By: P. Scott Richards, PhD Center for Change Director of Research

Introduction

At the Center for Change, we use a variety of measures to assess patients’ progress. We assess specific eating disorder symptomatic behaviors such as bingeing, purging, and food restriction as well as beliefs about food, dieting, body shape, and so on. We also assess patients’ general psychological and spiritual functioning by using measures of depression, anxiety, self-esteem, interpersonal relations, social role functioning, loneliness, and spiritual well-being. All patients are assessed on the above dimensions when they are admitted to our inpatient treatment program and, if possible, when they are discharged from the program.

The following outcome summary documents the types and amounts of change patients who were admitted to the Center for Change in-patient treatment program from January 1, 1999 through December 30, 1999. The statistical analyses and conclusions presented in Figures 1 through 11 and in Tables 2 and 3 are based on the 57 patients who completed outcome measures both at admission (pre-treatment) and discharge (post-treatment). The therapist ratings of the patients’ progress in Table 1 is based on 60 patients who completed treatment at the CFC in 1999.

Center for Change Inpatient Demographics1

All Center for Change patients in 1999 were female. Twenty-three patients were diagnosed with Anorexia Nervosa, 20 with Bulimia Nervosa, and 18 with Eating Disorder (NOS). Fifty-eight patients were also diagnosed with additional Axis I disorders, the most common of which were Mood Disorders (depression and/or anxiety disorders). Ten patients were also diagnosed with an Axis II Personality Disorder. The average age of the patients was 21 years; the age range was 14 to 46 years. All 60 patients were white. In regards to religious affiliation, 35 patients were Latter-day Saints, 6 were Protestant, 4 were Roman Catholic, and the affiliation of 13 patients was unknown. Fifty patients were single, 5 were married, and 4 were divorced. Thirty-two patients were college graduates, 12 had completed some college, 9 had completed high school, and 3 had not yet graduated from high school.

Outcome Summary

Figures 1 through 11 illustrate in graphical form the types and amounts of changes achieved by patients who were admitted and completed treatment at the Center during 1999. Figures 1 through 3 are based on patients’ self-reports and show that the frequency with which patients engaged in the most common eating disorder behaviors (bingeing, purging, and restricting their eating) drastically declined during their participation in the Center for Change inpatient program. The Center for Change treatment program milieu helps most patients gain control of and cease their disordered eating behaviors.

Figure 1

      Reductions in Weekly Frequency of Bingeing

Center for Change Outcomes

   Before Treatment         After Treatment

Figure 2

      Reductions in Weekly Frequency of Purging

Center for Change Outcomes

     Before Treatment         After Treatment

Figure 3

     Reductions in Weekly Frequency of Restricting Eating

Center for Change Outcomes

     Before Treatment         After Treatment

This conclusion is substantiated further by the data presented in Figure 4. Here it can be seen that on the Eating Attitudes Teat (EAT), a standardized measure of eating disorder symptoms (e.g., anxiety about eating, preoccupation with food, vomiting, dieting, weighing oneself frequently, etc), Center for Change patients’ scores declined from 61.69 before treatment to 16.82 after inpatient treatment. This is a very large decline in eating disorder symptoms and concerns; in fact, scores falling below the line drawn horizontally across the graph fall into the normal range (that is, women without eating disorders score 30 and below on the EAT). Thus, on the average, when they complete inpatient treatment, Center for Change patients’ concerns about food, dieting, and weight are much less intense and are within the normal range for women.

Figure 4

Reductions in Eating Disorder Symptoms as Measured by the
Eating Attitudes Test
(e.g., anxiety about eating, preoccupation with food, vomiting, dieting, weighing oneself frequently)

Center for Change Outcomes

     Before Treatment         After Treatment

Figure 5 illustrates that on the Body Shape Questionnaire, a standardized measure of women’s concerns about their body shape and size (e.g., feeling too fat, wanting to be thinner, feeling ashamed of one’s body, etc), Center for Change patients’ scores declined from 145.4 to 88.8. This is a large decline, and it can again be seen that on the average, when they complete inpatient treatment, Center for Change patients’ concerns about their body shape and size are much less intense and are within the normal range for women.

