"A proportion of those with eating disorders have also experienced traumatic events and ongoing symptoms of PTSD such as re-experiencing of the trauma and nightmares. We implemented an innovative trauma intervention called Imagery Rescripting (ImRs) to explore whether for those undergoing inpatient treatment for an eating disorder (in an underweight phase), it would be possible to treat the various trauma-related symptoms as well as the eating problems. Since this has not been investigated before, we asked the participants in this study to recount their experiences. Twelve participants who were underweight, reported a past history of trauma and were in an inpatient eating disordertreatment program participated in ImRs therapy intervention. One of these participant did not engage in the ImRs therapy because she discontinued the inpatient ED treatment. Analysis of interviews with these participants found that -although they were reluctant before the start of the treatment- the ImRs treatment during their inpatient admission had given them hope again. They added that it was important to have support from group members, sociotherapists and therapists. They shared a number of ways that the ImRs treatment could be adapted to people with eating disorders. Their experiences indicated that given these factors it was possible to treat PTSD during an underweight phase. This is important: until now, treatment for eating disorders has not specifically been trauma-focused and these tips have scope to improve the ImRs intervention and eating disorder treatment more broadly in the future."
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Background: In face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptomreduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy(web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists.Objective: This study aimed to investigate TA ratings measured at interim and after treatment, separately for patients andtherapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings;and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion.Methods: A secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eatingdisorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder nototherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping AllianceQuestionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclasscorrelations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists.A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predictedeating disorder pathology and therapy completion.Results: For treatment completers (128/170, 75.3%), the HAQ-total scores and HAQ-Helpfulness scores for both patients andtherapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7%), all HAQ scores decreasedsignificantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightlybetter after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatmentwere associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patientscores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulnessscores of therapists were positively associated with treatment completion.Conclusions: Our study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Ofparticular importance is patients’ confidence in their abilities as measured with the HAQ-Helpfulness subscale when predictingposttreatment eating disorder pathology and treatment completion.
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The aim of the study was to investigate if and how body image, taken from a contextual perspective, contributes to the eating disorder history. This qualitative study investigated the process of eating disorder development in eight elite women athletes in at-risk sports. The results showed that the relationship between eating disorder symptomatology and the sports environment was clearly recognized by the elite women athletes. Contextual body image, more specifically negative body-evaluations and upward body comparisons, appeared as an important factor in the development of eating disorders, particularly in the athletic context. It became clear that the two aesthetic and two endurance athletes as well as the two weight-class athletes in rowing described quite negative body evaluations in the context of sport, while some of them also recognized an impact of body image experiences in daily life. However, for both judokas, their eating disorder had nothing to do with their body image but was attributed to the weight-classes in their sport and accompanying weight making. Several unique trajectories and individual eating disorder histories were distinguished which confirms the value of taking a qualitative approach in investigating eating disorders in sport. We also discovered links between what the athletes had reported as contributors to their eating disorder history and how they told their stories by combining content analysis and narrative inquiry. Furthermore, the present study also highlights several critical aspects for prevention and treatment that should support sport federations and clinical sport psychologists in taking appropriate actions to deal more effectively with eating disorders in athletes.
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