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An investigation of inhibited expression of negative feelings and interpersonal orientation in women with anorexia nervosa is presented. It seems that these women are particularly likely to avoid expressing thoughts and feelings when they are not in alignment with those of others.

Objective Reluctance to recover may explain poor treatment outcome and high dropout and relapse rates in the treatment of anorexia nervosa (AN). This study systematically explored what AN patients describe as interfering with their wish to recover. Method Two independent samples of women with AN (total N = 36) were interviewed in-depth using a phenomenological study design. Interviews were tape recorded, transcribed and analysed using QSR-NVivo7 (QSR International, Melbourne, Australia) software. Results Seven core obstacles were found to interfere with informants' wish to recover as follows: (i) 'perceiving judgements'; (ii) 'feeling stuck'; (iii) 'feeling distressed'; (iv) 'denying AN'; (v) 'eating'; (vi) 'gaining weight'; and (vii) 'appreciating the benefits'. Conclusion The wish to recover is an autonomously based, fundamental motivational requirement for becoming ready to change. Understanding factors that contribute to this wish adds to the clinician's toolbox in motivational work with AN patients. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective: This study examined the extent to which inhibited expression of negative feelings and an interpersonal style that focuses on others' needs and expectations are related to eating disorder symptoms in adolescent females. Method: Female high school adolescents (N = 235) completed the Anger Expression Scale, the Silencing the Self Scale, and measures of eating disorder symptoms, self-esteem, and psychological adjustment. Results: Adolescents with higher eating disorder symptom scores had significantly higher levels of anger inhibition and silencing the self scores. In regression analyses, the Silencing the Self and Anger Expression Scales contributed statistically significant unique variance to cognitive and behavioural eating disorder symptoms scores after controlling for shape- and weight-based self-esteem. A similar, though weaker, pattern of results was found after controlling for global self-esteem. Discussion: These results partially replicate relationships found between inhibited self-expression and eating disorder symptoms in adult clinical samples. Implications for the development of eating disorder symptoms are addressed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Individuals with eating disorders (EDs) endorse fears of being self-compassionate, as assessed by the Fears of Compassion for Self scale (FCSelf; Gilbert, McEwan, Matos, & Rivis, 2011), and higher fears predict poorer treatment outcomes. Previous research using the FCSelf demonstrated a single factor solution in a non-clinical sample.Objectives: This research sought to explore the factor structure of the FCSelf in a clinical population and to examine correlations with associated constructs. The factor structure obtained was compared with its structure in a student sample.Methods: Individuals with EDs (n = 251) completed the FCSelf, and measures of readiness to change, self-compassion, quality of life, as well as psychiatric and ED symptom severity. A female student sample (n = 314) completed the FCSelf.Results: In the clinical sample a two-factor solution exhibited best fit. Factor 1, labeled "Meeting Standards," contained items expressing concern about showing flaws and losing achievements and relationships. Factor 2, labeled "Emotional Vulnerability," contained items focusing on difficult emotions such as grief, unworthiness, and vulnerability. The two subscales exhibited acceptable internal consistencies and were significantly correlated with clinical outcome variables. In the student sample, the two factor model was superior to a single factor model but given that the latent correlation was so high (r = 0.89) a single summary score is recommended.Conclusion: Future research is needed to determine the value of addressing barriers related to meeting standards versus emotional vulnerability in helping individuals with EDs develop self-compassion and recover from their illness. [ABSTRACT FROM AUTHOR]

