illness, there are still significant gaps in our knowledge on best clinical practice and factors affecting recovery. A literature review was performed using the Scopus and ScienceDirect databases in order to explore the progress in the treatment of eating disorders over time. A number of different treatment modalities have been employed in patients with an eating disorder with varying degrees of success. Most treatments utilised within an adult population have only achieved remission rates of up to forty percent. Moreover, dropout rates in this population remain high and recovery is complicated by non-treatment factors. Recently, a shift has been made from standard treatments to enhanced Cognitive Behavioural Therapy (CBT-E) that is transdiagnostic in its scope. In addition to targeting core eating disorder psychopathology, CBT-E is able to address more complex underlying factors of perfectionism, self-esteem, mood intolerance and interpersonal difficulties. CBT-E is beginning to gain momentum within the scientific community. The current project aimed to provide practice based evidence for the use of CBT-E in an outpatient treatment setting for adults. Method: Participants consisted of 24 clients who were referred to an outpatient psychotherapy centre’s treatment program for eating disorders, and who gave their consent to participate in the study. In order to measure treatment gains, participants completed several self-report measures. Eating disorder psychopathology was measured through the Eating Disorder Examination Questionnaire. General health and functioning was also explored using seven questionnaires selected from the literature to measure domains such as quality of life,depression, anxiety, sense of self, emotion regulation, work and social adjustment and mindfulness skills. These outcome measures were administered at baseline (n = 24), after six months of treatment (n = 16), after 12 months of treatment (n = 7), and again at one year post treatment follow up (n = 6) to follow participants’ clinical profiles across time. Results: Participants demonstrated significant declines in their eating disorder psychopathology by the end of six months of CBT-E. This was evidenced by improvements at both a global and subscale level in their scores on the Eating Disorder Examination Questionnaire (t=2.97, p<.01). Participants also showed improvements in work and social adjustment, as measured by scores on the Work and Social Adjustment Scale (t=2.32, p=.03). Moreover, the research was able to reveal non-treatment related factors that affected the likelihood of participants dropping out before treatment completion. Specifically, regression analyses revealed that participants were more likely to remain in the current study if they had more involvement with health services in the past, both for their eating disorder (t=2.61, p=.02) and other health issues (t=-2.59, p=.02). Furthermore, four participants provided data at the one year post treatment follow up, allowing their clinical profiles to be plotted and trends in recovery examined. Conclusion: Overall CBT-E was able to demonstrate significant treatment gains in eating disorder psychopathology and measures of general functioning. The results found in the current study provide evidence for CBT-E in improving the clinical profiles of patients fitting into each of the eating disorder diagnostic categories – anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified. Several measures were found to predict dropout rates from treatment, giving insight into the non-treatment factors that complicate recovery and advancing our knowledge on treatment implementation. While there were limitations, the study was able to demonstrate support for the new CBT-E modality in a naturalistic treatment setting with adult outpatients.
- Subject
- CBT-E; eating disorders; transdiagnostic; EDE-Q; outpatients; dropout rates
- Identifier
- http://hdl.handle.net/1959.13/1313033
- Identifier
- uon:22510
- Rights
- Copyright 2015 Lara Jane Ryan
- Language
- eng
- Full Text
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