Why families drop out of FBT – a call to parents

Calling all families who have either dropped out of Family-Based Treatment (FBT) or have completed FBT with limited success. Here is an opportunity for your voice to be heard, and to help others:

FBT, also known as the Maudsley Approach, is the empirical treatment of choice for early intervention of the development of anorexia nervosa in children and adolescents. It achieves success more than any other treatment, is known to have best chance of getting the child and family back on track quickly, and with best chance of full recovery.

But FBT does not work for every family. There is no blame in the development of an eating disorder, and likewise there is no blame when FBT does not work. However, if we can find out why it does not always work, there is every chance the treatment can be fine-tuned so that it does work for more families.
A young researcher is seeking help from parents in a bid to find the answers so that outcomes can be improved. Parents and carers, here is a wonderful opportunity to give value and voice to your experience. Taking part in research will help others.
Joanna Wiese is a doctoral student working on her PhD in Counseling Psychology at the University of Iowa, and is planning her dissertation. Joanna’s research and clinical focus is eating disorder treatment, and she is planning a qualitative research study to look at variables that contribute to why families may drop out of FBT prematurely, or have less-than-optimal results upon completion of treatment.
While FBT has a fantastic track-record as far as eating disorder treatment modalities go, and a generally low drop-out rate in clinical trials,10 to15 per cent of participants in clinical trials tend to have poor results (this percentage may differ in a naturalistic or community-based study).
Joanna seeks to interview parents and caregivers who have dropped out of FBT, or who have discontinued it due to less-than-optimal results, about their experiences and their perceived reasons on why FBT has not worked well for their families. Joanna explains why this research is important:

‘My hope is that this qualitative study will generate themes (via grounded theory) that can be further explored through quantitative survey-based studies, and that this information will eventually result in alterations to FBT protocols for different populations and improved treatment outcomes.’

Joanna needs 10 to15 families for her study, but would like to establish contact with at least 20 families. She will start gathering data in April and May 2012, but encourages families to get in touch now, to assist in planning. Where you live is inconsequential. Located in Iowa, Joanna will travel to interview parents face-to-face, or contact you via phone or Skype in cases where she is unable to travel for the interview. Participation will involve only one to two interviews of about 60 minutes, in case you are concerned about a time obligation.
This is a great opportunity to tap into the evidence of experience. Your voice really does count. To take part, email me on: june@junealexander.com
I will forward your details to Joanna. Alternatively, you may contact Joanna direct on:
Joanna Wiese, Doctoral Trainee
Counseling Psychology
University of Iowa
joanna-wiese@uiowa.edu
1-563-676-2500

SWAN puts ED on trial - call for participants

Free outpatient treatment for anorexia nervosa: the Strong Without Anorexia Nervosa (SWAN) study

I’m blowing my Aussie trumpet a little here.

Three promising state of the art treatments for anorexia nervosa are being compared in a world-first study led by researchers from The University of Western Australia (A/Prof. Susan Byrne), Flinders University (Prof. Tracey Wade), The University of Sydney (Prof. Stephen Touyz), and The University of Western Sydney (Prof. Phillipa Hay). International collaborators from Oxford University, Kings College London, and The University of Otago are also involved.

The SWAN study takes the form of a multi-centre randomised controlled trial of three psychological treatments for anorexia nervosa and atypical anorexia. The National Health and Medical Research Council of Australia is funding the research. Participants receive between 25 and 40 free, outpatient, individual sessions with a psychologist over a 10-month period. Treatment is being offered in Perth, Sydney and Adelaide.

Currently, there are no guidelines regarding the best treatment options for adults with anorexia nervosa. The three treatments being evaluated in this study have previously been found to produce promising results, and include Enhanced Cognitive Behaviour Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management for anorexia nervosa (SSCM).

Results from the SWAN trial are expected to provide much needed information about the relative efficacy of these alternate treatments for anorexia nervosa.

The four-year trial commenced in April 2010 and has generated more than 250 inquiries. More than 50 participants have been enrolled in treatment and referrals are being accepted until early 2013. The trial is suited to men and women aged 18 years and over with anorexia nervosa or atypical anorexia nervosa.

This a great opportunity to get involved in research that can help you and holds promise of helping many others.

Additional information regarding the trial can be found on the SWAN website, athttp://www.psychology.uwa.edu.au/research/swan-study . Inquiries also can be directed to Dr Karina Allen, Study Coordinator, at treatmenttrial-psy@uwa.edu.au .

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A weight brides can do without

September 12th, 2011

Weddings are big events. Brides like to be as near to ‘perfect’ as they can be for this (hopefully) once-in-a-life time event and there is an endless stream of ‘help’ on offer to make them so.

