The perceived influence of emotions on clinical decisions and practices in child and adolescent eating disorders

Recently, two theoretical models (the Iatrogenic Maintenance Model for Eating Disorders and the Therapist Drift Model) have identified clinician emotion as a factor that may negatively influence the treatment of eating disorders (ED). However, the role of clinician emotion in the delivery of treatment remains largely unstudied. The present article-based thesis sought to examine clinicians’ perceptions of the negative influence of emotions (clinicians’ own emotions and those of others) on clinical decisions and practices with respect to child and adolescent eating disorders. Two studies were conducted to examine clinicians’ perceptions of whether, and in what ways, emotions play a role in clinical decisions and practices. Overall, clinicians endorsed some degree of negative influence of emotions on clinical decisions. Specific treatment decisions were identified as being perceived to be more vulnerable to the negative influence of emotions (e.g., decisions related to the involvement of a critical or dismissive parent in treatment), and particular client/parent emotional states (anger, flat affect, hopelessness or helplessness) were identified as being perceived to be more likely to lead to a negative influence of emotions on clinical decisions. Clinicians also endorsed specific concerns that they perceive to drive emotion-based decisions, as well as several emotion-driven practices. Finally, clinician characteristics related to the perceived occurrence of this phenomenon were examined. Emotional drain and work setting were factors predictive of the perception of negative emotional influence on decisions and practices. The results are discussed in terms of the implications for clinical practice and future directions.Master of Arts (MA) in Applied Psycholog

Are we really delivering evidence-based treatments for eating disorders? How eating disordered patients describe their experience of cognitive behavioral therapy

Psychotherapists report routinely not practising evidence-based treatments. However, there is little research examining the content of therapy from the patient perspective. This study examined the self-reported treatment experiences of individuals who had been told that they had received cognitive-behavior therapy (CBT) for their eating disorder. One hundred and fifty-seven such sufferers (mean age = 25.69 years) were recruited from self-help organisations. Participants completed an online survey assessing demographics, clinical characteristics, and therapy components. The use of evidence-based CBT techniques varied widely, with core elements for the eating disorders (e.g., weighing and food monitoring) used at well below the optimum level, while a number of unevidenced techniques were reported as being used commonly. Cluster analysis showed that participants received different patterns of intervention under the therapist label of ‘CBT’, with evidence-based CBT being the least common. Therapist age and patient diagnosis were related to the pattern of intervention delivered. It appears that clinicians are not subscribing to a transdiagnostic approach to the treatment of eating disorders. Patient recollections in this study support the conclusion that evidence-based practice is not routinely undertaken with this client group, even when the therapy offered is described as such

Treatment Protocols for Eating Disorders: Clinicians’ Attitudes, Concerns, Adherence and Difficulties Delivering Evidence-Based Psychological Interventions

There are several protocols in existence that guide clinicians in the implementation of effective, evidence-based psychological interventions for eating disorders. These have been made accessible in the form of treatment manuals. However, relatively few clinicians use those protocols, preferring to offer more eclectic or integrative approaches. Following a summary of the research that shows that these evidence-based approaches can be used successfully in routine clinical settings, this review considers why there is such poor uptake of these therapies in such settings. This review focuses on the role of service culture and on clinicians’ own attitudes, beliefs and emotions. Possible means of enhancing uptake are considered, but these cannot be considered to be ideal solutions at present