Objective: Models of treatment for adults with severe and enduring eating disorders focus on harm reduction and improving quality of life. However, there is a notable gap in the pediatric literature in this area. The current study set out to assess the perspectives of health professionals regarding clinical care for young people (e.g., ages 10–25 years) with severe and enduring eating disorders, and to explore perceptions about appropriate treatment options for these presentations. Methods: Health professionals were invited to complete a two-stage online survey about their experiences with clinical care for pediatric eating disorders through Canadian and Australian professional eating disorder networks. Survey 1 included questions about their experiences in supporting individuals with severe and enduring presentations. Participants who completed Survey 2 reviewed clinical vignettes and shared their perspectives about treatment recommendations and models of care, including for a severe and enduring presentation. Results: A total of 85 clinicians responded to questions on Survey 1 about severe and enduring eating disorder presentations. A portion of these respondents (n = 25) also participated in Survey 2. The majority of respondents to Survey 1 reported providing clinical care for pediatric severe and enduring eating disorder presentations. Amongst respondents to Survey 2, there was low consensus amongst respondents for the clinical care that would be most appropriate for young people with a severe and enduring eating disorder presentation. Numerous challenges in models of care for severe and enduring presentations in pediatric settings were raised in responses on Survey 2, with clinicians sharing their awareness of models focusing on quality of life, while also raising concerns about the appropriateness of these models for young people. Conclusions: The preliminary results of this study demonstrate that the majority of clinicians report that they have provided care to young people with severe and enduring presentations. There is a clear need for establishing guidance for clinicians working in pediatric eating disorder settings around models of care focused on quality of life. Engagement with interested parties, including those with lived experience, can clarify the development of terminology and clinical pathways for severe and enduring presentations of pediatric eating disorders. Plain English Summary: Treatment models focusing on harm reduction and quality of life (as opposed to eating disorder recovery) are available for adults with severe and enduring eating disorders. However, these models are not widely available for young people. In fact, there is very limited research on severe and enduring eating disorder presentations in pediatric populations. We assessed the views of health professionals regarding clinical care for young people with severe and enduring eating disorder presentations, and asked professionals about what treatment options might be most appropriate for these presentations. Most participants reported providing clinical care for pediatric severe and enduring eating disorder presentations. However, clinicians had diverse views about the treatment that would be most appropriate for a severe and enduring eating disorder presentation in a young person. Further research and engagement with clinicians and those with lived experience is needed to clarify the terminology and clinical pathways for severe and enduring presentations of pediatric eating disorders. [ABSTRACT FROM AUTHOR]

Background: The familial environment can influence adolescents' risk for obesity. However, we do not fully understand the mechanisms through which parents can influence overweight/obese adolescents' dietary behaviours, specifically whether parenting practices (e.g., rules or routines) and/or their own dietary behaviours are associated with their overweight/obese adolescent's dietary quality.Objectives: This study examined whether parenting practices and/or parental modeling of dietary quality are associated with overweight/obese adolescents' dietary quality while considering the moderating effects of parenting styles and family functioning.Methods: Baseline data from 172 overweight/obese adolescents and one of their parents who enrolled in a lifestyle modification intervention were analyzed [mean age = 13.1 (1.8); mean BMI z-score = 2.70 (0.83)]. Parent-adolescent dyads completed three 24-hr dietary recalls online. An index of dietary quality was computed by summing the scores for different food categories assessed in the dietary recall over 3 days. Parents completed questionnaires about their family functioning, dietary parenting practices (i.e., whether child eats breakfast everyday), and styles (authoritative and permissive). Path analysis was used to model interrelationships among the variables using the Stata software version 13.Results: Parental modeling of dietary quality was significantly associated with adolescent dietary quality. Additionally, parenting styles significantly moderated parental modeling, such that an authoritative parenting style in conjunction with modeling healthy eating habits was associated with better adolescent dietary quality.Conclusions: This work suggests that parental modeling of health behaviours is important; however, it is necessary to consider the broader emotional/relational context into which modeling is expressed since parenting styles moderated these effects. This study provides insight into how parenting styles may alter the effectiveness of parental modeling and highlights the need to account for parenting styles to improve the efficacy of current family-based interventions. [ABSTRACT FROM AUTHOR]

