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3. Group Cognitive Remediation Therapy for children and adolescents receiving intensive day-patient treatment for anorexia nervosa : a feasibility study diagnosed with anorexia nervosa

Author

Rhind, Charlotte and Tchanturia, Ketevan

Abstract

Background: Cognitive Remediation Therapy (CRT) targets specific thinking styles that are thought to play a role in the development and maintenance of anorexia nervosa (AN). Evidence is emerging to support its use for young people diagnosed with AN, but less is known about its benefit when delivered as a brief group intervention. Even less is known about its potential benefit for those with high Autism Spectrum Disorder (ASD) features. Aims: This is the first study to explore the feasibility of brief group CRT in young people diagnosed with AN using neuropsychological measures of both set-shifting (SS) and central coherence (CC), and to consider the benefit for those with ASD features. This pre and post uncontrolled feasibility study aimed to i) establish recruitment and intervention retention rates, ii) estimate the likely effect size of group CRT with young people with AN using a range of neuropsychological assessment measures, and iii) establish characteristics of the CRT outcome measures (suitability to pre and post design). A second aim was to perform exploratory preliminary analysis using the data collected (not outcome analysis) to explore whether improvements in SS and CC may relate to (i) changes in weight restoration, and (ii) ASD features. Methods: Twenty-two young people aged 12-18 years receiving intensive day-patient treatment for AN or Atypical AN completed a neuropsychological assessment (two experimental measures of SS - the Wisconsin Card Sorting Task and the Brixton Spatial Anticipation Test - and one of CC - The Rey Osterrieth Complex Figures Task) pre and post 4 sessions of group CRT that was offered as part of their standard eating disorder treatment. The motivational ruler and standard measures of AN symptom severity, distress, and ASD features were also used. Results: Study uptake was 95%, intervention retention was 91%, and group CRT was rated as acceptable. Medium to large effect size improvements were found across measures of SS (dz=0.44 to dz=0.90) and medium size improvements found in CC (dz=0.59). There was a moderate (not significant) correlation between change scores in weight restoration and CC and one measure of SS and no correlation between cognitive improvement following group CRT and academic functioning. Young people with ASD features showed smaller to similar size improvements in SS, and larger improvements in CC following group CRT. Conclusions: This study suggests that an RCT examining group CRT in AN using neuropsychological measures and 4 sessions as a 'minimum dose' is feasible to conduct within a daypatient setting. Important study parameters have been estimated in order to plan a future definitive trial evaluating the effectiveness of group CRT in young people with AN. The Wisconsin Card Sorting Task and the Rey Osterrieth Complex Figures Task offered suitable measurement of pre and post change in SS and CC respectively, while the Brixton Spatial Anticipation Test was less suitable for use with this study design in this population. Group CRT is likely to benefit young people with AN with or without ASD features.

Published
2018

6. The clinical presentation of avoidant restrictive food intake disorder is largely independent of sex, autism spectrum disorder and anxiety traits

Author

Watts, Rosie, primary, Archibald, Tanith, additional, Hembry, Pippa, additional, Howard, Maxine, additional, Kelly, Cate, additional, Loomes, Rachel, additional, Markham, Laura, additional, Moss, Harry, additional, Munuve, Alfonce, additional, Oros, Anca, additional, Siddall, Amy, additional, Rhind, Charlotte, additional, Uddin, Mohammed, additional, Ahmad, Zain, additional, Bryant-Waugh, Rachel, additional, and Hübel, Christopher, additional

Published
2023
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19. The Objective and Subjective Caregiving Burden and Caregiving Behaviours of Parents of Adolescents with Anorexia Nervosa

Author

Rhind, Charlotte, Salerno, Laura, Hibbs, Rebecca, Micali, Nadia, Schmidt, Ulrike, Gowers, Simon, Macdonald, Pamela, Goddard, Elizabeth, Todd, Gillian, Tchanturia, Kate, Lo Coco, Gianluca, Treasure, Janet, Rhind, C, Salerno, L, Hibbs, R, Micali, N, Schmidt, U, Gowers, S, Macdonald, P, Goddard, E, Todd, G, Tchanturia, K, Lo Coco, G, and Treasure, J

Subjects
Adult, Male, Parents, Parenting/psychology, Adolescent, Anorexia Nervosa/psychology, caregiving burden, Mothers, Stress, behavioral disciplines and activities, anorexia nervosa, Psychological/psychology, Caregivers/psychology, Surveys and Questionnaires, mental disorders, Ambulatory Care, Humans, Parent-Child Relations, Maternal Behavior, Paternal Behavior, accommodating and enabling behaviour, Parenting, Depression, Middle Aged, Expressed Emotion, Clinical Psychology, Caregivers, Psychiatry and Mental Health, expressed emotion, Female, carer skill, Depression/psychology, Stress, Psychological, Parents/psychology
Abstract

