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Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial

  • Rebecca Hibbs (a1), Nicholas Magill (a2), Elizabeth Goddard (a3), Charlotte Rhind (a3), Simone Raenker (a3), Pamela Macdonald (a3), Gill Todd (a4), Jon Arcelus (a5), John Morgan (a6), Jennifer Beecham (a7), Ulrike Schmidt (a3), Sabine Landau (a2) and Janet Treasure (a3)...
Abstract
Background

Families express a need for information to support people with severe anorexia nervosa.

Aims

To examine the impact of the addition of a skills training intervention for caregivers (Experienced Caregivers Helping Others, ECHO) to standard care.

Method

Patients over the age of 12 (mean age 26 years, duration 72 months illness) with a primary diagnosis of anorexia nervosa and their caregivers were recruited from 15 in-patient services in the UK. Families were randomised to ECHO (a book, DVDs and five coaching sessions per caregiver) or treatment as usual. Patient (n=178) and caregiver (n=268) outcomes were measured at discharge and 6 and 12 months after discharge.

Results

Patients with caregivers in the ECHO group had reduced eating disorder psychopathology (EDE-Q) and improved quality of life (WHO-Quol; both effects small) and reduced in-patient bed days (7–12 months post-discharge). Caregivers in the ECHO group had reduced burden (Eating Disorder Symptom Impact Scale, EDSIS), expressed emotion (Family Questionnaire, FQ) and time spent caregiving at 6 months but these effects were diminished at 12 months.

Conclusions

Small but sustained improvements in symptoms and bed use are seen in the intervention group. Moreover, caregivers were less burdened and spent less time providing care. Caregivers had most benefit at 6 months suggesting that booster sessions, perhaps jointly with the patients, may be needed to maintain the effect. Sharing skills and information with caregivers may be an effective way to improve outcomes. This randomised controlled trial (RCT) was registered with Current Controlled Trials ISRCTN06149665.

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      Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial
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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Janet Treasure, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 103 Denmark Hill, London SE5 8AF, UK. E-mail: janet.treasure@kcl.ac.uk
Footnotes
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Declaration of interest

J.T. is a co-author of the book used in the ECHO intervention and receives royalties.

Footnotes
References
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Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial

  • Rebecca Hibbs (a1), Nicholas Magill (a2), Elizabeth Goddard (a3), Charlotte Rhind (a3), Simone Raenker (a3), Pamela Macdonald (a3), Gill Todd (a4), Jon Arcelus (a5), John Morgan (a6), Jennifer Beecham (a7), Ulrike Schmidt (a3), Sabine Landau (a2) and Janet Treasure (a3)...
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