Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa—Caregivers’ and Adolescents’ Perspective

Abstract

High expressed emotion (EE) is common in caregivers of patients with anorexia nervosa (AN) and associated with poorer outcome for patients. In this study, we examined the prevalence of high EE in caregivers of adolescents with AN and analyzed predictors for EE using multivariate linear regression models. We further analyzed whether EE is reduced by the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) intervention using general linear mixed models and whether a reduction of EE predicts patients’ outcomes. Caregivers were randomly allocated to the SUCCEAT workshop (N = 50) or online intervention (N = 50) and compared to a comparison group (N = 49). EE and patients’ outcomes were assessed at the baseline, post-intervention, and at the 12-month follow-up. Up to 47% of caregivers showed high EE. Lower caregiver skills, higher AN symptom impact, higher levels of depression and motivation to change in caregivers were significant predictors for high EE. EE significantly decreased in the SUCCEAT groups and the comparison group according to the caregivers’, but not the patients’ perspective. The level of reduction could partially predict subjective improvement and improvement in clinically assessed AN symptoms and body mass index of patients. Implementing interventions for caregivers addressing EE in the treatment of adolescents with AN is strongly recommended.

The Maudsley model of anorexia nervosa treatment for adolescents and young adults (MANTRa): a study protocol for a multi-center cohort study

“…Additionally, parents will be included regularly in the medical treatment provided by the case manager and will be invited to participate in the parental skills training “SUCCEAT” (see section ‘2.4.5. Relevant concomitant care permitted during trial’) [ 37 – 39 ].…”

A German version of the Caregiver Skills scale for caregivers of patients with anorexia nervosa

“…In further consequence, this may contribute to the maintenance of the adolescent's AN and increases caregivers' own psychopathology (Haigh & Treasure, 2003; Rhind et al., 2016; Treasure et al., 2008; Treasure & Nazar, 2016). Previous research has highlighted the benefits of skills‐based trainings for caregivers of patients with EDs and found a reduction of caregiver distress, burden and expressed emotion (Hibbs, Rhind, Leppanen, & Treasure, 2015b; Philipp, Truttmann, et al., 2020; Truttmann et al., 2020), as well as improvements of ED symptomatology in patients (Hibbs et al., 2015a; Philipp, Franta, et al., 2020).…”

Advances in Eating Disorders

“…To address this important health issue, the current Special Issue collected 21 articles examining the most recent and relevant scientific findings regarding advances in ED. The published articles comprised three reviews and 18 research articles focusing on different aspects, such as genetic [ 7 ] and epigenetic factors [ 8 ], biomarkers [ 9 ], comorbidity [ 10 , 11 , 12 , 13 , 14 ], clinical phenotypes [ 15 , 16 ], neurocognition [ 12 , 17 , 18 , 19 , 20 , 21 ], treatment predictors [ 22 ], and treatment models and therapeutic targets [ 19 , 23 , 24 , 25 , 26 , 27 ]. Altogether, these studies may provide increased knowledge about the pathogenesis, the risk factors, the maintenance factors, and the most appropriate treatments tools for ED.…”

“…This collection also includes a set of studies that analyze the role of implicit–explicit emotion in patients with ED and their families, supporting the important role of the emotion recognition [ 13 , 14 ], the expressed emotion [ 27 ] or the emotion regulation strategies [ 12 , 17 ] in the development and maintenance of these disorders.…”

“…Regarding the use of new technologies as an adjuvant therapeutic tool, the findings from Porras-García et al [ 24 ] provide evidence about the usefulness of virtual reality-based body exposure to elicit fear of gaining weight and other body-related disturbances in patients with AN. On the other hand, Philipp et al [ 27 ] demonstrated that parental expressed emotion (associated with higher distress and a lack of skills) was reduced after interventions for caregivers (namely the SUCCEAT program), and that this reduction positively influenced patients’ outcomes. Likewise, the results from the study of Truttmann et al [ 26 ] provide support for the efficacy of the same interventions for caregivers (i.e., SUCCEAT) reducing parental burden, distress and psychopathology.…”