By: P. Scott Richards, PhD Director of Research
At 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 inpatients who were admitted to the Center for Change inpatient treatment program from January 1, 2000 through December 30, 2000. The data in Table 1 is based on the 76 patients who completed treatment and whose degree of improvement was rated by their therapists at the conclusion of treatment. The statistical analyses and conclusions presented in Tables 2 and 3 and Figures 1 through 11 are based on the patients who completed outcome measures both at admission (pre-treatment) and discharge (post-treatment). The number of patients varies somewhat (from 67 to 76) for these data because not all patients completed all of the outcome measures at both admission and discharge.
All Center for Change patients in 2000 were female. Thirty-one patients were diagnosed with Anorexia Nervosa, 28 with Bulimia Nervosa, and 15 with Eating Disorder (NOS). Fifty-three patients were also diagnosed with additional Axis I disorders, the most common of which were Mood Disorders (depression and/or anxiety disorders). The average age of the patients was 21.2 years; the age range was 13 to 46 years.
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 2000. 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’s treatment program milieu helps most patients gain control of and cease their disordered eating behaviors.
This conclusion is substantiated further by the data presented in Figure 4. Here it can be seen that on the Eating Attitudes Test (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 58.8 before treatment to 15.1 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 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 146.6 to 98.7. 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.
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, 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 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 27.8 to an average score of 42.8, 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 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’s life and the direction it is headed, feeling a sense of purpose and meaning in one’s life), patients’ scores increased from 39.3 to 49.5. 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 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 46.2 to 50.7. 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.
In the attached Tables 1 , 2 , and 3 , a more detailed statistical presentation of the outcome data for 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 3.04 which means that the average rating fell slightly above “participated much”. The therapists indicated that 26 patients participated and attempted to benefit from the treatment program “very much”, 31 participated “much”, 13 participated “somewhat”, 5 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 0.56 (between “never” and “rarely”), purging was 0.57 (between “never” and “rarely”), and restricting was 0.99 (“rarely”). The average therapist rating of “healthiness of the patients’ “beliefs and attitudes about food and body shape” at discharge was 2.51 (about midway between “somewhat healthy” and “healthy”). The therapists indicated that 7 patients had “very healthy” attitudes about food and body shape, 35 patients had “healthy” attitudes about food and body shape, 24 patients had “somewhat healthy” attitudes, 7 patients had “unhealthy” attitudes, and 2 patients had “very unhealthy” attitudes at discharge. The average patient “global improvement” therapist rating was 3.08 (a “much improvement” average rating). According to the therapists, 26 patients had improved “very much” during their inpatient stay, 34 patients had improved “much” during their inpatient stay, 11 patients had improved “some,” 3 patients had improved “very little,” and 1 patient had not improved at all.
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.
Table 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, 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 used laxatives. They also reported that they rarely binged, vomited, used diet pills or 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 Center.
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 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 indicate 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 felt better about the direction their lives are headed, compared to the start of treatment.
In conclusion, the outcome data collectively provide strong evidence that the majority of Center for Change patients improved significantly during their inpatient stay at the Center. 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. These data provide evidence that the Center for Change 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 significant changes in a short period of time.
1 Note: Numbers do not necessarily add up to 68 because some demographic data was not available for all patients.
2 Many of the reductions were close to or more than one standard deviation unit 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).