Archive for April, 2009

Anorexia Nervosa and Autism Spectrum Disorder Link?

We saw this recent article in New Scientist about some links between Anorexia Nervosa and Autism Spectrum Disorder, particularly in some of the thinking styles.

Janet Treasure, PhD FRCP FRCPsych, a researcher and clinician in London, who spoke at the Center for Eating Disorders Symposium in 2008, has been researching this concept and has found that more than 1 in 5 individuals with Anorexia meet criteria for Autism Spectrum Disorder.  The Autism Society of America  states that Autism is reported to be found in 1 to 1.5 million Americans. As you can see, this represents a significantly higher rate in those with Anorexia then in the general public. With this information, additional research has been done to look at these thinking patterns, and potential therapies that may assist in working with these patterns.

The Center for Eating Disorders thinks that while more research is necessary, this study holds promise and we plan to keep our eyes and ears open for additional findings. Stay tuned to our blog for more information as it becomes available!

Published by Sarah Blake
April 25th, 2009 in Editor's Picks, In the News
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Q & A with Michael Levine, Ph. D.

Dr. Levine is a gifted speaker and the co-author The Prevention of Eating Problems and Eating Disorders: Theory, Research, and Practice.  He is the Samuel B. Cummings Jr. Professor of Psychology at Kenyon College and former chair of the Psychology Department. In addition, Dr. Levine received the Lori Irving Award for Eating Disorders Prevention and Awareness and the Meehan-Hartley Award for Leadership in Public Awareness and Advocacy. He is currently a Fellow of the Academy for Eating Disorders.

Last year, Dr. Levine provided us with an excellent presentation entitled “What are we waiting for?” The Necessity of Universal and Selective Approached to Preventing Disordered Eating. The feedback was so good, we brought him back this year to discuss, “Mass Media, Eating Disorders and the Bolder Model of Treatment, Prevention, and Advocacy. Dr. Levine joins us today to answer a few questions about eating disorder prevention, explain a little about what the Bolder Model of Treatment is and to explain the risks involved in a poorly constructed eating disorder prevention program.

Can eating disorders really be prevented?  At what age is it best to begin implementing prevention efforts? The honest answer is that no one really knows yet whether eating disorders can be prevented, because long-term longitudinal studies have not yet been conducted. There is substantial evidence that some risk factors can be reduced — and some protective factors (such as media literacy) increased — over a one-to-two-year period. It is probably best to begin full-blown prevention efforts around the ages of 6 or 7. At this age, we can begin to promote eating a variety of foods (including fruits and vegetables), to facilitate an active life style, to promote multiple competences, and to reduce weight-and-shape-based discrimination and teasing.

What is the Bolder Model of treatment, prevention and advocacy?  Where did it originate?

The “Boulder [Colorado] Model” of clinician-practitioner training, better known as the standard “scientist-practitioner model” informs current Ph.D. programs in Clinical and in Counseling Psychology. It was developed in the late 1940’s as the first Ph.D. programs in clinical psychology were being developed. The “Bolder” model of treatment, prevention, and advocacy was developed in the late 1990’s by the late Dr. Lori Irving and Michael Levine. It takes the feminist dictum that “the personal is the political” (and vice versa) and adds the professional element. An introduction to this approach may be found in:

Irving, L. (1999). A bolder model of prevention: Science, practice, and activism. In N. Piran, M.  P. Levine, & C. Steiner-Adair (Eds.), Preventing eating disorders: A handbook of interventions and special challenges (pp. 63-83). Philadelphia: Taylor & Routledge.

What are the signs of an ineffective or detrimental prevention program?

Ineffective programs, some of which are potentially detrimental, tend to treat students as ignorant and easily led astray by culture. These unhelpful programs tend to lecture at students so as to provide them with frightening information that is designed to deter them from, for example, extreme dieting. These programs run the risk of being a waste of time, and, worse of being either voyeuristic (e.g., “look at the horrible, thin anorexic people”) or of inadvertently promoting unhealthy means of weight management. One prominent sign of an ineffective program is students who are disinterested because they do not see the issues as having anything to do with them.

