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Individual and group format adjunct therapy on social emotional skills for adolescent inpatients with severe and complex eating disorders (CREST-A)

Ergänzende Einzel- und Gruppentherapie zu sozialen emotionalen Fähigkeiten für stationäre jugendliche Patienten mit schweren und komplexen Essstörungen (CREST-A)

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Summary

Background

Relatively little is known about which psychological treatment adjuncts might be helpful for supporting people with the most severe and complex forms of anorexia nervosa (AN) with very low weight and malnutrition requiring inpatient admissions, but targeting key perpetuating factors such as social emotional difficulties may be one way to advance knowledge. This pilot feasibility project reports on the development of an adolescent adaptation of Cognitive Remediation and Emotion Skills Training (CREST-A) and explores its acceptability, feasibility and possible benefits.

Methods

An uncontrolled, repeated measures design was employed with data collected at the start and end of treatment. CREST‑A was investigated in two formats: a 10-session individual format delivered to a case series of 12 patients and a 5-session group format delivered to 3 groups of 9 patients.

Results

Acceptability, measured using a Patient Satisfaction Scale was 7/10 for the individual and 6/10 for the group format. Individual take-up was 100% and group take-up was 34.62%. Drop-out was 8.33% and 29.63% in the individual and group formats respectively. Homework was completed 66.67% and 75% of the time in the individual and group formats respectively. Patients reported medium-sized improvements in components of social emotional functioning measured using the Work and Social Adjustment Scale, the Toronto Alexithymia Scale and the Revised Social Anhedonia Scale in the individual and group formats.

Conclusion

Future studies employing randomized controlled designs may now be warranted to advance this evidence base of this low intensity treatment adjunct.

Zusammenfassung

Grundlagen

Es ist relativ wenig darüber bekannt, welche psychologischen Zusatzbehandlungen dabei helfen könnten, Menschen mit den schwersten und komplexesten Formen der Anorexia nervosa (AN) mit sehr geringem Gewicht und Unterernährung, die eine stationäre Aufnahme erfordern, zu unterstützen. Der Fokus auf die wichtigsten fortbestehenden Faktoren, wie z. B. soziale emotionale Schwierigkeiten, könnte jedoch ein Weg sein, die Kenntnisse diesbezüglich zu erweitern. Dieses Pilotprojekt berichtet über die Entwicklung einer Anpassung des CREST‑A (Cognitive Remediation and Emotion Skills Training) an Jugendliche und untersucht dessen Akzeptanz, die Durchführbarkeit sowie den möglichen Nutzen.

Methoden

Ein unkontrolliertes, wiederholtes Messdesign mit zu Beginn und am Ende der Behandlung erhobenen Daten, wurde angewandt. CREST‑A wurde in zwei Formaten untersucht: ein Einzelformat mit 10 Sitzungen für eine Fallserie von 12 Patienten und ein Gruppenformat mit 5 Sitzungen für 3 Gruppen von 9 Patienten.

Ergebnisse

Die Akzeptanz, gemessen anhand einer Patientenzufriedenheitsskala, betrug 7/10 für das Einzel- und 6/10 für das Gruppenformat. Die individuelle Akzeptanz lag bei 100% und die Gruppenakzeptanz bei 34,62%. Die Abbrecherquote lag bei 8,33% im Einzel- und 29,63% im Gruppenformat. Die Hausaufgaben wurden in 66,67% bzw. 75% der Fälle im Einzel- bzw. Gruppenformat erledigt. Die Patienten berichteten über mittelgroße Verbesserungen bei den Komponenten der sozialen emotionalen Funktionsfähigkeit, die mit Hilfe der Arbeits- und Sozialanpassungsskala, der Toronto-Alexithymie-Skala und der revidierten sozialen Anhedonie-Skala in den Einzel- und Gruppenformaten gemessen wurden.

Schlussfolgerung

Zukünftige Studien, die randomisierte kontrollierte Designs verwenden, sind jetzt notwendig, um die Evidenzbasis für diese wenig intensive Zusatzbehandlung zu erweitern.

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Acknowledgements

Thank you to all patients who participated in the study and contributed to the development of this intervention.

Funding

Dr. Amy Harrison is supported by the Medical Research Council grant reference: MR/SO19707/1.

Prof. Kate Tchanturia is supported from the Medical Research Council grant reference: MR/S020381/1 and the Maudsley Charity.

Author information

Authors and Affiliations

  1. Department of Psychology and Human Development, University College London, 25 Woburn Square, WC1H 0AA, London, UK

    Amy Harrison

  2. Ellern Mede Service for Eating Disorders, Holcombe Hill, The Ridgeway, NW7 4HX, Mill Hill, London, UK

    Pamela Stavri

  3. Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK

    Kate Tchanturia

  4. Department of Psychology, Ilia State University, Tbilisi, Georgia

    Kate Tchanturia

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  1. Amy Harrison
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Correspondence to Amy Harrison.

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A. Harrison, P. Stavri, and K. Tchanturia declare that they have no competing interests.

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Harrison, A., Stavri, P. & Tchanturia, K. Individual and group format adjunct therapy on social emotional skills for adolescent inpatients with severe and complex eating disorders (CREST-A). Neuropsychiatr 35, 163–176 (2021). https://doi.org/10.1007/s40211-020-00375-5

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