Improving Patient Outcome in Group Therapy for Eating Disorders

Study Overview
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Brief Summary
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The current trial aims to investigate the impact of continuous feedback on dropout and outcome in group therapy. The hypothesis is that continuous feedback to patient and therapist on treatment progress and alliance will 1) increase adherence and 2) increase treatment outcome.

Detailed Description
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Background: In the psychotherapy of eating disorders, a dropout rate between 30% and 50% is reported internationally. The fact that up to half of the patients drop out of treatment calls for ways to improve it. Research shows that feedback to patient and therapist increases outcome and reduces the number of dropouts; however there is only three published works on the effect of feedback in eating disorders treatment. Therefore, the present trial, at the eating disorders unit at Stolpegaard Psychotherapy Centre, Gentofte, Denmark, may contribute to necessary improvements in the field. Objective: The current trial, which will be conducted from August 2012 to August 2014, aims to investigate the impact of continuous feedback on adherence and outcome in group psychotherapy. The hypothesis is that continuous feedback to patient and therapist on treatment progress and alliance will 1)increase adherence 2) increase treatment outcome. Method: The trial is set up in a randomized design with 159 patients allocated to a) treatment with feedback intervention or b) treatment as usual. Participants: The participants are diagnosed with Bulimia Nervosa, Binge Eating Disorder or Eating Disorder Not Otherwise Specified. Interventions: In the experimental group, two sets of feedback measures are added to the standard treatment: Outcome Rating Scale (ORS) and Group Session Rating Scale (GSRS). The ORS assesses areas of life functioning known to change as a result of therapeutic intervention. The GSRS assesses key dimensions of effective therapeutic relationships.

Official Title
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Feedback Versus no Feedback to Improve Patient Outcome in Group Psychotherapy for Eating Disorders: A Randomised Clinical Trial

Conditions
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Bulimia Nervosa (BN), Binge Eating Disorder (BED), Eating Disorder Not Otherwise Specified (EDNOS)

Intervention / Treatment
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* Other: Group psychotherapy
* Other: Group psychotherapy with feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 18 or older. BMI of minimum 20. Meet the diagnostic criteria for Bulimia Nervosa, Binge Eating Disorder or EDNOS according to DSM- IV. Exclusion Criteria: Acute suicidal risk. Psychosis. Severe depression. Abuse of alcohol, medicine and/or narcotics up to 3 months before referral. Use of cannabis once a month is accepted at intake but must stop during treatment. Concomitant psychotherapeutic/ psychiatric treatment outside Stolpegaard Psychotherapy Centre. Severe or non-regulated physical co-morbidity. Pregnancy. Unable to understand Danish. Previous participation in the current trial. Considered unable to attend treatment sessions as planned. Lack of informed consent.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group psychotherapy<br>20 sessions of systemic and narrative group psychotherapy | Other: Group psychotherapy<br>* 20 sessions of systemic and narrative group therapy<br>|
| Experimental: Group psychotherapy with feedback<br>20 sessions of systemic and narrative group psychotherapy with session-to-session feedback to patient and therapist. | Other: Group psychotherapy with feedback<br>* 20 sessions of systemic and narrative group therapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adherence | Treatment adherence in the intervention period defined as a rate, i.e., number of attended therapy sessions divided by the number of planned therapy sessions. If a patient ends therapy prematurely, and this is in accordance with the therapists, the number of attended sessions will be set equal to the planned number of sessions. | At end of treatment. Participants will be followed for the duration of treatment, an expected average of 20 weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Eating Disorders Examination Interview |  | At intake, end of treatment and follow-up. Participants will be followed for the duration of treatment and follow-up, an expected average of 3 years. |