Contrary to that, what major elements make up a successful approach to eating disorder prevention?

My review (Levine & Smolak, 2006) of every published and unpublished study that I could locate failed to reveal consistent elements in the successful programs. That said, I believe that the most successful programs have more (rather than less) of the 5 C’s:  Consciousness-raising in regard to personal, social, and cultural influences on body image and eating; Connection-building, that is, fostering of relationships between students and between students and positive adult mentors; Competence-building, that is, the development of life skills such as stress management and assertive communication; and Change via Choice, such that participants in the program are encouraged to put their knowledge, connections, and competencies to work changing unhealthy personal, social, and cultural practices. The work toward these changes must reflect choices and other input that the participants provide.

Levine, M. P., & Smolak, L. (2006). The prevention of eating problems and eating disorders: Theory, research, and practice. Mahwah, NJ: Lawrence Erlbaum Associates.

Many thanks to Michael Levine for giving us a glimpse into what is needed for a  prevention program to be successful and at what point prevention can begin. This is such an important topic, as developing solid, valid prevention programs is the aim of so many professionals working in the eating disorder field. We look forward to hearing Michael share more about this topic on Saturday – April 18th at our annual symposium. If you have not yet registered, but would still like to come, you can register for this event, by visiting our Events Page. 

Published by Sarah Blake
April 14th, 2009 in Celebrity Topical News
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Q & A with Judith Banker, MA, LLP, FAED

In addition to being the founder and Executive Director of an eating disorder treatment center, Judith Banker currently serves as President of the The Academy for Eating Disorders (AED), a global professional association dedicated to promoting excellence in eating disorder education, training, treatment, research and prevention.   She has lectured internationally on eating disorder treatment, and we are honored to welcome her to Baltimore for the Center for Eating Disorders’ annual professional symposium, Eating Disorders: State of the Art Treatment.   During this year’s symposium on April 18, 2009, Ms. Banker will deliver her presentation, Dynamic Tension to Dynamic Strength:  Integrating Research and Practice in the Treatment of Eating Disorders. For a sneak peak at her presentation, check out today’s blog in which Ms. Banker offers insight into the ” research-practice gap”  and why it is such an important issue for eating disorder professionals to learn about.

Ms. Banker, how would you define the term “research-practice gap”?  Is it unique to the field of eating disorder treatment?

The term research-practice gap (RPG) refers to a complex gap in attitudes, systems, knowledge and dialogue between those who primarily conduct research and those in direct practice who provide treatment to individuals and families. The RPG is not at all unique to the field of eating disorders- it occurs in most fields with a strong science and research-driven component.

What are some of the underlying causes of this gap between research and practice?

The RPG is driven by a combination of forces and conditions.  These can include, 1) a lack of opportunities for researchers and clinicians to interact and engage in dialogue about treatment issues, 2) a lack of training programs that promote a scientist-practitioner model,  3)  the use of different jargon by those in research and those who practice clinically, and 4) practical conditions such as a lack of time, funding and support for professionals to participate in both research and practice.

Why do you feel this is this an important area of study for eating disorder professionals?

There are many gaps in the knowledge base in our field. The lack of dialogue and contact between researchers and practitioners can be detrimental to both parties and to our patients.  When therapists and providers don’t have a chance to communicate to researchers, it results in the loss of important clinical observations that could help to inform the research.  Similarly,  when the research findings do not reach clinical settings, it means treatment providers are not always implementing the most effective treatments in their practice.  In the end, it is the quality of patient care that suffers. We need research-practice integration to build our knowledge base and to develop the very best, most effective treatments for people with eating disorders and their families.

In addition to attending your workshop on April 18th, where can clinicians and treatment providers go to learn more about your research and the work you have done around this issue? 

AED Past President, Kelly Klump, and I wrote a chapter on the RPG that is available in a book edited by Ida Dancyger, PhD & Victor Fornari, MD, entitled, Evidence Based Treatments for Eating Disorders: Children, Adolescents and Adults (Nova Science Publishers, 2009). 

