Electronic Letters to:
|
|
eLetters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Ambivalence in Eating Disorders
- Sara L Adshead (10 February 2009)
|
|
|||
|
Sara L Adshead, Specialist Registrar, General Adult Psychiatry
Send letter to journal:
sara.adshead{at}bsmhft.nhs.uk Sara L Adshead
|
Ambivalence towards recovery is a common feature amongst patients with Eating Disorders1,2, particularly those with Anorexia Nervosa3,4. The often valued and perversely positive role that an Eating Disorder (notably Anorexia Nervosa) plays within a patient’s life2 results in a fluctuating level of motivation to engage in therapy. This powerful degree of ambivalence plays a significant role in the high drop out rates along the care pathway4, along with other factors identified in Waller et al’s recent study. It is surprising therefore that as yet there has been little research evaluating the impact of the different stages within the motivation cycle for change on treatment outcomes in patients suffering from Eating Disorders2 . A standardised assessment of a patient’s level of ambivalence and drive for recovery, such as the Readiness and Motivation Interview1 or similar would not only provide guidance to the therapist as to an individual’s likely initial level of engagement, but also facilitate a picture of a patient’s fluctuating level of motivation as they pass along the care pathway, allowing the therapist to tailor motivational techniques towards this. It would also enhance the quality of further outcome data relating to patient engagement with Eating Disorder Services. I note that in Waller et al’s study, 13% of those patients offered outpatient therapy following initial assessment failed to engage with treatment. I would suggest that the waiting period between acceptance into the service and commencement of outpatient treatment is a critical stage in the care pathway, as a loss of ‘momentum’ through the service at this stage carries a significant risk of disengagement. In an attempt to counter this effect, the Birmingham Eating Disorder Service has recently introduced an ‘Awareness Group’. Designed specifically for newly assessed and diagnosed patients, the aim of the course of five weekly evening sessions is to consolidate initial engagement and bridge the gap between assessment and treatment, via the provision of information on Eating Disorders, treatment options, and the structure of the service. Although in its early stages, initial outcome for the group has proved positive, with 97% of patients who attended for the initial session subsequently remaining engaged throughout the full five week course. On completion of the course, patients provided feedback on each topic covered by means of a ten-point Likert Scale ranging from 1 (not at all useful), to 10 (very useful). 89% of ratings were 7 or above, with the physical consequences of Eating Disorders, comorbid psychological disorders, and the effects of laxatives/vomiting rated as the three most highly relevant topics covered. Additionally, several patients highlighted a desire for guidance and support in informing relatives and friends of their Eating Disorder, and one suggestion was that the final session be opened to such significant others for education. (A separate carers’ group is already available within our service). A common response from the majority of patients was that the group made them feel supported and less alone with their illness, whilst awaiting treatment. It is hoped that this positive experience will serve to perpetuate therapeutic engagement whilst they remain under the care of our service. Improving the overall quality of a patient’s experience when passing through the care pathway (as identified by Waller et al), with the direct involvement of the patient at all stages, from the booking of an initial appointment to a collaborative approach towards therapy, is essential in ensuring active engagement of patients with all psychiatric conditions, but particularly when attempting to support patients suffering from an illness with such strong egosyntonic qualities as Anorexia Nervosa in making a decision to pursue recovery. Dr Sara Adshead Specialist Registrar General Adult Psychiatry References 1) Geller, J; Zaitsoff, S; Srikameswaran, S ‘Tracking readiness and motivation for change in individuals with eating disorders over the course of treatment’ Cognitive Therapy and Research, October 2005, 29/5 (611-625) 2) Beato-Fernandez, L; Rodriguez-Cano, T ‘Eating disorders and stages of change: Prognostic influence on eating psychopathology’ Eating Disorders (New Research), 2006 (245-263) 3) Zeeck,A; Hartmann, A; Buchholz, C ‘Drop outs from in-patient treatment of anorexia nervosa’ Acta Psychiatrica Scandinavica 2005, 111 (29-37) 4) Guarda, A.S ‘Treatment of anorexia nervosa: Insights and obstacles’ Physiology and Behaviour, April 2008, 94/1, (113-120) Author details: Dr Sara L Adshead Specialist Registrar General Adult Psychiatry Eating Disorder Service The Barberry Centre, 25 Vincent Drive, Edgbaston, Birmingham B15 2FG Sara.adshead@bsmhft.nhs.uk Tel: 0121 301 2420 Fax: 0121 301 2411 |
|||