Carers’ Needs Why?


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The evidence base for New Maudsley Method
Eating disorders are complex and impact on more than the individual. The cognitive interpersonal model developed by Professors Schmidt and Treasure describes the brain, body, psychological and social elements that cause eating disorders to be maintained and this forms the basis of the skill sharing intervention [1-3]. Evidence is accumulating about how the interpersonal factors develop and are maintained [4-10]
A variety of interventions based on the cognitive interpersonal model have been developed. These include workshops, individual family work and family self management using the books and videos. Evidence for their effectiveness has been gathered [11-14] and collated within a systematic review. Carer distress is improved, carer burden is reduced and expressed emotion is reduced by this intervention [15]. Also, as predicted by the model, these positive benefits are passed onto the people with eating disorders themselves. One study including many inpatient units across the UK found the addition of the self-management form of the intervention (ECHO) to support the carers of inpatients with anorexia nervosa was associated with fewer early readmissions [16] and better patient outcomes two years following discharge [17]. ECHO has also been added as an adjunct to treatment for adolescents where it reduced care giver burden and increased skills and had some benefits also for patients [18]. Further scientific evidence is accumulating but perhaps it is the voice of the participants carers and patients that is most compelling.

1. Schmidt, U. and J. Treasure, Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Br J Clin Psychol, 2006. 45(Pt 3): p. 343-66.
2. Treasure, J. and U. Schmidt, The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord, 2013. 1: p. 13.
3. Treasure, J. and B.P. Nazar, Interventions for the Carers of Patients With Eating Disorders. Curr Psychiatry Rep, 2016. 18(2): p. 16.
4. Stefanini, M.C., et al., Living with someone with an eating disorder: factors affecting the caregivers’ burden. Eat Weight Disord, 2018.
5. Salerno, L., et al., An examination of the impact of care giving styles (accommodation and skilful communication and support) on the one year outcome of adolescent anorexia nervosa: Testing the assumptions of the cognitive interpersonal model in anorexia nervosa. J Affect Disord, 2016. 191: p. 230-6.
6. Salerno, L., et al., A longitudinal examination of dyadic distress patterns following a skills intervention for carers of adolescents with anorexia nervosa. Eur Child Adolesc Psychiatry, 2016. 25(12): p. 1337-1347.
7. Quiles Marcos, Y., et al., The Spanish Validation of the Accommodation and Enabling Scale for Eating Disorders Among Carers: A Pilot Study. Eur Eat Disord Rev, 2015.
8. Anastasiadou, D., et al., A systematic review of family caregiving in eating disorders. Eat Behav, 2014. 15(3): p. 464-77.
9. Anastasiadou, D., et al., Psychiatric comorbidity and maternal distress among adolescent eating disorder patients: A comparison with substance use disorder patients. Eat Behav, 2017. 24: p. 74-80.
10. Anastasiadou, D., et al., The relationship between dysfunctional family patterns and symptom severity among adolescent patients with eating disorders: A gender-specific approach. Women Health, 2016. 56(6): p. 695-712.
11. Schmidt, U., et al., The Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC): Comparison of the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) With Specialist Supportive Clinical Management (SSCM) in Outpatients With Broadly Defined Anorexia Nervosa: A Randomized Controlled Trial. J Consult Clin Psychol, 2015.
12. Schmidt, U., et al., Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. Br J Psychiatry, 2012. 201(5): p. 392-9.
13. Schmidt, U., et al., Two-year follow-up of the MOSAIC trial: A multicenter randomized controlled trial comparing two psychological treatments in adult outpatients with broadly defined anorexia nervosa. Int J Eat Disord, 2016.
14. Pepin, G. and R. King, Collaborative Care Skills Training workshops: helping carers cope with eating disorders from the UK to Australia. Soc Psychiatry Psychiatr Epidemiol, 2013. 48(5): p. 805-12.
15. Hibbs, R., et al., Interventions for caregivers of someone with an eating disorder: A meta-analysis. Int J Eat Disord, 2015. 48(4): p. 349-61.
16. Hibbs, R., et al., 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. British Journal of Psychiatry Open, 2015. 1(1): p. 56-66.
17. Magill, N., et al., Two-year Follow-up of a Pragmatic Randomised Controlled Trial Examining the Effect of Adding a Carer’s Skill Training Intervention in Inpatients with Anorexia Nervosa. Eur Eat Disord Rev, 2016. 24(2): p. 122-30.
18. Hodsoll, J., et al., A Pilot, Multicentre Pragmatic Randomised Trial to Explore the Impact of Carer Skills Training on Carer and Patient Behaviours: Testing the Cognitive Interpersonal Model in Adolescent Anorexia Nervosa. Eur Eat Disord Rev, 2017.