Relapse prevention for eating disorders: a randomized controlled trial targeting weight-related self-esteem
thesisposted on 08.06.2021, 11:58 by Sarah M Royal
A high level of weight-related self-esteem (WRSE) at the end of eating disorder treatment is predictive of relapse. The first goal of this project was to develop a cognitive-behavioural intervention to target WRSE in partially remitted eating disorder clients to prevent relapse (WRSE protocol). The second goal (Study 1) was to conduct a pilot study to assess whether receiving the WRSE protocol leads to improvements in WRSE and related variables. The final goal of this project (Study 2) was to conduct a randomized controlled trial to determine whether the individual-based treatment added to treatment as usual (TAU) provided additional benefits to eating disorder clients, with respect to WRSE, eating disorder symptoms, and relapse. After the treatment manual was developed, 16 clients were recruited and administered the treatment protocol in Study 1. The results indicated that participants had significant improvements in levels of WRSE and related variables following treatment. For Study 2, 47 participants who had achieved behavioural symptom interruption were randomly assigned to either 1) TAU + WRSE protocol or 2) TAU. Results were mainly consistent across Complete Case and Last Observation Carried Forward procedures where participants who received the additional WRSE protocol had greater improvements in WRSE, body checking behaviour, and self-esteem. Groups did not differ with respect to body avoidance, general avoidance, fat talk, and other variables compared to participants who received TAU only. Multiple imputation procedures, which accounted for missing data, indicated no significant differences for all measured variables. Participants who completed the WRSE protocol had significantly greater adherence to their meal plan (i.e., less dietary restriction) compared to participants who only received TAU. Groups did not differ regarding level of binge eating and/or vomiting after the intervention period, and there were no differences in relapse between groups at 3-month follow-up. Overall, the newly developed treatment provided some benefit to eating disorder clients above and beyond TAU. However, the data appear to have been sensitive to attrition. Future research should include further refinement of the treatment protocol and evaluation across a longer follow-up period to assess its impact on relapse rates.