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Background: Treatment for anorexia nervosa (AN) is typically delivered on a continuum of care, starting with outpatient treatment, and moving onto intensive outpatient, day or residential treatment and/or inpatient hospitalisation. However, minimal attention has been afforded to the lived experiences of persons undergoing inpatient treatment for AN. In particular, qualitative literature pertaining to the lived experiences of specialist inpatient or residential treatment of AN remains fragmented and incomplete. The aim of this review was to synthesise current literature exploring patients' lived experiences of residential and inpatient treatment for AN within eating disorder-specific treatment services. Methods: Five databases were searched and a qualitative thematic systematic review and meta-synthesis of 11 studies were conducted. Results: Eleven studies of 159 participants were included. Four meta-themes were constructed from the data: (1) a medical discourse—"I don't think it's individualised here"; (2) restrictive practice—living in a "bubble"; (3) myself, others and "a similar demon"; and (4) I am "not just another anorexic". The data also revealed two cross-cutting themes: (1) more than a single experience; and (2) meaning making and identity. Conclusions: These findings highlight the complex and multifaceted nature of the inpatient treatment experience as well as the inherent conflicts in balancing the necessity of medical and psychological intervention with person-centred treatment approaches in the treatment of AN. Plain English Summary: Treatment for anorexia nervosa (AN) is typically delivered on a continuum of care, starting with outpatient treatment, and moving onto intensive outpatient, day or residential treatment and/or inpatient hospitalisation. However, not much is known about the lived experiences of people going through inpatient treatment for AN. An improved understanding of individuals' treatment experiences is essential in informing the development of new models of care with the potential to improve outcomes. In this systematic review, we examined the lived experiences of individuals going through inpatient treatment for AN available in the current literature. Searching in scientific databases resulted in 10,666 articles, 11 of which met the rigorous inclusion criteria. Four meta-themes and two cross-cutting themes were observed in patient experiences across the studies reviewed. These themes provide insight into the complex and multifaceted nature of the inpatient treatment experience as well as the inherent conflicts in balancing the necessity of medical and psychological intervention with person-centred treatment approaches in the treatment of AN. [ABSTRACT FROM AUTHOR]

Motivation is considered essential in the treatment of anorexia nervosa (AN). However, the in-session nature of, and variables associated with, changes in motivation are only partially understood in this population. The aim of this study was to conduct an exploratory investigation of the in-session nature of motivation to change in people during cognitive behavioural therapy for anorexia nervosa (CBT-AN). Thirty-eight therapy-session transcripts from nine participants, collected as part of a larger multi-site randomised control trial, were analysed using inductive thematic analysis. Two superordinate themes were generated: (i) betwixt and between; and (ii) rhythms of motivation. Two concurrent yet distinct rhythms of motivation were observed within and across participant sessions, with shifts in motivation occurring alongside identity (re)negotiations. Findings highlight the complex and multifaceted nature of the in-session processes of motivational change in persons with AN, and support previous literature suggesting factors independent of treatment may facilitate tipping points of change. Furthermore, this study proposes that an integrated or dual-wave model of motivation may assist clinicians in understanding how they can better facilitate and support motivation for change in clients with AN during treatment. What is already known about this topic: Enhancing motivation is considered essential for improving treatment outcomes. Motivation is conceptualised as a dynamic process; however, it is typically assessed through quantitative self-report measures at set points during treatment. The in-session dynamics of motivation to change are poorly understood. What this topic adds: In-session motivation to change is a complex, multifaceted process closely associated with individual identity (re)negotiations. There may be dual processes of motivation occurring during treatment that are influenced by factors independent of treatment. A proposal for an integrated model of motivation for anorexia nervosa. [ABSTRACT FROM AUTHOR]

Purpose: Lifestyle modification programs have been shown to effectively treat chronic disease. The Coronary Health Improvement Program has been delivered by both paid professional and unpaid volunteer facilitators. This study compared participant outcomes of each mode in the United States. Design: Pre-/post-analysis of CHIP interventions delivered between 1999 and 2012. Setting: Professional-delivered programs in Rockford Illinois 1999-2004 and volunteer-delivered programs across North America 2005-2012. Subjects: Adults ≥21 years (professional programs N = 3158 34.3% men, mean age = 54.0 ± 11.4 years; volunteer programs N = 7115 33.4% men, mean age = 57.4 ± 13.0 years). Measures: Body mass index, blood pressure (systolic and diastolic), blood lipid profile (total cholesterol, high-density lipoprotein, triglycerides, low-density lipoprotein), and fasting plasma glucose. Analysis: Analysis of Covariance, with adjustment for age, gender, BMI change and baseline biometric and effect sizes. Results: The professional-delivered programs achieved significantly greater reductions in BMI (.4%, P <.001) and HDL (1.9%, P <.001) and the volunteer-delivered programs achieved greater reductions in SBP (1.4%, P <.001), DBP (1.1%, P <.001), TC (1.4%, P =.004), LDL (2.3%, P <.001), TG (4.0%, P =.006), and FPG (2.7%, P <.001). However, the effect size differences between the groups were minimal (Cohen's d.1-.2). Conclusions: Lifestyle modification programs have been shown to effectively treat chronic disease. The Complete Health Improvement Program (CHIP) lifestyle intervention has been delivered by both paid professional and unpaid volunteer facilitators. This study compared selected chronic disease biometric outcomes of participants in each mode in the United States. It found volunteer-delivered programs do not appear to be any less effective than programs delivered by paid professionals, which is noteworthy as volunteers may provide important social capital in the combat of chronic disease. [ABSTRACT FROM AUTHOR]