Figure 5

Reductions in Unhealthy Perceptions of Body Image and Shape as Measured by the Body Shape Questionnaire
(e.g., feeling too fat, wanting to be thinner, feeling ashamed of one’s body)

Center for Change Outcomes

          Before Treatment         After Treatment

Figures 6 through 8 illustrate that on the Outcome Questionnaire (OQ45.2), a standardized measure of psychiatric symptoms (i.e., depression, anxiety, and substance abuse), interpersonal relationship distress (i.e., conflict and distress in relationships with family, spouse, and friends), and social role conflict (i.e., distress and inadequacy about one’s ability to perform social roles (i.e., at work, home, and in recreational settings), Center for Change patients’ scores declined from being clinically elevated (abnormal, disturbed range) to normal ranges. Thus, after participating in the Center for Change inpatient program, on the average, Center for Change patients’ psychiatric symptoms, interpersonal relationship distress, and social role conflict were all much less intense and were comparable to those of normal functioning people.

Figure 6

Reductions in Depression, Anxiety, and Substance Abuse Symptoms as Measured by the Outcome Questionnaire (OQ-45)

Center for Change Outcomes

      Before Treatment         After Treatment

Figure 7

Reductions in Relationship Conflicts with Spouse, Family and Friends as Measured by the Outcome Questionnaire (OQ-45)

     Before Treatment         After Treatment

Figure 8

Reductions in Dissatisfaction, Conflicts, and Inadequacy in Social Roles (work, family, leisure) as Measured by the Outcome Questionnaire (OQ-45)

Center for Change Outcomes

      Before Treatment         After Treatment

Figure 9 illustrates that on the Multidimensional Self-Esteem Inventory, a standardized measure of self-esteem (e.g., liking oneself, feeling lovable and accepted, perceiving oneself as competent, etc), Center for Change patients’ scores increased from a very low average score of 28.1 to an average score of 45.6, which is within the normal range. Thus, after participating in the Center for Change inpatient program, on the average, Center for Change patients’ feelings of self-esteem had improved significantly and were more comparable to the feelings of self-esteem reported by normal functioning college students.

Figure 9

Improvements in Global Self-Esteem as Measured by the Multidimensional Self-Esteem Inventory

Center for Change Outcomes

    Before Treatment         After Treatment

Figure 10 illustrates that on the Existential Well-Being subscale of the Spiritual Well-Being Scale, a standardized measure of life satisfaction and life direction (e.g., feeling satisfied with one” life and the direction it is headed, feeling a sense of purpose and meaning in one’s life), Center for Change patients’ scores increased from 38.3 to 47.5. This is a sizable increase and indicates that the patients’ feelings of life satisfaction and life direction became more positive and fell in the normal range after they had completed the Center for Change inpatient treatment program.

Figure 10

Improvements in Life Satisfaction and Direction as Measured by the Existential Well-Being Scale

Center for Change Outcomes

Before Treatment         After Treatment

Figure 11 illustrates that on the Religious Well-Being subscale of the Spiritual Well-Being Scale, a standardized measure of how people feel about their relationship with God (i.e., they believe that God loves them and is concerned about their well-being, they feel close to God and receive strength and comfort from their relationship with God), Center for Change patients’ scores increased from 43.2 to 49.7. This is a sizable increase and indicates that the patients’ feelings about their relationship with God became more positive and fell in the normal range after they had completed inpatient treatment at the Center for Change.

Figure 11

Improvements in Relationship with God as Measured by the Religious Well-Being Scale
(e.g., feelings of love and closeness to God, believing that God is concerned and supportive)

Center for Change Outcomes

      Before Treatment         After Treatment

In the attached Tables 1, 2, and 3, a more detailed statistical presentation of the outcome data for the Center for Change inpatients is presented. Table 1 summarizes therapist outcome ratings and measurements. The average “therapists’ ratings of the patients’ participation and effort in the treatment program” was 3.09 which means that the average rating fell slightly above “participated much.” The therapists indicated that 25 patients “participated and attempted to benefit from the treatment program” “very much,” 26 participated “much,”, 15 participated “somewhat,”, 2 participated “very little,” and no patients participated “not at all.” According to the therapists, at discharge the average frequency of bingeing for the patients was 0.40 (between “never” and “rarely), purging was 0.34 (between “never” and “rarely), and restricting was 0.81 (slightly less than rarely). The average therapist rating of “healthiness of the patients’ “beliefs and attitudes about food and body shape” at discharge was 2.37 (almost midway between “somewhat healthy” and “healthy”). The therapists indicated that 11 patients had “very healthy” attitudes about food and body shape, 26 patients had “healthy” attitudes about food and body shape, 31 patients had “somewhat healthy” attitudes, 5 patients had “unhealthy” attitudes, and 2 patients had “very unhealthy” attitudes at discharge. The average patient “global improvement” therapist rating was 2.74 (over halfway between a “much improvement” and a “some improvement” rating). According to the therapists, 11 patients had improved “very much” during their inpatient stay, 30 patients had improved “much” during their inpatient stay, 25 patients had improved “some,” 2 patients had improved “very little,” and there were no patients that had not improved at all.

