Part 1: Critical Review
The key aim of Fairburn, Christopher G., et al.’s “A Transdiagnostic Comparison of Enhanced Cognitive Behaviour Therapy (CBT-E) and Interpersonal Psychotherapy in the Treatment of Eating Disorders” published by Behaviour Research and Therapy is to understand eating disorders from a transdiagnostic perspective and examine the existing evidence on the efficacy of cognitive behavior therapy (CBT-E) in the treatment of the condition. The study compares various treatment methods (CBT-E and interpersonal psychotherapy) for eating disorders. This study’s result affirmed that the proposed CBT-E is a potent treatment method for the mentioned condition. The following critical review comprehensively analyses the mentioned article.
Design and Research Questions
The study relied on a randomized controlled trial of the selected patients or research respondents, and the design method was appropriate for it because it was effective in reducing certain biases while testing the efficacy of the treatment methods. For example, a randomized controlled trial can reduce selection and allocation biases through the free selection of participants. Furthermore, the design facilitated the random allocation of subjects to different groups for testing purposes. For instance, the randomized controlled trial was restricted to patients with eating disorders with a BMI (body mass index) of over 17.5 and under 40.0. Therefore, the randomized controlled trial is important for this article because it allowed all units in the specific population to have an equal chance of selection. However, a highly controlled environment did not clearly illustrate the effectiveness of the treatment methods. Furthermore, the design lacks clear integration of statements of hypotheses and research objectives. Lastly, the research questions are not clearly stated, which made it hard to formulate or identify clear objectives.
Recruitment of Participants
The recruitment has some flaws. The study relied on referrals from family doctors and other clinicians. The eligibility criterion for the referrals included the determination of a history of the patients’ eating disorders. However, the referrals possibly violated patient-doctor relationships in this study. In particular, the decision of the doctors and other relevant clinicians, such as senior eating disorder specialists, to provide details of their eating disorder patients to third parties for research purposes is not ethically justified because it violates the respondents’ privacy principles. Lastly, the researchers could have used random sampling or selection of the respondents to ensure fairness and rational decision-making.
Relevant Ethical Issues
While the study observed various ethical considerations, it had some ethical concerns too. For instance, the researchers requested that the participants sign a consent form after reading and understanding the purpose of the study. However, the decision to refer the patients to the research was unethical. Typically, doctors and clinicians can have undue influence on their patients to participate in the research. Lastly, the researchers could have asked the participants to respond honestly and confidentially to the treatment methods and questions.
Treatment or Measures
The measures used in this study aimed to monitor the modification of eating and weight-control behaviors among the selected respondents. However, the researchers failed to ascertain how the study would measure the effectiveness of the proposed treatment methods, such as interpersonal therapy. While the article used independent raters to establish the quality of the treatment methods, the researchers did not provide adequate justifications for the proposed treatment methods.
In essence, the assessment methods were effective and generated an accurate diagnosis of targeted eating disorders. The study relied on the 16th edition of the Eating Disorder Examination (EDE) interview to assess the treatment conditions. The researchers also used the EDE ratings to generate Operational DSM-IV diagnoses of bulimia nervosa and binge eating disorder.
Sample Size and Randomization
The sample size is not suitable. The researchers used a sample size of 65 participants per treatment condition. However, because of the sample’s non-random nature, the researchers could not generalize the results beyond the selected respondents. Typically, a good sample size should be representative. Moreover, the results generated from the selected respondents should capture accurate conditions in the targeted population. In this case, a random sampling method was appropriate because it could have resulted in higher sample size and a more representative outcome.
The analysis approach is inadequate for the research. The primary analysis method used in this research is the intent-to-treat (ITT). The ITT method is relevant because it integrated all the randomized participants using separate linear mixed models. In essence, the randomized participants in the study had equal chances of participation in the study. However, the analysis method was biased because it included only those participants considered fully competent for the treatment by their therapists and other clinicians. Besides, the generated outcomes failed to ascertain the potential impacts of the specific treatment methods. Lastly, while the Stata v13 software can generate comprehensive outcomes, it is applicable in general-purpose research. Thus, the analysis of results using the software could generate statistically insignificant conclusions.
Advantages and Disadvantages of the Study
The researchers do not provide clear descriptions of the advantages and disadvantages of the study. However, the main advantage of the research is that outcomes could enhance the treatment of eating behaviors.
Results and Discussion
The results section captures every important element of the research. For instance, the research included relevant descriptive statistical tables on different demographic data and information and treatment outcomes. The discussion section also provided clear information on the implications and efficacy of the research outcomes.
Part 2: Developments in the field
New developments have emerged in the clinical management and treatment of eating disorders since the publication of the article by Fairburn et al. For instance, there are new diagnostic and treatment methods of ED. These new developments are improving the provision of quality care and life to patients. Diagnostic criteria should provide clear guides on how individuals can identify specific signs, symptoms, and tests for certain conditions. In particular, the criteria should provide a true or accurate reflection of different characteristics of a disease.
The treatment of eating disorders varies depending on the severity of the patients’ conditions. The medications include specialized care, intensive clinical management of weight, and nutritional rehabilitation. Researchers are seeking to establish the potential benefits of various classes of medications in the treatment of signs and symptoms of eating disorders. Recent studies have suggested that certain antidepressants and antiepileptic drugs can reduce binge eating in patients with ED. For instance, a clinical trial involving the admission of zonisamide to ED patients revealed a significant reduction in eating disorder behaviors (Davis and Evelyn 10). Similarly, a clinical trial using antidepressant drugs, such as fluoxetine on ED patients, revealed a reduction in the frequency of binge eating (Lutter 617). The successful trial of these new medications will improve the health outcomes of eating disorder patients.
