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Articles tagged with: Research

The Broad Response to Evidence Based Treatment

April 09, 2013. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Dr. Mark Warren

    Harriet Brown, well known to readers of this blog and to the eating disorder community for her book Brave Girl Eating, recently published an article in the New York Times on why evidence based care is so rarely used in the field of mental health and psychology. Her article is the latest in what has become a very important conversation about the translation of evidence based research into the treatment of mental illness. This topic was also discussed at great length at the recent eating disorder conference in London, organized by Drs Bryan Lask and Rachel Bryant-Waugh. The keynote of this conference, which echos Harriet's article, shows that the number of practitioners in the community using evidence based care is shockingly low.

    Unsurprisingly the response to this article, the presentation in London, and other articles of this nature has been twofold. Many people and clinicians are excited and hopeful that there is effective treatment for historically difficult to treat illnesses. On the other hand, some practitioners are responding by challenging the notion that evidence based care should be the standard of care. The reasons for this vary from the notion that the evidence is weak (possibly, but it is the best we have), to the assumption that the evidence doesn't apply to every practice (unclear why not), to the criticism that the evidence doesn't acknowledge cultural and clinical realities (it does). Many criticisms are based on the anecdotal experience of the provider. One provider referred to the evidence as "weak tea."

    It is very difficult when scientific evidence challenges our own personal experiences and beliefs. However, if you happen to have an eating disorder, or a loved one has an eating disorder, and if you're aware of the last 20 years of eating disorder treatment, you would want to know that since the advent of evidence based care we have started to get better outcomes. If I, or a loved one, had an eating disorder, I would far prefer a glass of weak tea to no tea at all.

    For more information: Looking for Evidence That Therapy Works

    Contributions by Sarah Emerman

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Eating Disorder Awareness Week: What you may have missed at “Body Beautiful”

March 01, 2013.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    Our expert panel answers your questions about body image disorder and eating disorders.

    Thanks to those of you who joined us on Monday at "Body Beautiful," presented by Cleveland Center for Eating Disorders and John Carroll University. We had a great turnout! Students, professors, eating disorder professionals and families came out to increase awareness and promote hope around body image disorder and eating disorders.

    The event, which ran in conjunction with National Eating Disorders Awareness Week, featured a student interactive art show, "Mirror Images" and a screening of the popular documentary, "America the Beautiful." Immediately following, our expert panel was there to answer questions from the audience.

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Recent Maudsley FBT Research

January 15, 2013. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Dr. Mark Warren

    A recent article in the International Journal of Eating Disorders by Couturier, Kimber, and Szatmari (2013) adds to the literature on the effectiveness of Maudsley Family Based Therapy (FBT). Their conclusion is that while FBT does not show superiority to other therapies during treatment, there are significant benefits at the 6 -12 month follow up. These benefits reach a level of significance that would cause one to recommend FBT for the treatment of eating disorders in adolescents instead of individual therapy. As they discuss in their article, there are multiple limitations to this study, however research literature has long pointed to the superiority of FBT over individual therapy. This article therefore adds to a growing body of data.

    From a CCED perspective, we are particularly interested in what happens in those first 6 months and if there is a way to improve the outcome of FBT more rapidly for adolescents. Our clinical experience is that by adding higher levels of care, in particularly partial hospitalization in conjunction with FBT, that we can improve orientation, adherence, and effectiveness of FBT, while still staying in line with the FBT model. Our clinical experience does not meet the criteria of the research considered in this particular article, since it is not a randomized control trial or have a control group associated with it. However, given the data that we have, we hope to find that the utilization of FBT within a higher level of care may be a more rapid way to help our clients move from anorexia to recovery. We hope to publish in the next year on the results of our research into this question.

    Couturier, J., Kimber, M. and Szatmari, P. (2013), Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. Int. J. Eat. Disord., 46: 3–11. doi: 10.1002/eat.22042

    Contributions by Sarah Emerman

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Biology and Eating Disorders

August 01, 2012. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Mark Warren, MD

    The book Eating Disorders and the Brain edited by Drs Lask and Frampton continues to be an extraordinarily important book to understanding the etiology of eating disorders. Given our current knowledge, we often say that eating disorders are biologically based. Yet, this is somewhat of a two-dimensional statement as eating disorders are experienced as complex and multi factorial. A large number of factors seem to be interacting when someone presents with an eating disorder. These include genes, early attachment, personality issues, cultural issues, cultural norms, peer relationships, sensitivity, and on and on. Current biological work is beginning to show us is that many of these factors may in fact be related to one and other. The complex development of the eating disorder can be understood as the product of a specific genetic profile that develops in a specific individual under specific circumstances. Rigidity, perfectionism, skillfulness, and skill deficits, that are often seen in individuals with the illness are often mislabeled as "causes" when they are in fact part and parcel of the same developmental picture that may ultimately result in an eating disorder. With continued research of the brain, we are closer to understanding this complexity in terms of a specific biology that causes multiple expressions and can ultimately understood and treated through development and improvement of structures within the brain.

    Contributions by Sarah Emerman

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The Importance of Early and Aggressive Treatment

February 06, 2012. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    A recent study by Dr. Janet Treasure, one of the world's most prominent eating disorder researchers, has demonstrated the significant importance of early and aggressive treatment for anorexia nervosa. In her study, regardless of the treatment mechanism, patients who had been ill for longer than three years had significantly worse outcomes after treatment then those who had been ill for less time. Give the lack of evidence based treatment available until ten years ago, we do not know if current treatment mechanism may be more effective for those who have been ill longer. However, we can certainly say that based on this study, the faster someone gets into treatment and the more aggressive the treatment, clients are faster into recovery and less likely to relapse.

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New Research from the Journal of Adolescent Health

January 06, 2012. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    An interesting article from the Journal of Adolescent Health was recently profiled in the New York Times. This article challenges traditional methodologies for in-patient re-feeding of teenagers with anorexia nervosa. Historically, the protocol for teens hospitalized for anorexia has been to "start low and go slow" with food. However, this often results in much slower weight gain or even lack of weight gain during the first week of hospitalization and may result in a teen being discharged from the hospital at a significantly lower weight than they would have been if they had been re-fed more aggressively. As we know from other literature, not reaching prior growth curves is thought to be the single greatest factor in relapse for anorexia and hospitalization is often utilized to jump start this vital and necessary weight gain.

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