Even if a bride is relaxed about her appearance, everyone from the dressmakers, family members,  wedding planners, weight loss and diet companies, boot camps, body toners, personal trainers and (heaven forbid) maybe even the fiancé, may drop not-so-subtle hints that the bride is a little ‘too cuddly’ and needs to lose some weight or the wedding will be terrible. The suggestion that future children will be ashamed of the ‘fat mother’ in the wedding portrait on the dining room wall, is enough to send some women into a frenzy, counting calories. Frankly, such behavior is dangerous – it can trigger disordered eating for vulnerable women and, for those brides who already have an eating disorder, it can sabotage recovery efforts.

My own wedding day, outlined in A Girl Called Tim, describes what can happen. Back in 1971, little was known about eating disorders. I thought I was the only one with my terrible secret. Looking at the portrait of me, the 20-year-old bride, you would probably would not guess that I fainted from lack of nutrition on the morning of this, my wedding day, and that instead of being free to happily anticipate walking down the aisle, a major consideration on my mind was the number of calories I could eat at the wedding reception. I was suffering bulimia at the time and yes, ‘Ed’ walked down the aisle with me…

Fast forward to today … research findings from Flinders University, South Australia, contain compelling reasons on why brides should not lose weight for their Big Day. Such a focus detracts from the real meaning of the event, is a waste of time, money and, as stated above, is not beneficial for health.

Ivanka Prichard presented her enlightening paper on Wedding-related weight change: Are brides an ‘At risk’ sample for disordered eating? at the 2011 ANZAED conference in Sydney.

Her research, carried out with Marika Tiggemann, is published in the Journal of Health Psychology. It investigates the prevalence of appearance and weight-related concerns in 879 Australian brides-to-be recruited from five bridal websites. Close to 75 per cent of the sample intended to exercise more and follow a ‘healthy eating plan’, while over 35 per cent planned to cut fat or carbohydrates out of their diets. On average, participants wished to lose over 8kg (18lbs) by their wedding day, and one-third had been told to lose weight by someone else for the wedding.

On average participants did not achieve pre-wedding weight loss, and actually gained more than 2kg after the wedding.

Interestingly, the brides who responded to pressure to lose weight, regained even more weight after the big event.

The research findings demonstrate the priority placed on appearance concerns among brides-to-be and highlight the need to promote a healthier bridal body ideal. As Ivanka noted, clinicians should be mindful of the potential risks associated with wedding appearance management, especially for those women already concerned with their weight. Additionally, there is a need for interventions designed to promote positive bridal body image and to reduce the pressure on women to emulate the ideal of the thin and toned bride on their wedding day.

Let’s all work to keep ‘Ed’ out of our personal life, and out of our marriage, too.

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But I look ‘normal’

You are in your mid-twenties, thirties, forties or fifties – and from what you have been reading, you think ‘I identify with these symptoms. This is how I have been feeling for years. I haven’t been weak-minded, I have an eating disorder.’

So you do something you have not had the courage to do before: you call and make an appointment with your doctor, who has possibly been treating you for depression until now. This time, you tell the doctor that you believe the real problem is ‘ED’. It takes much bravery to share this.

The doctor looks at you in amazement and says: ‘But you can’t have an eating disorder. You are a normal weight.’

Your heart sinks and if you had a tail, it would be dragging between your legs when you leave the health clinic that day. Your mind is racing and screaming: ‘See, you don’t have an illness; you are simply weak, weak, weak for not coping.’ You vow never to share your most inner gut feelings again. You destine yourself to a life of silent suffering.

You are not alone. Most people in the community – could be your next door neighbour, or the man or woman who sits next to you in the office – do not seek help for an eating disorder. If they do seek help, and that first encounter is rebuffed, it is extremely difficult to find the courage to seek help a second time.

The fact is that most people with an eating disorder do look ‘perfectly normal’. We don’t go around with neon signs flashing, saying ‘there’s an ED in there’. Eating disorders, like people, come in many shapes and sizes.

Tracey Wade, Flinders University, told the 2011 ANZAED conference that weight and shape concerns are one of the most potent and consistent risk factors for the development of disordered eating. Prof. Wade was reporting on a Longitudinal Investigation of Predictors of Weight and Shape Concern in 699 Adolescent Female Twins.

Gender, weight and shape concerns are likewise a major focus for people who developed Bulimia and to a less extent, Anorexia.

In the past year, how often have you:

* worried about having fat on your body?

* felt fat?

* thought about wanting to be thin?

* worried about gaining 1kg (2 lbs)?

If you think of all the things that influence the way you feel about yourself as a person, where does weight and shape sit on that list? (Other items on the list might include friends, sport, work, family …).

Your answers will help you see if it is time to seek help and free yourself to soar to new heights of life enjoyment and fulfilment.

You may look ‘normal’ but be suffering inside.  No matter what our age, recovery and improvement in life quality is possible. Reach out today and don’t stop reaching out until you find someone who will listen and help you. We are fortunate to have researchers like Prof. Wade pulling for us, seeking to understand why we feel the way we do, and to translate these findings into prevention programs for the next generation.

PS: If your doctor is not up to par on eating disorder awareness, suggest a small and informative booklet published by the Academy of Eating Disorders. It is called ‘Eating Disorders: Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders’.

 

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