Objective: The study aimed to examine caregiving burden and levels of distress, accommodating behaviours, expressed emotion (EE) and carers' skills, in parents of adolescents with anorexia nervosa. Method: A semi-structured interview assessed the objective burden (time spent across caregiving tasks) in parents (n = 196) of adolescents (n = 144) receiving outpatient treatment for anorexia nervosa. Subjective burden (carers' distress), accommodating behaviours, EE and carers' skills were measured by self-report. Results: Mothers, on average, spent 2.5 h/day of care, mainly providing food and emotional support, compared with 1 h/day by fathers. The level of distress and accommodating behaviour was significantly lower in fathers than in mothers. Accommodating behaviours mediated the relationship between objective burden and subjective burden in mothers, whereas EE and carers' skills did not mediate this relationship for either parent. Discussion: The objective burden for most mothers is high. In order to reduce subjective burden, it may be helpful to target accommodating behaviours. Trial Registration: ISRCTN83003225 - Expert Carers Helping Others (ECHO). Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Published
2016

20. Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Author

Schmidt, Ulrike, primary, Sharpe, Helen, additional, Bartholdy, Savani, additional, Bonin, Eva-Maria, additional, Davies, Helen, additional, Easter, Abigail, additional, Goddard, Elizabeth, additional, Hibbs, Rebecca, additional, House, Jennifer, additional, Keyes, Alexandra, additional, Knightsmith, Pooky, additional, Koskina, Antonia, additional, Magill, Nicholas, additional, McClelland, Jessica, additional, Micali, Nadia, additional, Raenker, Simone, additional, Renwick, Bethany, additional, Rhind, Charlotte, additional, Simic, Mima, additional, Sternheim, Lot, additional, Woerwag-Mehta, Sabine, additional, Beecham, Jennifer, additional, Campbell, Iain C, additional, Eisler, Ivan, additional, Landau, Sabine, additional, Ringwood, Susan, additional, Startup, Helen, additional, Tchanturia, Kate, additional, and Treasure, Janet, additional

Published
2017
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22. An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents

Author

Rhind, Charlotte, Bonfioli, Elena, Hibbs, Rebecca, Goddard, Elizabeth, Macdonald, Pamela, Gowers, Simon, Schmidt, Ulrike, Tchanturia, Kate, Micali, Nadia, and Treasure, Janet

Subjects
Parents, Social aptitude, Anorexia nervosa, Eating disorder, Autism Spectrum Disorders, Obsessive-compulsive disorder, Adolescents, Research, digestive, oral, and skin physiology, Development, Well-being assessment, Traits, behavioral disciplines and activities, mental disorders, Autism spectrum disorder
Abstract

BACKGROUND: There may be a link between anorexia nervosa and autism spectrum disorders. The aims of this study were to examine whether adolescents with anorexia nervosa have autism spectrum and/or obsessive-compulsive traits, how many would meet diagnostic criteria for autism spectrum disorder, and whether these traits are shared by parents.METHODS: A total of 150 adolescents receiving outpatient treatment for anorexia nervosa or subthreshold anorexia nervosa and their parents completed the autism spectrum disorder and eating disorder sections of the Development and Well-being Assessment. Patients also completed the Children Yale-Brown Obsessive-Compulsive Scale and other measures of psychiatric morbidity, and parents completed the short Autism Quotient and Obsessive-Compulsive Inventory Revised.RESULTS: Adolescents with anorexia nervosa had a below average social aptitude (19% below cut-off) and high levels of peer relationship problems (39% above cut-off) and obsessive-compulsive symptoms (56% above cut-off). Six cases (4%, all females) were assigned a possible (n = 5) or definite (n = 1) diagnosis of autism spectrum disorder. Parental levels of autism spectrum and obsessive-compulsive traits were within the normal range.CONCLUSIONS: This study suggests that adolescents with anorexia nervosa have elevated levels of autism spectrum traits, obsessive-compulsive symptoms, and a small proportion fulfil diagnostic criteria for a probable autism spectrum disorder. These traits did not appear to be familial. This comorbidity has been associated with a poorer prognosis. Therefore, adaptation of treatment for this subgroup may be warranted.TRIAL REGISTRATION: Controlled-trials.com: ISRCTN83003225. Registered on 29 September 2011.