Background: Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families' access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children's and caregivers' acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. Methods: In our 2.5-year study, 108 6–17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families' barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. Discussion: Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. Trial registration: This trial was registered prospectively at ClinicalTrials.gov (#NCT05403658; first posted: June 3, 2022). [ABSTRACT FROM AUTHOR]

This study aimed to identify aspects of treatment that adolescents with anorexia nervosa (AN) believe are helpful or unhelpful. Adolescent females receiving treatment for AN or subthreshold AN ( n =21) were prompted during semi-structured interviews to generate responses to open-ended questions on what they felt would be most helpful or unhelpful in treating adolescents with eating disorders. Eight codes were developed and the two most frequently endorsed categories were (1) Alliance, where the therapist demonstrates clinical expertise and also expresses interest in the patient ( n =21, 100.0%), and (2) Client Involvement in treatment ( n =16, 76.2%). These top two categories were shared by participants with AN versus subthreshold AN and participants with high versus low readiness to change their dietary restriction behaviours. Development of the coding scheme and sample participant responses will be discussed. The integration of identified factors into empirically supported treatments for adolescent AN, such as Family-based Treatment, will be considered. This study provides initial information regarding aspects of treatment that adolescents identify as most helpful or unhelpful in their treatment. [ABSTRACT FROM AUTHOR]

Background: Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake., Methods: Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8-10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups., Discussion: Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies., (© 2023. The Author(s).)

Background: Collaborative care is described as showing curiosity and concern for patient experiences, providing choices, and supporting patient autonomy. In contrast, in directive care, the clinician has authority and the patient is expected to adhere to a treatment plan over which they have limited influence. In the treatment of eating disorders, collaborative care has been shown to be more acceptable and produce better outcomes than directive care. Despite widespread patient and clinician preference for collaborative care, it is common for clinicians to be directive in practice, resulting in negative patient attitudes toward treatment and poor adherence. There is a need to understand factors which contribute to its use., Purpose: This study examined the contribution of clinicians' experience of distress and how they relate to themselves and others in times of difficulty (self-compassion and compassion for others), to their use of collaborative support., Method: Clinicians working with individuals with eating disorders from diverse professional backgrounds (N = 123) completed an online survey., Results: Whereas clinician distress was not associated with use of collaborative or directive support behaviours, self-compassion and compassion for others were. Regression analyses indicated that compassion for others was the most important determinant of collaborative care., Discussion: Relating to their own and others' distress with compassion was most important in determining clinicians' use of collaborative support. Understanding how to cultivate conditions that foster compassion in clinical environments could promote the delivery of collaborative care., (© 2023. The Author(s).)

Background: Individuals with eating disorders (EDs) experience barriers to self-compassion, with two recently identified in this population: Meeting Standards, or concerns that self-compassion would result in showing flaws or lead to loss of achievements or relationships, and Emotional Vulnerability, or concerns that self-compassion would elicit difficult emotions such as grief or anger. This exploratory study examined the utility of self-compassion and two barriers to self-compassion in predicting clinical outcomes in intensive ED treatments., Method: Individuals in inpatient (n = 87) and residential (n = 68) treatment completed measures of self-compassion and fears of self-compassion, and ten clinical outcome variables at pre- and post-treatment., Results: Pre-treatment self-compassion was generally not associated with outcomes, whereas pre-treatment self-compassion barriers generally were. In both treatment settings, fewer Emotional Vulnerability barriers were associated with improved interpersonal/affective functioning and quality of life, and fewer Meeting Standards barriers were associated with improved readiness and motivation. Interestingly, whereas Meeting Standards barriers were associated with less ED symptom improvement in inpatient treatment, Emotional Vulnerability barriers were associated with less ED symptom improvement in residential treatment., Conclusions: Given that few longitudinal predictors of outcome have been established, the finding that pre-treatment barriers to self-compassion predict outcomes in both inpatient and residential settings is noteworthy. Targeting self-compassion barriers early in treatment may be helpful in facilitating ED recovery., (© 2022. The Author(s).)