Practice guidelines such as NICE, which are relevant in the treatment of eating disorders, have been developed. NICE practice guidelines are evidence-based criteria for the provision of health and care to patients with specific conditions, and they provide an accurate assessment, treatment, and monitoring of patients. In the case of eating disorders, the primary objective of the practice guidelines is to improve the quality of care for patients (Rowe 833). The guidelines allow accurate identification of eating disorders, treatment methods, and co-morbidities. Chart 1 below is a NICE interactive flowchart for the treatment and management of eating disorders. Chart 2.NICE Interactive Flowchart
According to the practice guideline, people with suspected eating disorders should receive prompt and quality treatment. The chart also stipulates that adequate information and support can help reduce the stigma and shame associated with eating disorders. For instance, when assessing potential causes of eating disorders, professionals should engage immediate family members and caregivers to address various misconceptions and myths. Additionally, the NICE practice guidelines emphasize consent and confidentiality when working with eating disorder patients and close family members (Rowe 833). For example, professionals should maintain and respect a patient’s privacy and dignity by limiting access to treatment information to third parties. Overall, NICE practice guidelines are relevant in the treatment of eating disorders because they help clinicians to improve the quality of care.
Specialist Supportive Clinical Management (SSCM)
The SSCM is a new psychotherapeutic method that is relevant in the treatment of eating disorders. The criterion focuses on the clinical management of the condition to identify and eliminate disease symptoms. A therapist with expertise in the management of eating disorders designed the SSCM to optimize the treatment of eating disorders (Robinson et al. 549). The model combines various clinical management processes with supportive therapeutic environments. The primary objective of SSCM therapy is to establish the existing link or connection existing between the identified symptoms and the patients’ eating behaviors. The model also encourages the provision of adequate support to facilitate gradual changes in eating behaviors and weight. According to the SSCM model, the patients should play a critical in the elimination of unwanted behaviors. For example, the therapy allows patients to discuss their personal concerns and irrational beliefs that encourage their abnormal eating behaviors. Overall, the new treatment approach is more practical and supportive in its approach to eating disorder patients compared to other previous models, such as cognitive-behavioral therapy.
Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA)
This specialist integrative therapy model targets the treatment of different eating disorders, and it is effective because it addresses the patients’ cognitive, emotional, relational, and biological factors contributing to their eating disorders. Essentially, integrative therapy is unique because it can help individuals to identify some of the factors contributing to their behaviors, and gradually help them establish alternative and adaptive coping strategies (Byrne et al. 8). The treatment is majorly applicable to patients with extremely strict cognition, slow emotional procession, and low motivation. Furthermore, patients subjected to the MANTRA treatment model undergo between 20 and 40 sessions, depending on their specific needs and preferences, that address the patients’ fears, avoidant emotions, and encourage the development of positive beliefs. Indeed, professionals using MATRA should work based on the patients’ pace and treatment preferences. In conclusion, the MATRA model is a relevant treatment method because it emphasizes the suppression of highly expressed unwanted emotions and the accommodation of the patients’ conditions and feelings.
Neuromodulation and Neuroimaging
Neuromodulation describes the alteration of body nerve activities and nervous tissue functions through a focused delivery of certain electrical or chemical stimulation, and it is used to treat eating disorders. While the treatment method is old, recent advances in neuromodulation offer possible solutions to the treatment of mental health conditions such as eating disorders (Lutter 616). In particular, the new studies seek to understand how individual eating scales triggers depressive symptoms leading to EDs. The study also aims to normalize or modulate the responses of nervous functions and activities to individuals’ eating behaviors (Lutter 616). Similarly, new advances in neuroimaging aim to offer viable solutions to different eating disorders. In essence, the advancements are enhancing clinical knowledge of various neurobiological processes. For instance, through neuroimaging, clinical professionals are seeking to monitor the functioning and reactions of specific parts of the brain (prefrontal cortex) associated with eating disorders (Davis and Evelyn 9). The new development will enable professionals to control the responses of ED patients to images of food.
A neurobiological model for the Treatment of Eating Disorders
New advances in neurobiological studies seek to offer viable treatment options for eating disorders, such as binge eating. The studies aim to establish new treatment methods for eating disorders through an enhanced understanding of how etiological influences can impact the development of EDs (Hill et al. 31). The research could establish the specific role of temperament and brain alternation in the body’s ability to limit excessive food desires causing binge eating.
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Davis, Lauren E., and Evelyn Attia. “Recent Advances in Therapies for Eating Disorders.” F1000Research, vol. 8, 2019.
Fairburn, Christopher G., et al. “A Transdiagnostic Comparison of Enhanced Cognitive Behaviour Therapy (CBT-E) and Interpersonal Psychotherapy in the Treatment of Eating Disorders.” Behavior research and therapy, vol. 70, 2015, pp. 64-71.
Hill, Laura, et al. “Applying Neurobiology to the Treatment of Adults with Anorexia Nervosa.” Journal of eating disorders, vol. 4, no. 1, 2016, pp. 31.
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