Published
2014

23. The Objective and Subjective Caregiving Burden and Caregiving Behaviours of Parents of Adolescents with Anorexia Nervosa

Author

Rhind, Charlotte, primary, Salerno, Laura, additional, Hibbs, Rebecca, additional, Micali, Nadia, additional, Schmidt, Ulrike, additional, Gowers, Simon, additional, Macdonald, Pamela, additional, Goddard, Elizabeth, additional, Todd, Gillian, additional, Tchanturia, Kate, additional, Lo Coco, Gianluca, additional, and Treasure, Janet, additional

Published
2016
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24. Two-year Follow-up of a Pragmatic Randomised Controlled Trial Examining the Effect of Adding a Carer's Skill Training Intervention in Inpatients with Anorexia Nervosa

Author

Magill, Nicholas, primary, Rhind, Charlotte, additional, Hibbs, Rebecca, additional, Goddard, Elizabeth, additional, Macdonald, Pamela, additional, Arcelus, Jon, additional, Morgan, John, additional, Beecham, Jennifer, additional, Schmidt, Ulrike, additional, Landau, Sabine, additional, and Treasure, Janet, additional

Published
2015
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26. Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial

Author

Hibbs, Rebecca, primary, Magill, Nicholas, additional, Goddard, Elizabeth, additional, Rhind, Charlotte, additional, Raenker, Simone, additional, Macdonald, Pamela, additional, Todd, Gill, additional, Arcelus, Jon, additional, Morgan, John, additional, Beecham, Jennifer, additional, Schmidt, Ulrike, additional, Landau, Sabine, additional, and Treasure, Janet, additional

Published
2015
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28. Emotional Processing of Infants Displays in Eating Disorders

Author

Cardi, Valentina, primary, Corfield, Freya, additional, Leppanen, Jenni, additional, Rhind, Charlotte, additional, Deriziotis, Stephanie, additional, Hadjimichalis, Alexandra, additional, Hibbs, Rebecca, additional, Micali, Nadia, additional, and Treasure, Janet, additional

Published
2014
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29. Development and validation of a scale to measure caregiver skills in eating disorders

Author

Hibbs, Rebecca, primary, Rhind, Charlotte, additional, Salerno, Laura, additional, Lo Coco, Gianluca, additional, Goddard, Elizabeth, additional, Schmidt, Ulrike, additional, Micali, Nadia, additional, Gowers, Simon, additional, Beecham, Jennifer, additional, Macdonald, Pamela, additional, Todd, Gillian, additional, Campbell, Iain, additional, and Treasure, Janet, additional

Published
2014
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31. Caregiver Skills Scale

Author

Hibbs, Rebecca, primary, Rhind, Charlotte, additional, Salerno, Laura, additional, Lo Coco, Gianluca, additional, Goddard, Elizabeth, additional, Schmidt, Ulrike, additional, Micali, Nadia, additional, Gowers, Simon, additional, Beecham, Jennifer, additional, Macdonald, Pamela, additional, Todd, Gillian, additional, Campbell, Iain, additional, and Treasure, Janet, additional

Published
2014
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32. Confirmatory factor analysis for two questionnaires of caregiving in eating disorders

Author

Hibbs, Rebecca, primary, Rhind, Charlotte, additional, Sallis, Hannah, additional, Goddard, Elizabeth, additional, Raenker, Simone, additional, Ayton, Agnes, additional, Bamford, Bryony, additional, Arcelus, Jon, additional, Boughton, Nicky, additional, Connan, Frances, additional, Goss, Ken, additional, Lazlo, Bert, additional, Morgan, John, additional, Moore, Kim, additional, Robertson, David, additional, Schreiber-Kounine, Christa, additional, Sharma, Sonu, additional, Whitehead, Linette, additional, Lacey, Hubert, additional, Schmidt, Ulrike, additional, and Treasure, Janet, additional

Published
2014
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35. Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Author

Schmidt, Ulrike, Sharpe, Helen, Bartholdy, Savani, Bonin, Eva-Maria, Davies, Helen, Easter, Abigail, Goddard, Elizabeth, Hibbs, Rebecca, House, Jennifer, Keyes, Alexandra, Knightsmith, Pooky, Koskina, Antonia, Magill, Nicholas, McClelland, Jessica, Micali, Nadia, Raenker, Simone, Renwick, Bethany, Rhind, Charlotte, Simic, Mima, Sternheim, Lot, Woerwag-Mehta, Sabine, Beecham, Jennifer, Campbell, Iain, Eisler, Ivan, Landau, Sabine, Ringwood, Susan, Startup, Helen, Tchanturia, Kate, Treasure, Janet, Schmidt, Ulrike, Sharpe, Helen, Bartholdy, Savani, Bonin, Eva-Maria, Davies, Helen, Easter, Abigail, Goddard, Elizabeth, Hibbs, Rebecca, House, Jennifer, Keyes, Alexandra, Knightsmith, Pooky, Koskina, Antonia, Magill, Nicholas, McClelland, Jessica, Micali, Nadia, Raenker, Simone, Renwick, Bethany, Rhind, Charlotte, Simic, Mima, Sternheim, Lot, Woerwag-Mehta, Sabine, Beecham, Jennifer, Campbell, Iain, Eisler, Ivan, Landau, Sabine, Ringwood, Susan, Startup, Helen, Tchanturia, Kate, and Treasure, Janet

