Category: Eating Disorders
Routine outcome monitoring (ROM) is essential for improving patient outcomes in psychotherapy (Gondek et al., 2016). A majority of available ROM measures either fail to assess ED-specific treatment outcomes or focus exclusively on weight, shape, and eating concerns without addressing underlying maintaining factors (e.g., experiential avoidance). This study sought to address these limitations and extend development of a brief, ED-specific ROM tool to be used with evidence-based ED treatment in a community setting. Psychometric properties of the preliminary 15-item measure have previously been reported (Espel, et al., 2016). In this study, twenty-two items were added to assess transdiagnostic and ED-specific symptom domains deemed pertinent to progress in treatment (e.g., engagement in maladaptive emotion-driven behaviors). The new, expanded measure was administered to 531 adolescent and adult female patients upon admission to and discharge from residential ED treatment; a subset of these patients (n=105) also completed the measure on a weekly basis to track progress throughout treatment.
Exploratory factor analysis yielded a 26-item, 5-factor solution (Cronbach’s α = .88; 44.9% of variance explained). Final subscale domains included: negative affect intolerance; weight & shape concern; overt ED behavior; use of effective coping skills (reverse-scored); & interpersonal functioning in the treatment community (reverse-scored). Results from multilevel modeling also demonstrated sensitivity to weekly change; significant linear (b = -0.87, SEb = 0.21, p < .0001) and quadratic (b = 0.09, SEb = 0.02, p < .0001) fixed effects of time on total scale scores were detected, such that patients demonstrated rapid early declines in symptoms that slowed toward discharge. Furthermore, residual change in subscale scores from admission to discharge was associated with residual change on validated assessment measures (association between weight & shape concern subscale and Eating Disorder Examination Questionnaire—Global: r = .73, p < .001; negative affect intolerance subscale and Multidimensional Experiential Avoidance Questionnaire: r = .66, p < .001).
Thus, this measure shows promise as an efficient ROM instrument for use in intensive ED treatment. Regular use of this specific and sensitive measure may help clinicians track patient progress and respond more rapidly to poor treatment response in intensive settings.
Hallie Espel– Doctoral Candidate, Drexel University, Philadelphia, Pennsylvania
James Boswell– Assistant Professor of Psychology, University at Albany, SUNY, Albany, New York
Heather Thompson-Brenner– Boston University
Shelby Ortiz– Research Coordinator, The Renfrew Center
Gayle Brooks– The Renfrew Centers, Inc.
Michael Lowe– Professor, Drexel University
Assistant Professor of Psychology
University at Albany, SUNY
Albany, New York