Information dissemination of evidence-based psychological treatment
Eating disorders can affect anyone from any socioeconomic background, race, ethnicity, or gender. There are three proven treatments for patients who have reached a level of medical and psychiatric stability that they can receive outpatient care.
Family-based treatments
The Maudsley treatment is often used to refer to family-based treatment of anorexia nervosa in adolescents.
1) The illness is not caused by the family.
2) Adolescents must accept the involvement of their parents and family in therapy. Parents are responsible for managing weight gain in malnourished children.
3) A successful treatment requires the support of all family members.
4) The illness is considered to have disrupted normal adolescent growth.
Treatment typically lasts between 6 and 12 months. It usually consists of 10-20 sessions. The first step to recovery is nutrition. Therapy begins by coaching parents on how to feed their child.
Therapy that focuses on modifying behavior and thoughts
Cognitive behavioral therapy is used to treat bulimia-nervosa or binge-eating disorder. Cognitive-behavioral theories of EDs state that ED maintenance is characterized by the control and over-evaluation of weight and shape. Most of the clinical features are thought to be directly related to this psychopathology.
CBT can be completed in 20 sessions, spread over 5 months. Some of the key strategies include control over eating using behavioral techniques. This includes self-monitoring as well as establishing a regular eating pattern. Modules can also be included in the enhanced version for CBT-E to address one or several external processes that may contribute to the ED.
Research has shown that guided self-help using CBT is effective in treating bulimia, nervosa, and binge-eating disorder. This guidance is designed to assist the patient in their own treatment.
Guided self-help has a lower contact rate than standard treatments. It is cost-effective and acceptable for patients. It can also be done by nurses or other non-specialists who have no clinical training. In the United Kingdom, the National Institute for Health and Care Excellence has recommended guided self-help cBT as the first-line treatment for people with bulimia nervosa and related disorders.
Psychotherapy with a friend
Interpersonal psychotherapy can be used to treat bulimia, nervosa, and binge-eating disorder. This treatment assumes that ED symptoms are developed and maintained in an interpersonal setting. Interpersonal problems, such as low self-esteem or negative affect, can contribute to ED behavior.7 This could further exacerbate social problems and make it more difficult to cope. Interpersonal psychotherapy is a way to break the cycle. It helps patients improve their communication skills and solve interpersonal problems.
In general, interpersonal psychotherapy consists of 15 to 20 sessions spread over four to five months. The onset or maintenance of ED is usually associated with at least one of four areas. This is where the treatment shifts to achieving these goals. During this time, the therapist assists the patient to recognize the connection between improved ED symptoms and improvements in interpersonal functioning.
Research-practice Gap
These evidence-based psychological treatment for EDs is recommended by many international, well-researched clinical guidelines. Despite these recommendations, care for individuals suffering from EDs is often not evidence-based. The research-practice gap, also known as the gap between what is known and what is actually offered to patients receiving care is what is commonly referred to as the research gap. Approximately 6% to 35% ED specialists say they follow evidence-based protocols. There are many clinicians who report using a combination of evidence-based and unproven techniques to treat EDs.8
Information dissemination of evidence-based treatment
Thomas Insel MD, the former director of National Institute of Mental Health, said that while there are powerful and evidence-based interventions for psychosocial problems, they are not widely accessible. . . There is a significant deficit in the training of psychosocial interventionists who are evidence-based. These models can be used for increasing the availability of evidence-based treatments to EDs.
Train-the-trainer. Current training methods for therapists to provide new treatments include a workshop lasting one or two days. Experts present the workshops and attendees receive a therapy guide. Workshops can increase the knowledge of therapists, but they may not have a lasting effect without additional consultation. There is another option: the “train-thetrainer” approach. This involves a person (the trainer) who comes from a specific setting (eg, community counseling center, college counseling centre) and is trained to then train others. The trainer also provides support to those who are implementing the treatment. The trainer is a champion and coach for the treatment.
This method is recommended as the best way to change therapist behavior.11 The trainer can also train new therapists at a lower cost. This method has been shown to be effective in guided self help CBT.12 The method is being tested for its effectiveness in college counseling for interpersonal psychotherapy for EDs.
Web-centered training. Web-centered training is also an option. It is flexible and inexpensive.
There are several key benefits to it:
1) Training can be provided to trainees who are geographically dispersed using very limited person-based resources.
2) You can access the website anytime, anywhere. This allows you to be flexible and accommodate your busy schedule.
It allows trainees the ability to review material multiple times, reinforcing their learning.
4) You can customize the process to suit your needs with feedback and quizzes.
5) You can update the website regularly to incorporate new information.
6) Website usage data can be used to gather valuable information that will help refine your program features.
It has been possible to develop a comprehensive platform for CBT for EDs training; the findings suggest that this platform may increase competence scores.14-15 Also, a comprehensive online training program for interpersonal psychotherapy, which includes telephonic simulation assessments for measuring adherence and competence. Testing is currently underway.16
Best-buy interventions. Best-buy interventions. Interpersonal psychotherapy may be a top-buy because it can address EDs as well as other issues, such anxiety, depression, and PTSD.
When deciding on the best buy, it is important to consider cost effectiveness. A family-based treatment may be a better option than inpatient hospitalization for weight loss. Guided self-help CBT is also very affordable and easy to learn.
Tools for electronic assistance. Electronic support tools are a great way to improve the quality and efficiency of therapy.
Checklists are a great way for therapists to ensure that all important points are covered during a session. They also help with decision-making. One example is an electronic measurement feedback system for routine outcomes monitoring. Routine outcome feedback is a method that can help improve patient outcomes. Clients may feel reassured by the presence of symptoms improving and can enhance their therapeutic alliance.
E-support tools can be used to increase adherence and to facilitate communication with the therapist. Patients with EDs have the option to use Recovery Record as a mobile application to monitor their emotions, thoughts and behaviors and then share that information with their therapist.
Policy and support at higher levels. Higher-level support and policy are required for evidence-based healthcare to significantly increase. Improving Access to Psychological Therapy (IAPT), is a system for organizing the delivery and monitoring of evidence-based treatment within the National Health Service of England. It follows the NICE guidelines. IAPT services use evidence-based treatments and routine outcome monitoring. Regular and outcomes-focused supervision is also used. Routine outcome monitors provide valuable information for the patient as well as information about whether or not this approach is cost-effective. The Veterans Health Administration in the USA is currently implementing a national initiative that disseminates and implements evidence-based treatment.
IAPT and VHA models are based on centralized control at the top of money and have to be implemented. They are more likely than individual therapists to be trained and modified by such initiatives to influence therapist behavior.
Future directions and conclusions
There are many evidence-based psychological treatments that can be used to treat EDs. However, these treatments are only available to a very small number of patients suffering from EDs. The use of innovative approaches is necessary to close the gap in research and practice and make it easier for more people to access high-quality, evidenced-based care.
Higher-level support, policy, and advocacy will prove most effective in addressing the gap in research-practice. To answer policy-related questions, it is crucial to collaborate with policymakers to create research questions. This could significantly increase patient access to evidenced-based care in EDs.
The vast majority of patients suffering from EDs are not receiving any treatment.