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A randomized controlled trial of an Internet-based cognitive-behavioural skills package for carers of people with anorexia nervosa

Published online by Cambridge University Press:  20 May 2011

M. Grover ,
U. Naumann ,
L. Mohammad-Dar ,
D. Glennon ,
S. Ringwood ,
I. Eisler ,
C. Williams ,
J. Treasure  and
U. Schmidt
M. Grover
Affiliation:
King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
U. Naumann
Affiliation:
King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
L. Mohammad-Dar
Affiliation:
King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
D. Glennon
Affiliation:
King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
S. Ringwood
Affiliation:
King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
I. Eisler
Affiliation:
King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
C. Williams
Affiliation:
King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
J. Treasure
Affiliation:
King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
U. Schmidt*
Affiliation:
King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK
*
*Address for correspondence: U. Schmidt, M.D., Ph.D., FRCPsych, PO 59, Section of Eating Disorders, Institute of Psychiatry, 103, Denmark Hill, London SE5 8AF, UK. (Email: [email protected])
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Abstract

Background

Anorexia nervosa (AN) poses a major burden on families. Carers (e.g. parents or partners) of people with AN are often highly distressed and may inadvertently respond in ways that can contribute to the maintenance of the disorder, e.g. through high levels of over-involvement and criticism [also known as expressed emotion (EE)]. This study aimed to evaluate the efficacy of a novel web-based systemic cognitive-behavioural (CBT) intervention for carers of people with AN, designed to reduce carer distress and teach skills in how to offer effective support.

Method

Carers of people with AN (n=64) were randomly allocated to either the web-intervention, overcoming anorexia online, with limited clinician supportive guidance (by email or phone), or to ad-hoc usual support from the UK patient and carer organization Beat. Carer outcomes were assessed at post-treatment (4 months) and follow-up (6 months).

Results

Compared with the control intervention, web-based treatment significantly reduced carers' anxiety and depression (primary outcome) at post-treatment, with a similar trend in carers' EE. Other secondary outcomes did not favour the online intervention. Gains were maintained at follow-up.

Conclusions

This is the first ever study to use an online CBT program to successfully reduce carer distress and improve carers' ability to support the person with AN.

Keywords

Anorexia nervosacarersinternetinterventionRCT
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 12 , December 2011 , pp. 2581 - 2591
Copyright
Copyright © Cambridge University Press 2011