Table 1

Therapist Ratings and Measurements

Variable Admission Discharge
Mean     SD Mean     SD     Rating Freq.
Patient’s Participation and Effort in the Treatment Program (4=very much; 3=much; 2=somewhat; 1=very little; 0=not at all) NA
3.09     .84      4:N= 25
3:N= 26
2:N= 15
1:N= 2
0:N= 0
Weekly Frequency of Behaviors (0=never; 1=rarely; 2=weekly; 3=daily; 4=several times per week):
Bingeing NA  0.40     0.63
Purging NA  0.34     0.64
Restricting NA  0.81     0.74
Healthiness of Patient’s Beliefs and Attitudes about Food and Body Shape (4=very healthy; 3=healthy; 2=somewhat healthy; 1=unhealthy; 0=very unhealthy) NA  2.37     0.83

4:N= 11
3:N= 26
2:N= 31
1:N= 5
0:N= 2
Patient’s Global Improvement (4=very much; 3=much; 2=some; 1=very little; 0=none) NA  2.74     0.77

4:N= 11
3:N= 30
2:N= 25
1:N= 2
0:N= 0

Overall, therefore, the Center for Change therapists were somewhat conservative in their ratings of patients’ progress. Though acknowledging that most of their patients had made progress during their inpatient stay, the therapists perceived that they were not yet “cured” and that they still had the need for further change and growth. According to the therapists, there was considerable variability between patients in regards to their progress. From the perspective of the therapists, some patients improved a large amount during their inpatient stay, but several patients benefited very little, perhaps due to their failure to participate fully in the treatment program.

Tables 2 presents the results of the client self-report data regarding their “eating disorder specific symptomology.” Table 2 begins with a presentation of the average “frequency of clients thoughts” about various unhealthy eating and dieting practices (e.g., thoughts about bingeing, vomiting, using laxatives, etc.) reported the first week of their admission compared to the last week they were in the inpatient program. It can be seen that the frequency of patients’ thoughts about unhealthy eating and dieting behaviors significantly declined during their stay in the inpatient program. By the time patients were discharged from the Center for Change, most of them rarely had thoughts about bingeing, purging, using laxatives, and so on. Not only were the reductions in frequencies of these thoughts statistically significant, but they were of the magnitude that we can conclude that the reductions in unhealthy thinking were clinically significant.2

The weekly frequency of unhealthy eating and dieting behaviors also significantly declined according to patients self-reports. As a group, the patients reported that they no longer vomited or used diet pills and laxatives. They also reported that they rarely binged, used enemas, restricted eating, spit out food, or skipped meals during the last week of treatment. Two standardized measures of attitudes and beliefs about eating, dieting, and body shape were also administered, the Eating Attitudes Scale and Body Shape Questionnaire. Again, the patients showed statistically and clinically significant improvement on both of these measures suggesting that, on the average, patients acquired much healthier attitudes and beliefs about food, dieting, and body shape during their inpatient stay at the CFC.

Table 2

Client Self-Report: Specific Eating Disorder Symptomology

Variable Admission Discharge
Weekly Frequency of Thoughts About: (0=never; 1=rarely; 2=occasionally; 3=often; 4=very often). Mean     SD Mean     SD     t-value
Bingeing 2.02     1.66 0.57     0.69     7.30***
Purging 2.51     1.69 0.94     0.91     7.87***
Using Laxatives 1.40     1.67 0.19     0.56     5.54***
Using Diet Pills 1.09     1.57 0.19     0.65     4.44***
Using Enemas 0.09     0.35 0.07     0.27     0.29
Restricting Eating 3.06     1.32 1.32     0.87     8.38***
Spitting out Food 1.77     1.61 0.30     0.64     7.68***
Skipping a Meal 3.00     1.33 0.83     0.99     10.69***
Weekly Frequency of Behaviors:
Binged 5.83     9.77 1.00     4.73     3.41***
Vomited 9.75     13.57 0.00     0.00     5.23***
Used Laxatives 1.32     3.59 0.00     0.00     2.68**
Used Diet Pills 1.75     5.23 0.00     0.00     2.44*
Used an Enema 0.00     0.00 0.66     1.22     3.93***
Restricted Eating 8.04     9.52 0.07     0.27     6.08***
Spit out Food 2.13     5.97 0.77     3.31     1.42
Skipped a Meal 4.59     5.16 2.27     3.49     2.60*
Standardized Testing:
Eating Attitudes Test 61.69     24.41 16.82     16.99     11.3***
Body Shape Questionaire 145.42     40.46 88.83     33.77     9.6***