Abstract

Background Anorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited. Objectives This programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness. Methods WP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England. Results WP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitiv

36. Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial

Author

Hibbs, Rebecca, Magill, Nicholas, Goddard, Elizabeth, Rhind, Charlotte, Raenker, Simone, Macdonald, Pamela, Todd, Gill, Arcelus, Jon, Morgan, John, Beecham, Jennifer, Schmidt, Ulrike, Landau, Sabine, Treasure, Janet, Hibbs, Rebecca, Magill, Nicholas, Goddard, Elizabeth, Rhind, Charlotte, Raenker, Simone, Macdonald, Pamela, Todd, Gill, Arcelus, Jon, Morgan, John, Beecham, Jennifer, Schmidt, Ulrike, Landau, Sabine, and Treasure, Janet

Abstract

Background Families express a need for information to support people with severe anorexia nervosa. Aims To examine the impact of the addition of a skills training intervention for caregivers (Experienced Caregivers Helping Others, ECHO) to standard care. Method Patients over the age of 12 (mean age 26 years, duration 72 months illness) with a primary diagnosis of anorexia nervosa and their caregivers were recruited from 15 in-patient services in the UK. Families were randomised to ECHO (a book, DVDs and five coaching sessions per caregiver) or treatment as usual. Patient (n=178) and caregiver (n=268) outcomes were measured at discharge and 6 and 12 months after discharge. Results Patients with caregivers in the ECHO group had reduced eating disorder psychopathology (EDE-Q) and improved quality of life (WHO-Quol; both effects small) and reduced in-patient bed days (7–12 months post-discharge). Caregivers in the ECHO group had reduced burden (Eating Disorder Symptom Impact Scale, EDSIS), expressed emotion (Family Questionnaire, FQ) and time spent caregiving at 6 months but these effects were diminished at 12 months. Conclusions Small but sustained improvements in symptoms and bed use are seen in the intervention group. Moreover, caregivers were less burdened and spent less time providing care. Caregivers had most benefit at 6 months suggesting that booster sessions, perhaps jointly with the patients, may be needed to maintain the effect. Sharing skills and information with caregivers may be an effective way to improve outcomes. This randomised controlled trial (RCT) was registered with Current Controlled Trials ISRCTN06149665.

37. An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents.

Author

Rhind C, Bonfioli E, Hibbs R, Goddard E, Macdonald P, Gowers S, Schmidt U, Tchanturia K, Micali N, and Treasure J

Abstract

Background: There may be a link between anorexia nervosa and autism spectrum disorders. The aims of this study were to examine whether adolescents with anorexia nervosa have autism spectrum and/or obsessive-compulsive traits, how many would meet diagnostic criteria for autism spectrum disorder, and whether these traits are shared by parents., Methods: A total of 150 adolescents receiving outpatient treatment for anorexia nervosa or subthreshold anorexia nervosa and their parents completed the autism spectrum disorder and eating disorder sections of the Development and Well-being Assessment. Patients also completed the Children Yale-Brown Obsessive-Compulsive Scale and other measures of psychiatric morbidity, and parents completed the short Autism Quotient and Obsessive-Compulsive Inventory Revised., Results: Adolescents with anorexia nervosa had a below average social aptitude (19% below cut-off) and high levels of peer relationship problems (39% above cut-off) and obsessive-compulsive symptoms (56% above cut-off). Six cases (4%, all females) were assigned a possible (n = 5) or definite (n = 1) diagnosis of autism spectrum disorder. Parental levels of autism spectrum and obsessive-compulsive traits were within the normal range., Conclusions: This study suggests that adolescents with anorexia nervosa have elevated levels of autism spectrum traits, obsessive-compulsive symptoms, and a small proportion fulfil diagnostic criteria for a probable autism spectrum disorder. These traits did not appear to be familial. This comorbidity has been associated with a poorer prognosis. Therefore, adaptation of treatment for this subgroup may be warranted., Trial Registration: Controlled-trials.com: ISRCTN83003225. Registered on 29 September 2011.

Published
2014
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