Additionally, the AED has created a listserv that is open to all members for discussion regarding causes and solutions for the RPG.  The AED also sponsors annualGlobal Think Tank sessions at the AED International Conference on Eating Disorders where attendees can address how to promote research-practice integration in our field.  Eating disorder professionals can learn more about these opportunities at www.aedweb.org.

Many thanks to Judith Banker for taking the time to offer her knowledge in regards to the Research-Practice Gap.  It is clearly a relevant topic that, for the purpose of improving and advancing treatment for individuals with eating disorders, deserves more attention from professionals in the field.  We hope many of you will be able to find out more during Ms. Bankers presentation at The Center for Eating Disorders’ annual symposium on April 18, 2009.  To register for this event, please visit our Events Page. 

Published by Sarah Blake
April 9th, 2009 in Celebrity Topical News
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Q & A with Stewart Agras, M.D.

On April 18th, 2009  Dr. Stewart Agras will be among five national speakers to present in Towson, Maryland at The Center for Eating Disorders’ annual professional symposium, Eating Disorders: State of the Art Treatment.  Dr. Agras is currently a Professor Emeritus of Psychiatry at Stanford University School of Medicine and has made significant contributions to the field of eating disorder treatment through his extensive research over the last twenty years.   At this year’s symposium, Dr. Agras will deliver the most up-to-date treatment information for professionals in his talk,  Improving the Treatment of Bulimia .  He responded to some of our questions about this topic and we’ve posted them in today’s blog.  

Dr. Agras, how have the treatments for bulimia nervosa changed and progressed over time?  What do you think has driven these changes? 

“When the number of individuals with bulimia began to increase in clinics during the 1970’s no treatment for bulimia nervosa had been described in the literature.  This led researchers at Oxford University (UK) and Stanford to develop cognitive-behavioral therapy based, in part, on clinical insights into the disorder and using elements from the behavioral treatments of binge eating and depression. Subsequent research studies over the years refined the treatment, adding elements such as attention to interpersonal triggers of binge eating.  Hence, the changes were largely driven by research studies and more extensive clinical experience with this difficult patient group.”

Why is cognitive behavioral therapy (CBT) considered the “treatment of choice” for bulimia nervosa? 

“A fairly large number of controlled studies have shown that CBT is more effective than medication (both tricyclic antidepressants and SSRI), supportive-expressive psychotherapy, stress management, and interpersonal psychotherapy (IPT).  However, in a large-scale controlled trial interpersonal therapy was as effective as CBT at 1-year follow-up.  Hence, the evidence clearly suggests that CBT is the treatment of choice and that it will act more quickly than IPT.”

What is guided self-help (GSH) and is it beneficial for patients who are struggling with bulimia nervosa? 

“Guided self-help is a shortened version of CBT in which the patient is encouraged to read a book describing the disorder and its treatment and is “coached” by a therapist in brief 20-30 minute sessions. Within the session the emphasis is on using the book to solve problems.  A number of small scale trials have shown that GSH is about as effective as full CBT, and one large-scale trial has confirmed this finding.  Hence, GSH is clearly effective for at least some patients who are struggling with bulimia nervosa, and the question arises whether GSH should be used as a first step in the treatment of bulimia nervosa.”

Many thanks to Dr. Stewart Agras for his responses and participation in today’s blog.  The Center for Eating Disorders is happy to present eating disorder professionals with the opporuntinity to hear Dr. Agras speak live at the symposium on April 18th.  Additionally, he has several recent publications that are available from Gurze Books online.

To download the symposium program brochure or to register for the April 18th symposium, please visit our events page.  This event is open to all professionals who treat patients with eating disorders and has been approved for 6.25 CEUs for physicians, nurses, psychologists, social workers and counselors and 6.5 credits for dietitians.  The discounted registration rate expires on April 10th and space is limited so don’t delay!  Please call (410) 938-4593 if you have any questions.

Published by Kate Clemmer
April 6th, 2009 in Celebrity Topical News
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