Academic journal article The International Journal of Behavioral Consultation and Therapy

Evidence-Based Practices in Outpatient Treatment for Eating Disorders

Academic journal article The International Journal of Behavioral Consultation and Therapy

Evidence-Based Practices in Outpatient Treatment for Eating Disorders

Article excerpt

Eating disorders remain a significant concern in a culture where thinness is unduly emphasized, and where anorexia nervosa is the disorder with the highest premature fatality rate of any mental illness (Sullivan, 1995). Four out of five women in the United States are dissatisfied with their appearance (Smolak, 1996), and forty percent of Americans have experienced an eating disorder or know someone who has (NEDA, 2005). Eating disorders often go unrecognized and undiagnosed due to lack of education and awareness about signs and symptoms of eating disorders in the general public, an absence of societal sanctions for maintaining an unhealthy weight, and minimizing or denial of symptoms among people with eating disorders and their loved ones. In the current economic climate, many individuals are finding the cost of treatment to be an additional, significant obstacle. As mental health professionals, it is becoming more important than ever to make available effective treatment options that yield promising results in a relatively short time period.

This study examines current issues related to implementing evidence-based practice in psychology for people with eating disorders, and examined the effectiveness of a day treatment program for people with eating disorders.

Evidence-Based Practice

According to the APA Presidential Task Force on Evidence-Based Practice (2006), the field of psychology is fundamentally committed to evidence-based practices. The APA Task Force defined evidence-based practice in psychology (EBPP) as "the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences" (2006, p.273). Thus, evidence-based practices are derived from three components, which are all relevant to good outcomes in psychotherapy: 1) research, 2) clinical expertise, and 3) individual patient characteristics. Therefore, when treating patients with eating disorders, it is best to keep in mind all three components.

First, a thorough knowledge of outcome research is critical in deciding which interventions to use with eating disorder patients, and research offers a way to keep common human errors in judgment (e.g., confirmatory bias, self-enhancement bias, availability heuristic) in check. Yet, while one typically thinks of high-quality research as the foundation for identifying true evidence-based interventions, clinical expertise is also essential for identifying and integrating the best research evidence with clinical data, which is obtained through a relationship with the patient over the course of treatment (APA Task Force, 2006). Evidence-based treatments for eating disorders include cognitive-behavioral therapy for bulimia nervosa (Fairburn, 1985) and binge eating disorder (Wilson, Grilo, & Vitousek, 2007), and the Maudsley approach to family-based treatment for adolescents with anorexia nervosa (Lock et al., 2001; Wilson, Grilo, & Vitousek, 2007).

The second component, clinical expertise, is a less quantifiable, but equally important component that may include informal analysis, clinical experience, clinical observations, psychological theory, and consultation with colleagues (Shapiro, Friedberg, & Bardenstein, 2006). Though both research and clinical expertise have susceptibility to error, they can be integrated in such a way so as to maximize our overall understanding of both the internal and external validity of a particular treatment intervention for people with eating disorders. In addition, research and practice share a commitment to providing the best knowledge about psychological methods and treatment in order to improve patient care (Kazdin, 2008). According to the APA Task Force, clinical expertise includes components such as a) assessment, diagnostic judgment, systematic case formulation, and treatment planning, b) clinical decision making, treatment implementation, and monitoring of patient progress, c) interpersonal expertise, d) continual self-reflection and acquisition of skills, e) evaluation and use of research evidence, f) understanding the influence of individual, cultural, and contextual differences on treatment, g) seeking available resources as needed through consultation or alternative services, and h) a cogent rationale for clinical strategies. …

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