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  • Underlying assumptions and core beliefs related to eating disorders in the mothers of overweight girls

    26 August 2018

    Little is known about the weight, shape and eating concerns of mothers with young, overweight daughters. Even less is known about how these relate to their daughters' concerns. In a small pilot study (18 mother-daughter pairs in each group), general concerns and specific beliefs related to eating disorders were assessed, both in the mothers of overweight girls and in the mothers of average weight girls. These were then compared with their daughters' concerns. The findings indicated that mothers with overweight daughters (aged 11 and 12 years) scored more highly than the mothers of average weight girls on both general concerns and specific beliefs (i.e., underlying assumptions about weight, shape and eating and negative self-beliefs) related to eating disorders. While assumptions in mothers were highly correlated with daughters' concerns in the average weight group, no such relationship was found in the overweight group. The findings are briefly discussed and suggestions are made for further research.

  • A specialist unit for difficult to manage patients: Preliminary findings

    26 August 2018

    Preliminary findings are reported from a specialist unit for difficult to manage patients (those patients who have severe behavioural problems in addition to a mental illness). Staff attitudes and residents' psychiatric and social needs were assessed after the unit had been open for just over a year. The effect on residents' behaviour and symptoms over the course of that year was also evaluated. Findings showed that staff attitudes were resident orientated and that interactions between staff and residents and of staff with each other were almost always positive. These findings compared favourably with data collected on three other continuing care units in the same Trust and with data from previously published studies. The Cardinal Needs Schedule, a recent adaptation of the MRC Needs for Care Assessment Schedule, appeared to be a useful way of identifying unmet needs of the residents and gaps in service provision. Over the course of the year, behaviour in one third of the residents improved sufficiently for them to be considered suitable for potential discharge into community based accommodation. Implications of the findings for specialist units for difficult to manage patients are discussed, together with suggestions for further research.

  • Selective memory bias in women with bulimia nervosa and women with depression

    26 August 2018

    Memory bias for weight and shape, and for food related words, was investigated in women with bulimia nervosa (12), women with depression (12) and female nonclinical controls (18). The aim of this study was to investigate whether women with bulimia nervosa demonstrate memory biases congruent with their primary concerns. Participants listened to target and control words. They performed a self-referent encoding task and recall memory was assessed. The results indicated that women with bulimia nervosa demonstrated a bias to recall positive and negative weight and shape related words compared to emotional words, but not compared to neutral nouns and body words. Memory biases for food related words were not found to be specific to women with bulimia nervosa, but were also found in women with depression. Contrary to previous research the recall bias for food related words was related to levels of hunger, in both groups. The findings provide partial support for memory biases for weight and shape, but not food related information in bulimia nervosa. These findings and their implications for existing research on information processing in eating disorders are discussed.

  • Cognitive Behavioural Models in Eating Disorders

    26 August 2018

    A number of cognitive behavioural (CB) models and approaches have been suggested for eating disorders (EDs). This chapter provides an overview of those that have been published and applied, highlighting their specific and enduring contributions in the context of current practice and understanding of EDs. Following a brief summary of the empirical evidence that supports these models, including relevant treatment outcome studies, the case for a change in approach, while maintaining a cognitive behavioural focus, is presented, together with a brief summary of the supporting evidence. The chapter then outlines a revised cognitive model of bulimia nervosa (BN), together with some preliminary suggestions for a revised, cognitive model or understanding of anorexia nervosa (AN). Diagrammatic formulations are presented and a case material is used to illustrate the two models. Relevant empirical support for the proposed revisions is presented, and the implications for future research are summarized. © 2012 John Wiley & Sons, Ltd.

  • A preliminary study of negative self-beliefs in anorexia nervosa: A detailed exploration of their content, origins and functional links to "not eating enough" and other characteristic behaviors

    26 August 2018

    Objective: The study explored the semantic content and origins of negative self-beliefs, and their functional links to "not eating enough" and other behaviors, in participants with anorexia nervosa (AN). Method: Fifteen women meeting DSM-IV criteria for AN were compared with 17 dieting and 18 non-dieting women matched on age and number of years of education. The main outcome measure was a semi-structured interview. Results: Six themes were identified in the beliefs of participants with AN. These were, in order of decreasing frequency, powerlessness (present in all but three AN participants), failure, defectiveness, unattractiveness, worthlessness and emptiness. Importantly, powerlessness and failure beliefs were consistently present independent of Beck Depression Inventory-II scores. The negative early life experiences associated with these beliefs had high distress and responsibility ratings. Participants with AN reported that they employed specific behaviors, particularly 'not eating enough,' and 'placating others,' to try to reduce the cognitive and emotional impact of their negative self-beliefs. Discussion: The findings are discussed in relation to the role of powerlessness and the function of "not eating enough" in cognitive theory and therapy for AN. © 2006 Springer Science+Business Media, Inc.

