Eating disorders: sibling experience and implementing externalisation in FBT

1. The Experience of Healthy Siblings of People with Eating Disorders: A Systematic Review and Thematic Synthesis Background: Within the area of eating disorders (EDs), research on carers has predominantly focused on the experience of parents and partners of those diagnosed with EDs. This led to siblings being referred to as the “forgotten” kin. Sibling relationships play an important and often long-standing role in peoples’ lives. Having a sibling with an ED can impact on healthy siblings in many ways including negatively affecting their quality of life, their sibling bond, and their physical, mental and emotional health. Aim: A meta-synthesis of qualitative studies was conducted to explore the experiences of healthy siblings of people who have EDs. Method: Seven databases (MEDLINE, PsychINFO, psycARTICLES, Psychology & Behavioural Sciences Collections, CINAHL, Social Sciences Full Text (H.W Wilson) and SocINDEX with Full Text) were searched for qualitative studies reporting on the experience of healthy siblings who have a brother or sister with a diagnosed ED. Thematic synthesis was used to analyse the studies included in this review. Results: 10 studies were included. Five core themes and twelve subthemes were identified. Themes related to the impact of the ED on both interpersonal and intrapersonal aspects of the healthy siblings’ lives. This included disruption to the sibling relationship and family life, experiencing difficult emotions, changes in the healthy sibling’s relationship with their own body, and coping skills. Conclusions: These findings are discussed in relation to the existing literature within the area and the implications for clinical practice. 2. Mental Health Clinicians’ Perspectives on Implementing Externalisation in Family-Based Treatment Objective: Family-Based Treatment (FBT) is a first line intervention for the treatment of adolescent eating disorders (EDs). FBT consists of a number of phases and interventions, including the use of externalisation, a therapeutic technique which aims to separate the person from the problem through the use of language and metaphor. There is a paucity of scientific research on this technique and consequently, little is known about how clinicians understand, conceptualise and support families to externalise the ED in the context of FBT. This research aimed to gain a deeper understanding of how clinicians employ this technique in the context of FBT. Method: Using thematic analysis, eight semi-structured interviews were conducted with FBT trained clinicians working in child and adolescent mental health services. Results: Three major themes emerged which related to how clinicians use externalisation, the impact it has on family functioning, and the barriers which make externalisation difficult to implement with families. Conclusion: Externalisation is a therapeutic technique which can support a family and young person’s (YP’s) recovery from an ED when used in conjunction with other therapeutic skills. Clinicians should be aware of potential barriers to the implementation of externalisation such as the YP’s problem awareness, age, and duration of ED symptomatology

Measuring reliable change in cognition using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS)

doi:https://doi.org/10.1080/21678421.2017.1407794Background: Cognitive impairment affects approximately 50% of people with amyotrophic lateral sclerosis (ALS). Research has indicated that impairment may worsen with disease progression. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was designed to measure neuropsychological functioning in ALS, with its alternate forms (ECAS-A, B, and C) allowing for serial assessment over time. Objective: The aim of the present study was to establish reliable change scores for the alternate forms of the ECAS, and to explore practice effects and test-retest reliability of the ECAS?s alternate forms. Method: Eighty healthy participants were recruited, with 57 completing two and 51 completing three assessments. Participants were administered alternate versions of the ECAS serially (A-B-C) at four-month intervals. Intra-class correlation analysis was employed to explore test-retest reliability, while analysis of variance was used to examine the presence of practice effects. Reliable change indices (RCI) and regression-based methods were utilized to establish change scores for the ECAS alternate forms. Results: Test-retest reliability was excellent for ALS Specific, ALS Non-Specific, and ECAS Total scores of the combined ECAS A, B, and C (all?>?.90). No significant practice effects were observed over the three testing sessions. RCI and regression-based methods produced similar change scores. Conclusion: The alternate forms of the ECAS possess excellent test-retest reliability in a healthy control sample, with no significant practice effects. The use of conservative RCI scores is recommended. Therefore, a change of ?8, ?4, and ?9 for ALS Specific, ALS Non-Specific, and ECAS Total score is required for reliable chang

Externalisation in family-based treatment of anorexia nervosa: The therapist's experience

Family-based treatment (FBT) is an evidence-based treatment for adolescent eating disorders that incorporates many principles from family therapy. It uses the externalisation of anorexic thoughts and behaviours to separate the person from the anorexia nervosa (AN) through language and metaphor. Little is known about how clinicians understand, conceptualise and support families to externalise. Semi-structured interviews conducted with FBT-trained clinicians working in child and adolescent mental health services were analysed using thematic analysis. Three themes emerged: the clinicianâ s use of externalisation, the impact on family functioning and the barriers to externalisation. Externalisation can support a young personâ s recovery from AN when used in conjunction with other therapeutic skills. Clinicians should be aware of potential barriers to the implementation of externalisation, such as problem awareness, age and duration of illness. Practitioner points Clinicians value externalisation as an important therapeutic technique within the FBT model, while acknowledging that the â ED as illnessâ metaphor can challenge their own beliefs. Externalisation can improve family functioning, family communication and reducing conflict within relationships in families with AN. Lack of insight into the AN can present as a barrier to externalisation for a young person

ALS Difficulty and Discrimination Performance.

<p>ALS Difficulty and Discrimination Performance.</p

Itemised Reliability Statistics.

<p>Itemised Reliability Statistics.</p