* < .05; ** < .01; *** < .001

 

Table 3 presents patients’ self-reports regarding their psychological and interpersonal functioning. An examination of the means, standard deviations, and t-values reveals that the patients experienced, on the average, statistically and clinically significant improvement in their psychological and social functioning. The patients’ level of symptom distress (depression and anxiety) as measured by the OQ-45 outcome scale significantly declined. The patients’ level of psychological symptoms and distress had improved to normal levels at the time they were discharged from the CFC inpatient program. They had also shown significant improvements in their interpersonal relations and feelings about their ability to perform normal social roles-in fact, their scores again fell into the normal ranges on these scales. The Multidimensional Self-Esteem Inventory results indicate that the patients’ feelings of self-esteem, self-worth, and feelings of capability and competence significantly improved during their inpatient stay. In light of the clinical observation that low self-esteem and feelings of self-hate seem to be one of the root causes of eating disorders, the finding that the patients significantly improved in their self-esteem would seem to bode well for their continued growth and long-term progress. The Attitudes Towards Parents results indicates that the patients’ attitudes towards their mothers significantly improved during treatment (became less negative and resentful). The patients attitudes towards their fathers also slightly improved, although these changes were not statistically significant.

The patients’ scores on the Religious Well-Being scale significantly increased which indicates that the patients felt more positively about their relationship with God (they feel that God loves and helps them) at the conclusion of treatment compared to the start of treatment. The patients’ scores on the Existential Well-Being scale also significantly increased which indicates that the patients felt more meaning and purpose in their lives, and better about the direction their lives are headed, compared to the start of treatment.

Table 3

Client Self-Report: Psychological and Interpersonal

Variable Admission Discharge
Mean SD Mean SD t-value
Standardized Testing:
OQ45 Symptom Distress 51.25     16.42 28.15     11.65     10.77***
OQ45 Interpersonal Relat. 17.23     6.82 11.17     5.25     6.83***
OQ45 Social Role 15.47     5.11 9.30     3.77     7.91***
Multdimensional Self-Esteem Scale
Global Self-Esteem 28.15     12.80 45.58     11.89     7.91***
Competence 34.66     14.33 44.90     12.23     4.91***
Lovability 37.75     12.38 47.11     11.18     5.06***
Likeability 35.26     14.95 46.09     13.41     5.26***
Self-Control 30.91     14.75 43.05     11.98     5.09***
Power 38.06     13.34 47.62     12.39     5.71***
Moral Self-Approval 41.21     15.46 48.20     12.67     3.16**
Body Appearance 29.67     11.27 41.74     11.07     6.73***
Body Functioning 28.01     11.07 37.27     10.36     5.44***
Identity Integration 36.18     11.53 46.94     10.43     6.17***
Negative Attitudes Toward Father 28.40     26.83 25.82     25.05     1.10
Negative Attitudes Toward Mother 29.18     26.11 24.20     22.31     1.88*
Religious Well-Being 43.16     14.91 49.65     13.33     4.64***
Existential Well-Being 38.25     11.16 47.49     0.55     6.50***

* < .05; ** < .01; *** < .001

In conclusion, the outcome data collectively provide strong evidence that the majority of Center for Change patients got significantly better during their inpatient stay at the CFC. A small number of patients showed little improvement during their stay, but most of the patients made statistically and clinically significant improvements in terms of their disordered eating behaviors, beliefs, and attitudes as well as in their psychological, social, and spiritual functioning and well-being. Compared to the outcome data from 1996, 1997 and 1998, the patients that received treatment during 1999 as a group showed somewhat greater improvements on most measures, which supports the idea that the CFC inpatient program further improved in its’ effectiveness during 1999. These data also provide evidence that the CFC inpatient program successfully achieved its purposes with the majority of patients. That is, for most patients, the inpatient program gave them a “jump start” toward a healthier life by helping them make some make some significant changes in a short period of time.

1 Note: Numbers do not necessarily add up to 60 because some demographic data was not available for all patients.

2 Many of the reductions were close to or more than one standard deviation units in magnitude which is considered a large effect size; for example, a change of .85 standard deviation units indicates that at the end of treatment, the average treated person is better off than 80 percent of untreated patients (see Lambert & Bergin, Handbook of Psychotherapy and Behavior Change, Allen E. Bergin and Sol L. Garfield (Eds.), 1994, Wiley, New York, pp. 143-189).