Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial

Abstract

BackgroundFamilies express a need for information to support people with severe anorexia nervosa.AimsTo examine the impact of the addition of a skills training intervention for caregivers (Experienced Caregivers Helping Others, ECHO) to standard care.MethodPatients over the age of 12 (mean age 26 years, duration 72 months illness) with a primary diagnosis of anorexia nervosa and their caregivers were recruited from 15 in-patient services in the UK. Families were randomised to ECHO (a book, DVDs and five coaching sessions per caregiver) or treatment as usual. Patient (n=178) and caregiver (n=268) outcomes were measured at discharge and 6 and 12 months after discharge.ResultsPatients with caregivers in the ECHO group had reduced eating disorder psychopathology (EDE-Q) and improved quality of life (WHO-Quol; both effects small) and reduced in-patient bed days (7–12 months post-discharge). Caregivers in the ECHO group had reduced burden (Eating Disorder Symptom Impact Scale, EDSIS), expressed emotion (Family Questionnaire, FQ) and time spent caregiving at 6 months but these effects were diminished at 12 months.ConclusionsSmall but sustained improvements in symptoms and bed use are seen in the intervention group. Moreover, caregivers were less burdened and spent less time providing care. Caregivers had most benefit at 6 months suggesting that booster sessions, perhaps jointly with the patients, may be needed to maintain the effect. Sharing skills and information with caregivers may be an effective way to improve outcomes. This randomised controlled trial (RCT) was registered with Current Controlled Trials ISRCTN06149665.Declaration of interestJ.T. is a co-author of the book used in the ECHO intervention and receives royalties.Copyright and usage© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

An examination of the clinical outcomes of adolescents and young adults with broad autism spectrum traits and autism spectrum disorder and anorexia nervosa: A multi centre study

“…Some baseline features have been described previously (Rhind et al, 2014) as well as details regarding the original trial (Hibbs et al, 2015). Some baseline features have been described previously (Rhind et al, 2014) as well as details regarding the original trial (Hibbs et al, 2015).…”

“…For example, the addition of the New Maudsley method of collaborative care, which equips families with skills training to improvetheir understanding and support for the individual, was found to improve peer functioning and prosocial behavior in AN patients(Hibbs et al, 2015). It is possible that this group need a form of psychosocial intervention which focuses more on social identity and functioning (McNamara & Parsons, 2016).…”

Treatment of eating disorders in child and adolescent psychiatry

“…The sample comprised 178 individuals treated previously as inpatients who were randomized to either the active arm with the caregiver programme in addition to TAU or to TAU only; of the participants, 11 were adolescents. Patients in the ECHO group showed significantly reduced bed use 7-12 months after discharge [36]. At the 2-year follow-up, there were small to moderate improvements in all patient and caregiver variables; however, they failed to reach significance [37 && ].…”

Applying evidence-based management to anorexia nervosa

“…Many patients remain dependent on their families or the state during their lifetime44 and the burden on families is high 45. Interventions targeting problematic interpersonal functioning improve carer well-being46 and increase their caregiving skills 17. Difficulties with family and friends develop over time47 48 and lead to isolation,47 loneliness48 and a poorer prognosis 36…”

“…Preliminary studies examining relapse following inpatient care suggest that CBT67 or skills training for family members may improve the outcome following discharge 68…”