A new treatment for eating disorders combining physical exercise and dietary therapy (the PED-t): experiences from patients who dropped out

Abstract

Purpose: Eating disorders (ED) are complex and severe illnesses where evidence-based treatment is needed to recover. However, about half of the patients with ED do not respond to treatments currently available, which call for efforts to expand the portfolio of treatments. The aim of this study was to explore experiences from patients who dropped out of a new treatment for bulimia nervosa and binge ED, combining physical exercise and dietary therapy (PED-t). Methods: We conducted open-ended face-to-face interviews. The interviews were transcribed verbatim and the data were analysed with a phenomenological hermeneutical approach. Results: Three themes emerged: "standing on the outside", "unmet expectations" and "participation not a waste of time". Feelings of standing on the outside were elicited by being different from other group members and having challenges with sharing thoughts. Unmet expectations were related to treatment content and intensity, as well as the development of unhealthy thoughts and behaviours. Finally, some positive experiences were voiced. Conclusion: A need to clarify pre-treatment expectations and refining criteria for treatment suitability is indicated. The findings have contributed to the chain of clinical evidence regarding the PED-t and may lead to treatment modifications improving the treatment and thereby reducing drop out.

Patient perspectives on premature termination of eating disorder treatment: a systematic review and qualitative synthesis

“…An intense fear of weight gain led some patients to terminate treatment prematurely [ 35 ]: “ Just the feeling of [ being ] forced to gain weight. It was kind of just scary for me ” [ 36 ].…”

“…[…] often found myself in a listening position. I had a lot to say but I was never able to share my thoughts ” [ 35 ]. Some patients left treatments where they felt therapists lacked receptiveness to their individual needs: “ I don’t think he was sensitive enough to see what I really needed.…”

“…Patients commonly expected a greater degree of personalised and clinician-led guidance than was received, and were left disappointed and desiring more detailed strategies [ 31 , 33 , 35 ]. Several dropped out due to dissatisfaction with their therapeutic programme [ 36 ], the quality of the service [ 37 ], or because they felt treatment was not offering new insights [ 31 ].…”

“…Insufficient clinician contact was also cited as problematic for patients [ 31 ]: “ Too many days where I had to do everything by myself. […] I needed a more intensive treatment ” [ 35 ]. Patients called for a greater utilisation of individual therapy [ 39 ] as group therapy was deemed unsuitable due to the wide-ranging group demographics, coupled with varying degrees of illness severity, and concern that others’ inexperience in therapy negatively impacted its value [ 35 ].…”

“…[…] I needed a more intensive treatment ” [ 35 ]. Patients called for a greater utilisation of individual therapy [ 39 ] as group therapy was deemed unsuitable due to the wide-ranging group demographics, coupled with varying degrees of illness severity, and concern that others’ inexperience in therapy negatively impacted its value [ 35 ]. “ They were just so different from me in terms of eating and exercising.…”