The three-legged stool of evidence-based practice in eating disorder treatment: research, clinical, and patient perspectives

Abstract

BackgroundEvidence-based practice in eating disorders incorporates three essential components: research evidence, clinical expertise, and patient values, preferences, and characteristics. Conceptualized as a ‘three-legged stool’ by Sackett et al. in 1996 (BMJ), all of these components of evidence-based practice are considered essential for providing optimal care in the treatment of eating disorders. However, the extent to which these individual aspects of evidence-based practice are valued among clinicians and researchers is variable, with each of these stool ‘legs’ being neglected at times. As a result, empirical support and patient preferences for treatment are not consistently considered in the selection and implementation of eating disorder treatment. In addition, clinicians may not have access to training to provide treatments supported by research and preferred by patients. Despite these challenges, integrating these three components of evidence-based practice is critical for the effective treatment of eating disorders.DiscussionCurrent research supports the use of several types of psychotherapies, including cognitive-behavioral, interpersonal, and family-based therapies, as well as certain types of medications for the treatment of eating disorders. However, limitations in current research, including sample heterogeneity, inconsistent efficacy, a paucity of data, the need for tailored approaches, and the use of staging models highlight the need for clinical expertise. Although preliminary data also support the importance of patient preferences, values, and perspectives for optimizing treatment, enhancing treatment outcome, and minimizing attrition among patients with eating disorders, the extent to which patient preference is consistently predictive of outcome is less clear and requires further investigation.SummaryAll three components of evidence-based practice are integral for the optimal treatment of eating disorders. Integrating clinical expertise and patient perspective may also facilitate the dissemination of empirically-supported and emerging treatments as well as prevention programs. Further research is imperative to identify ways in which this three-legged approach to eating disorder treatment could be most effectively implemented.

Predictors of premature termination from psychotherapy for anorexia nervosa: Low treatment credibility, early therapy alliance, and self‐transcendence

“…Our finding of low patient alliance predicting PTT is consistent with Sly, Morgan, Mountford, & Lacey (2013) but not Brown, Mountford, & Waller, (2013). It aligns with previous research regarding the predictive power of patient alliance (see Horvath, Re, Fluckiger, & Symonds, 2011) and mounting evidence suggesting that regular monitoring of client progress and response to session content improves outcomes (see Dyer, Hooke, & Page, 2014;Peterson, Becker, Treasure, Shafran, & Bryant-Waugh, 2016). Several VPPS therapist subscales also predicted PTT, highlighting therapist contribution to the alliance/ process and countering previous reports that only patient perspectives were informative (see Del Re, Fl€ uckiger, Horvath, Symonds, & Wampold, 2012).…”

“…Low treatment credibility also predicted late dropout from web‐based CBT for eating disorders (ter Huurne, Postel, de Haan, van der Palen, & DeJong, ). The importance of considering patient preferences in AN therapies has been highlighted, notwithstanding that non‐negotiable elements of evidenced‐based treatments (e.g., weight‐gain focus) may not be preferred (Peterson, Becker, Treasure, Shafran, & Bryant‐Waugh, ).…”

Adolescent and Parent Experience of Care at a Family-Based Treatment Service for Eating Disorders

“…The importance of consumer perspectives for effective evidence-based practice (1,2) has received increasing recognition in relation to optimizing treatment of eating disorders (3). For adolescents with anorexia nervosa (AN), current evidence supports family-based treatment [FBT (4)] preferably within a specialist multidisciplinary service (5)(6)(7).…”

Patients' experiences of brief cognitive behavioral therapy for eating disorders: A qualitative investigation

“…To address the acceptability and uptake of therapies, one should consider the potential contribution of patients' perspectives on existing and newly developed therapies and use such feedback to inform further treatment development (e.g., Crawford, Weaver, Rutter, Sensky, & Tyrer, 2002;Newton, 2001;Peterson, Black Becker, Treasure, Shafran, & Bryant-Waugh, 2016). Such research might include identifying what patients find obscure or challenging in therapies, as well as understanding what they see as positives.…”