  • Can we prevent readmission? needs for care and gaps in service provision

    26 August 2018

    In a pilot study we aimed to assess needs for care (and gaps in service provision) in readmitted psychiatric patients. Semi-structured interviews using the Cardinal Needs Schedule were conducted, and case notes were examined. Most readmitted patients had many needs (clinical and social) that were not being met in the community. Psychological interventions were required to meet many of the clinical needs, while a broad range of interventions was required to meet social needs. There was a poor match between the needs identified by the Cardinal Needs Schedule and those identified at discharge planning.

  • Working with imagery to modify core beliefs in people with eating disorders: A clinical protocol

    26 August 2018

    Imagery is a relatively novel area of interest in eating disorders (EDs). Clinical experience and some research work indicate that rescripting of early memories may be a useful way to modify core beliefs in EDs. Relevant constructs, as applied in the current paper, are defined and described, including core beliefs, imagery rescripting, and early memories. Existing empirical research on the outcome of imagery rescripting of early memories is outlined, including in EDs. Relevant ED research on images and early memories in EDs is presented. A case is made for applying imagery rescripting to early memories in EDs. The origins and development of a clinical protocol are described. The aim of the protocol is to identify and rescript or modify early memories associated with the core beliefs characteristic of EDs. This process has also been applied in other disorders. Clinical examples illustrate the application of the protocol in EDs, including extracts of dialogue from a clinical case. The paper covers indications for use of the protocol, practical and ethical considerations, its suitability in individual cases, and some final practical tips. These include examples of useful questions to ask patients that facilitate successful rescripting of memories, and thus core belief modification. The paper concludes with some thoughts on future work. © 2011.

  • Adolescent inpatient treatment for anorexia nervosa: A qualitative study exploring young adults' retrospective views of treatment and discharge

    26 August 2018

    Objective: To explore young adults' views regarding: the inpatient treatment they received for anorexia nervosa during their adolescences; their experiences of discharge; and the impact their admission had on issues of control and low self-esteem. Method: Semi-structured interviews were conducted with seven young adults treated in general adolescent psychiatric units. Data were analysed using Interpretative Phenomenological Analysis. Results: Four super-ordinate themes emerged from participants' accounts: (1) Removal from normality versus connecting with the outside world; (2) Treated as another anorexic versus a unique individual in distress; (3) Control and collaboration; (4) The importance of peer relationships. Discussion: Findings unique to this study concerned a sense of feeling removed and disconnected from 'normality'; a feeling that one's developmental needs were not always addressed; and the importance placed on supportive relationships with fellow patients. It was also found that authoritarian approaches may compound patients' feelings of ineffectiveness, worthlessness and isolation. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.

  • A new pyramid of research knowledge for the NHS

    26 August 2018

    Background: Although the research and development (R&D) initiative in the NHS clearly encompasses a wide range of research activities, existing guidance emphasizes efficacy (explanatory) research, namely the generation of new knowledge under rigorous scientific conditions. Aims: We argue that this needs to be counter-balanced with an equivalent emphasis on effectiveness (pragmatic) research, being those activities that improve the effects of new knowledge within the NHS. Method: Treating the efficacy framework for complex interventions as one half of a research knowledge pyramid, we set out a parallel effectiveness (service improvement/evaluation) framework. Results: With the aid of local examples, we show how this pyramid approach can facilitate R&D training, specifically in relation to clinical psychology. Conclusions: Our pyramid of research knowledge redresses the current emphasis on explanatory research and indicates how we can apply a more balanced model, hopefully aiding professionals who teach or practise effectiveness research. Declaration of interest: None. © Shadowfax Publishing and Informa UK Ltd.

  • Assessing eating disorder thoughts and behaviors: The development and preliminary evaluation of two questionnaires

    26 August 2018

    This paper describes the development of two measures. The first is designed to assess eating disorder-related automatic thoughts; the second is designed to assess a wide range of eating disorder-related behaviors. Principal components analysis identified three dimensions of thoughts: positive thoughts about eating, negative thoughts about eating, and permissive thoughts. Principal components analysis also identified six dimensions of behavior related to: shape and weight, bingeing, dieting, food, eating, and overeating. Both measures possess promising psychometric properties, including good construct and criterion-related validity. Both successfully discriminated eating disorder patients from dieting and non-dieting groups. The two measures may be useful additions to those currently available to researchers (and clinicians) interested in eating disorders. © 2006 Springer Science+Business Media, Inc.