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References

Baron, R, Kenny, DA (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182.CrossRefGoogle ScholarPubMed
Cairns, JC, Styles, LD, Leichner, P (2007). Evaluation of meal support training for parents and caregivers using a video and a manual. Journal of the Canadian Academy of Child and Adolescent Psychiatry 16, 164–166.Google ScholarPubMed
Cole, JD, Kazarian, SS (1993). Predictive validity of the Level of Expressed Emotion (LEE) Scale: readmission follow-up data for 1, 2, and 5-year periods. Journal of Clinical Psychology 49, 216–218.3.0.CO;2-G>CrossRefGoogle Scholar
de la Rie, SM, van Furth, EF, Koning, A, Noordenbos, G, Donker, MCH (2005). The quality of life of family caregivers of eating disorder patients. Eating Disorders. The Journal of Treatment & Prevention 13, 345–351.CrossRefGoogle ScholarPubMed
Dummett, N (2006). Processes for systemic cognitive-behavioural therapy with children, young people and families. Behavioural and Cognitive Psychotherapy 34, 179–189.CrossRefGoogle Scholar
Gega, L, Marks, I, Mataix-Cols, D (2004). Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions. Journal of Clinical Psychology 60, 147–157.CrossRefGoogle ScholarPubMed
Gellatly, J, Bower, P, Hennessy, S, Richards, D, Gilbody, S, Lovell, K (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine 37, 1217–1228.CrossRefGoogle ScholarPubMed
Goddard, E, Macdonald, P, Sepulveda, AR, Naumann, U, Landau, S, Schmidt, U, Treasure, J (in press). The cognitive interpersonal maintenance model of eating disorders: testing an intervention for carers. British Journal of Psychiatry.Google Scholar
Grover, M, Williams, C, Eisler, I, Fairbairn, P, McCloskey, C, Smith, G, Treasure, J, Schmidt, U (2010). An off-line pilot evaluation of a web-based systemic cognitive-behavioral intervention for carers of people with anorexia nervosa. International Journal of Eating Disorders. Published online: 15 November 2010.doi:10.1002/eat.20871.Google ScholarPubMed
Haigh, R, Treasure, J (2003). Investigating the needs of carers in the area of eating disorders: development of the Carers' Needs Assessment Measure (CaNAM). European Eating Disorders Review 11, 125–141.CrossRefGoogle Scholar
Highet, N, Thompson, M, King, RM (2005). The experience of living with a person with an eating disorder: the impact on the carers. Eating Disorders: The Journal of Treatment & Prevention 13, 327–344.CrossRefGoogle ScholarPubMed
Kamerling, V, Smith, G (2010). The carers' perspective. In The Clinician's Guide to Collaborative Caring in Eating Disorders. The New Maudsley Method (ed. Treasure, J., Schmidt, U. and Macdonald, P.) pp. 20–29. Routledge: East Sussex.Google Scholar
Kyriacou, O, Treasure, J, Schmidt, U (2008). Understanding how parents cope with living with someone with anorexia nervosa: modelling the factors that are associated with carer distress. International Journal of Eating Disorders 41, 233–242.CrossRefGoogle ScholarPubMed
Martinez, R, Whitfield, G, Dafters, R, Williams, C (2008). Can people read self-help manuals for depression? A challenge for the stepped care model and book prescription schemes. Behavioural and Cognitive Psychotherapy 36, 89–97.CrossRefGoogle Scholar
Miller, WR, Rollnick, S (2002). Motivational Interviewing: Preparing People for Change. Guilford Press: New York.Google Scholar
Perkins, SJ, Murphy, R, Schmidt, U, Williams, C (2006). Self-help and guided self-help for eating disorders. Cochrane Database Systematic Reviews 6, CD004191.Google Scholar
Pinheiro, JC, Bates, DM (2000). Mixed-Effects Models in S and S-Plus. Springer Verlag: New York.CrossRefGoogle Scholar
Schmidt, U, Treasure, J (2006). Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology 45, 343–366.CrossRefGoogle ScholarPubMed
Schmidt, U, Williams, C, Eisler, I, Fairbairn, P, McCloskey, C, Smith, G, Treasure, J (2007). Overcoming anorexia online: effective caring. A web-based programme for carers of people with AN. Media Innovations Ltd: Leeds (www.overcominganorexiaonline.com). Accessed 29 April 2011.Google Scholar
Sepulveda, AR, Kyriacou, O, Treasure, J (2009). Development and validation of the accommodation and enabling scale for eating disorders (AESED) for caregivers in eating disorders. BMC Health Services Research 9, 171.CrossRefGoogle ScholarPubMed
Sepulveda, AR, Lopez, C, Macdonald, P, Treasure, J (2008 a). Feasibility and acceptability of DVD and telephone coaching-based skills training for carers of people with an eating disorder. International Journal of Eating Disorders 41, 318–325.CrossRefGoogle ScholarPubMed
Sepulveda, AR, Lopez, C, Todd, G, Whitaker, W, Treasure, J (2008 b). An examination of the impact of ‘the Maudsley eating disorder collaborative care skills workshops’ on the well-being of carers: a pilot study. Social Psychiatry and Psychiatric Epidemiology 43, 584–591.CrossRefGoogle ScholarPubMed
Sepulveda, AR, Whitney, J, Hankins, M, Treasure, J (2008 c). Development and validation of an eating disorders symptom impact scale (EDSIS) for carers of people with eating disorders. Health and Quality of Life Outcomes 6, 28.CrossRefGoogle ScholarPubMed
Szmukler, GI, Burgess, P, Herrman, H, Benson, A (1996). Caring for relatives with serious mental illness: The development of Experience of Caregiving Inventory. Social Psychiatry and Psychiatric Epidemiology 31, 137–148.CrossRefGoogle ScholarPubMed
Treasure, J, Schmidt, U (2001). Ready, willing and able to change: motivational aspects of the assessment and treatment of eating disorders. European Eating Disorders Review 9, 4–18.CrossRefGoogle Scholar
Treasure, J, Sepulveda, AR, MacDonald, P, Whitaker, W, Lopez, C, Zabala, M, Kyriacou, O, Todd, G (2008). The assessment of the family of people with eating disorders. European Eating Disorders Review 16, 247–255.CrossRefGoogle ScholarPubMed
Treasure, J, Smith, G, Crane, A (2007). Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method. Routledge: London.CrossRefGoogle Scholar
Treasure, J, Whitaker, W, Whitney, J, Schmidt, U (2005). Working with families of adults with anorexia nervosa. Journal of Family Therapy 27, 158–170.CrossRefGoogle Scholar
Williams, CJ (2001). Overcoming Depression: A Five Areas Approach. Arnold: London.Google Scholar
Williams, CJ (2009). Overcoming Depression and Low Mood: A Five Areas Approach. Hodder: London.Google Scholar
Winn, S, Perkins, S, Walwyn, R, Schmidt, U, Eisler, I, Treasure, J, Berelowitz, M, Dodge, L, Frost, S, Jenkins, M, Johnson-Sabine, E, Keville, S, Murphy, R, Robinson, P, Yi, I (2007). Predictors of mental health problems and negative caregiving experiences in cases of adolescents with bulimia nervosa. International Journal of Eating Disorders 40, 171–178.CrossRefGoogle Scholar
Zigmond, AS, Snaith, RP (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361–370.CrossRefGoogle ScholarPubMed