Eating Disorders, Self Regulation and Mentalization
Condition: Eating Disorders
MeSH terms: Feeding and Eating Disorders
Study type: Interventional

Summary: 
      A randomized blinded feasibility study using the Eating Attitudes Test (EAT-26) and the
      Reflective Functioning Questionnaire RFQ - as the main outcome to assess two interventions
      for eating disorders. Six experienced therapists, and their consecutively 8-9 admitted
      clients, were randomly allocated to the intervention group and control group. The sample
      included a total of 52 participants, all women, mean age 24.2 yrs. old. In the intervention
      group, participants received mentalization-based psychotherapy with ECOSA - a novel developed
      mentalization tool and in the control group, participants received interpersonal
      psychotherapy that focused on resolving interpersonal problems and symptomatic recovery. Four
      randomized samples for each participant were checked for therapy-focused fidelity by two
      different psychotherapists.
    

Detailed description: 
      Six experienced therapists (more than 10 yrs. in the eating disorders' treatment) within one
      eating disorder center, were randomly allocated using the excel randomization function to the
      intervention group and control group. All participants in the clinical sample were drawn
      consecutively from admitted population to these therapists in a community-based eating
      disorder center between September 2018 to April 2019. The sample (total of 52 patients)
      included 26 participants in each group, all women, (mean age 24.2±3.2). Forty two percent of
      participants in each group were diagnosed with BN, 13% with BED, 35% with AN and 10% with
      ARFID. Thirty percent of participants in each group, also met criteria for borderline
      personality disorder on the SCID-II .The overall sample had predominantly high socioeconomic
      status.

      Each therapist received a written consent from 8 to 9 clients to participate in the study and
      record all sessions. The research student, who collected the data was blind to treatment
      groups. Therapists and participants were blinded to the research aims and hypothesis.

      In the intervention group, therapist received mentalization-based supervision along all
      participants' treatments, with the suggested tool and facilitated mentalization-focused
      therapy. The control group's participants received ITP-interpersonal psychotherapy that
      focused on resolving interpersonal problems and symptomatic recovery. The control group's
      therapist received regular supervision - with no emphasis on mentalization or tool's usage.

      Participants' sessions were recorded over 12 months of treatment. Four randomized samples for
      each participant were checked for therapy-focused fidelity by two different psychotherapist
      Measures All participants underwent on entry a standard assessment of eating disorder,
      including a semi structured interview to measure co-morbid disorders, by experienced
      psychologist. Participants in both groups completed the Eating Attitudes Test (EAT-26) and
      the Reflective Functioning Questionnaire RFQ as part of a larger assessment battery.

      The EAT-26 is a self-administered questionnaire that reveals abnormal eating behaviors. It
      consists of 26 items with six components scored from 0 to 3 (Zero: "Never," "Rarely," and
      "Sometimes"; 1: "Often"; 2: "Very often"; and 3: "Always"). The total score range from 0 to
      78, and a score ≥ 20 is considered to represent abnormal eating attitudes or behaviors. The
      Cronbach's alpha in this study ranged between 0.75-0.90.

      The RFQ was developed as a brief, easy-to-administer screening measure to assess severe
      impairments or imbalances in mentalization capacities. It includes 8 items scaled on 7-point
      Likert-type scale scored from 0 to 3. High values on this scale indicate high uncertainty
      about mental states, hence difficulties with mentalizing. The Cronbach's alpha in this study
      ranged between 0.8-0.94.

      Statistical analysis All analyses were conducted using SPSS 23®. Normality distributions and
      outliers for each outcome variable were examined prior to commencing analysis. Independent
      T-tests analysis was used to assess differences between groups at baseline and between
      groups' improvements. Paired T-tests within each group used to assess the improvement between
      baseline, and 12 months treatment. Pearson correlations were computed to assess the
      relationship between change in eating disorder's symptoms and change in mentalizing
      capacities.
    

Intervention name(s): Mentalization -based therapy using novel tool to demonstrate eating behavior and control axis
Intervention type(s): Other
Intervention description(s): To address the gap between theory and practice in the treatment of eating disorders we y developed a novel axis, ECOSA, to better conceptualize the complex interaction between eating style, control conditions, and the impact of the "emotional brain" versus the "thinking brain". A randomized pilot study was used to evaluate the integration of this tool in a mentalization-based treatment compared to treatment as usual (IPT).
Methods: The suggested tool was tested in a randomized blinded feasibility study using the Eating Attitudes Test (EAT-26) and the Reflective Functioning Questionnaire RFQ - as the main outcome.
Other intervention name(s): IPT - interpersonal psychotherapy
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: Six experienced therapists (more than 10 yrs. in the eating disorders' treatment) within one eating disorder center, were randomly allocated using the excel randomization function to the intervention group and control group. All participants in the clinical sample were drawn consecutively from admitted population to these therapists in a community-based eating disorder center between September 2018 to April 2019.
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: eating disorders; self-regulation; self-control; Mentalization