Characteristics of the Eating Disorders Day Treatment Program EDDTP considered important for effecti

1
Characteristics of the Eating Disorders Day
Treatment Program (EDDTP) considered important
for effective treatment

• Natalie Crino
• Clinical Psychologist
• Eating Disorders Day Treatment Program (EDDTP)
• Ms. Stephanie Aldis, Ms. Mellisa Ashley, Ms.
  Ivana Djokvucic,
• Dr. Li Hong, Dr. Frances Wilson

2
Description of program

• EDDTP established 2003
• In keeping with best practice guidelines (RANZCP
  2004)
• Reasons for development
• Increase access to intensive treatment
• Reduce lengthy inpatient admissions

3
Service model
4
EDDTP
5
Theoretical conceptualisation

• Transdiagnostic cognitive behavioural model
  (Fairburn, Cooper Shafran 2003 Waller 1993)
• Overevaluation of eating, shape, weight and their
  control (Fairburn et al. 2003)
• Avoidance of affect (Waller, Kennerley Ohanion
  2007).
• Integrates readiness and motivational principles
  (Vitousek, Watson, Wilson 1998)
• Treatment focuses on
• Symptoms
• Developing self-understanding
• Managing interpersonal and emotional difficulties
• Improving psychosocial functioning

6
Aim- Preliminary evaluation of early treatment
response

• Outcome measures
• Body mass index (BMI)
• Eating Disorders Inventory (EDI3) (Garner 2004)
• Eating Disorders Inventory-Symptom checklist
  (EDI3-SC) (Garner 2004)
• Eating Attitudes Test (EAT-26) (Garner et al.
  1982)
• Depression, Anxiety and Stress (DASS) (Lovibond
  Lovibond 1995)

7
Diagnoses

• N54
• AN- 46 (AN-BP 15 AN-R 32)
• BN- 19
• EDNOS- 35
• Females- 96 Males- 4
• 76 completed 3 months.
• 24 dropped out of day- treatment before 3
  months.
• Data based on N41

8
Sample

• Variable Mean (sd) Range
• Age 24.51 (8.28) 18-54
• Years of Edu. 13.56 (1.71) 9-17
• Ed. Years 7.06 (7.85) 1-41
• Mean age of onset 16.65 (5.17) 12-45
• Mean yrs of tmt lt 6 months 41 6
  months-2yrs 44 2 yrs 15

9
Early Treatment Response (contd)Body Mass Index
10
Early treatment responseBinge Frequency (EDI3-SC)
11
Early treatment responsePurge Frequency (EDI3-SC)
12
Early Treatment Response (contd)Exercise
frequency (EDI3- SC)
13
Early Treatment Response (EDI3)

• Variable t Sig.
• Drive for thinness 4.89 .000
• Bulimia 4.275 .000
• Low-self-esteem 2.44 .019
• Interpersonal insecurity 2.339 .024
• Maturity fears 3.418 .001
• Emotional dysregulation 2.289 .027
• Personal alienation 5.521 .000

14
Early Treatment Response (contd)Interoceptive
deficits (EDI3)
15
Early Treatment Response (contd)Eating
Attitudes (EAT-26)
16
Early Treatment Response (contd)Depression,
Anxiety and Stress (DASS)
17
Summary

• Effectiveness of EDDTP consistent with what is
  reported in international treatment outcome
  studies
• Weight gain
• Reduced compensatory behaviours
• Improvements in disturbed eating, shape and
  weight attitudes
• Reduction in other psychopathology
• Improvements in self-esteem
• Early changes possible with large effect sizes

18
Characteristics considered important for
effective treatment
19
Integrated service

• Stepped-care model- flexibility in intensity of
  treatment
• A high level of communication across services-
• Case review
• Staff working/consulting across services

20
Allocation of primary clinician at point of entry

• Care planning guided by clinical formulation
• Facilitates transition
• Continuity of care

POINT OF ENTRY
21
Consistency and stability of therapy environment

• Shared conceptualisation of the disorder in
  multidisciplinary team. Influences-
• Therapy stance
• Provides boundaries, consistency and containment,
  minimises splitting
• Requires sharing of knowledge in
  multidisciplinary team
• Commitment to training and supervision. Services
  have to grow their own clinicians (Palmer 2000)

22
Service implications arising from development of
day-program
23
Increased access to intensive treatment
24
Reduced length of stay in inpatient treatment
25
Profile of inpatient admissions
26
Service implications (contd)

• Inpatient admissions can be shortened with
  alternative intensive treatment option
• Longer admissions still required for some
• Change in model of inpatient care (Vandereycken
  2003)-
• Managing serious medical risk (crisis
  intervention)
• Treating those that would be unsuited to
  day-patient model of care
• Risk of burnout and deskilling on inpatient
  program