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

Jordan, Jennifer; McIntosh, Virginia V.W.; Carter, Frances A.; Joyce, Peter R.; Frampton, Christopher; Luty, Suzanne E.; McKenzie, Janice M.; Carter, Janet D.; Bulik, Cynthia M.

doi:10.1002/eat.22726

Cited by 17 publications

(15 citation statements)

References 24 publications

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“…Moreover, those who did not complete the end of intervention assessment showed a trend toward more frequent purging behaviors. These findings confirm the importance of considering patient-and early process-related variables when delivering technology-based interventions (Kelders et al, 2012) and are consistent with the literature indicating that low treatment credibility and poor early alliance with the therapist are associated with premature termination of treatment (Jordan et al, 2017). The poorer quality of the relationship with the mentor found in the group of non-completers is particularly important when considering the specific characteristics of RecoveryMANTRA.…”

Section: Discussionsupporting

confidence: 87%

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

et al. 2020

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The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02336841.

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Section: Discussionsupporting

confidence: 87%

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

et al. 2020

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“…In other words, patients who might not profit from early symptom change may instead be the ones who drop out of studies, leading to a potential bias in estimating the effect of early symptom change on TA. Supporting this hypothesis, our review found support for the predictive effect of TA on completion of treatment [45,46,57]. On the other hand, some studies failed to find a predictive effect of TA on completion [44,58,63,71].…”

Section: Integration With Previous Research and Suggestions For Further Researchsupporting

confidence: 61%

“…Five articles analyzing four samples looked into the influence of TA on treatment outcome of adult patients suffering from AN [44][45][46][47][48]. Three of those samples received outpatient treatment, and one study took place in an inpatient setting.…”

Section: Anorexia Nervosa: Adultsmentioning

confidence: 99%

“…Stiles-Shields and colleagues [73], finding a significant prediction, used the aforementioned HAQ. The other studies finding an effect [45][46][47] did not suffer from particular limitations other than the limited sample size, but with regards to outcome, they only looked into completion vs. non-completion. For adolescent AN patients, all studies found predictive effects of TA on outcome.…”

Section: Evaluation Of Studiesmentioning

confidence: 99%

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Alliance matters: but how much? A systematic review on therapeutic alliance and outcome in patients with anorexia nervosa and bulimia nervosa

2021

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Purpose Patients with eating disorders (ED) pose a high-risk group regarding relapse. The understanding of factors contributing to a better outcome is much-needed. Therapeutic alliance (TA) is one important, pantheoretical variable in the treatment process, which has shown to be connected with outcome. This review looks into a possible predictive effect of TA on outcome as well as related variables. Methods A systematic review with pre-determined inclusion criteria following the PRISMA guidelines was conducted for studies published since 2014. Three previous reviews including studies up until 2014 were analyzed for studies matching our inclusion criteria. A total of 26 studies were included. Results The results were heterogeneous between different patient groups. Regarding the predictive effect of TA, in adolescent samples, the TA of either the patients or their parents seems to impact outcome as well as completion. For adults, results are mixed, with a tendency to a greater impact of TA for anorexia nervosa (AN) patients, while some samples of adult bulimia nervosa (BN) patients did not find any relation between TA and outcome. Conclusion The effect of TA on clinical outcome depends on the patient group. TA has a greater impact on adolescents, irrespective of diagnosis, and on adults with AN. The examined studies have different limitations which include small sample sizes and questionable study design. The examination of motivation as a potential influencing factor is recommended. Level of evidence Level I, systematic review.

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“…Despite these strengths, study results should be interpreted in light of some limitations. Although the sample allowed investigation of NES in a novel way within a clinically diagnosed ED sample, the current sample had a different pro le of personality traits, including higher harm avoidance, than the general population, as has been found with other ED samples [39]. Personality is believed to be relatively stable during a person's lifetime [40], so it could be hypothesised that NES may be a consequence of particular personality traits.…”

Section: Strengths and Limitationsmentioning

confidence: 89%

Personality Traits and Night Eating Syndrome in Women With Bulimia Nervosa and Binge Eating Disorder

Melunsky

Solmi

Haime

et al. 2021

Preprint

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Purpose Evidence suggests that the harm avoidance personality type is more common among individuals with night eating syndrome (NES) than in the general population. Evidence of associations with other personality traits is limited. The current study investigated the association between a range of personality traits and NES.Methods Cross-sectional data were used from women with bulimia nervosa or binge eating disorder referred for treatment in an outpatient psychotherapy trial. Regression analyses were used to test associations between personality traits (measured with the Temperament and Character Inventory-Revised) and NES symptoms (measured with the Night Eating Questionnaire), adjusting for potential confounding variables.Results The sample included 111 women. Low cooperativeness scores were associated with greater NES symptoms in the multivariable model (mean difference: -.10, 95% confidence intervals: -.20 to -.01, p = 0.033). There was weak evidence of associations between both high harm avoidance and low self-directedness personality traits and greater NES symptoms.Conclusions The finding that low cooperativeness was associated with greater NES symptoms is novel. Further research is needed to validate its presence in those with and without comorbid eating disorders and to examine the relative change in NES, eating disorder symptoms and personality scores in treatments focusing on cooperativeness.Level of evidence Level I (randomised controlled trial, CTB/04/08/139)

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

Abstract: Routine assessment of treatment credibility and early process (comprehensively assessed from multiple perspectives) may help clinicians reduce PTT thereby enhancing treatment outcomes.

Cited by 17 publications

References 24 publications

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

Alliance matters: but how much? A systematic review on therapeutic alliance and outcome in patients with anorexia nervosa and bulimia nervosa

Personality Traits and Night Eating Syndrome in Women With Bulimia Nervosa and Binge Eating Disorder

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