The Center for Change eating disorder treatment program is based on cutting-edge research into eating disorders. The Center also conducts and publishes its own research on eating disorders, including on-going treatment outcome research. As new innovations in treating disorders are proven effective in research, they are implemented to enhance the Center for Change treatment programs.
In keeping with current research findings and clinical guidelines, and in order to provide the best possible services in the most cost-effective manner, Center for Change offers a multi-dimensional, multi-disciplinary, stepped-care treatment program. Each client who comes to the Center for treatment participates in an ongoing comprehensive assessment which begins with an evaluation of their physical status, eating disorder history, associated emotional and mental illness and difficulties, substance use patterns, developmental history, family history, and a thorough family interview. Based on this assessment, one or more levels of care will be recommended, and a treatment plan designed depending on the severity of the client’s symptoms.
About Eating Disorders and Treatment
Eating disorders are characterized by severe disturbances in eating behavior. Bulimia Nervosa is characterized by repeated episodes of binge eating followed by unhealthy compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. Anorexia Nervosa is characterized by refusal or inability to maintain a minimally normal body weight. Binge Eating Disorder is characterized by unhealthy patterns of eating food for emotional needs beyond feelings of hunger and nourishment. An unhealthy and inaccurate self-view of body shape and weight is an essential feature of both Bulimia Nervosa, Anorexia Nervosa and Binge Eating Disorder.
Experience and research show that individual, group, and family therapy in a warm and loving setting is superior to the sterile, impersonal atmosphere found in many hospitals. The Center for Change facility contains semi-private rooms with baths, a family-style dining room, kitchen, comfortable common living areas, individual and group therapy rooms, family visiting rooms and professional offices. The design of the Center provides patients with privacy while the residential decor and attitude of the Center’s specialized staff creates a warm, caring atmosphere.
The Center is situated on private property to afford maximum privacy and a magnificent view of the mountains. Grounds are beautifully landscaped to produce a peaceful, tranquil setting our clients can enjoy. Recreation areas are shielded by our building and offer adequate space to provide outside activities and the adjacent Wasatch mountains provide a beautiful, natural setting for recreational activities.
The Center’s primary focus is the treatment of women suffering from anorexia nervosa, bulimia nervosa and binge eating disorder. Related characteristics treated include mal-nourishment, body image disturbance, poor self-esteem, feelings of helplessness, family conflicts, and traumatic life events such as sexual trauma and other abuse. Other co-existing disorders such as depression, substance abuse, anxiety, OCD, post traumatic stress disorder, and diabetes are also treated. Center for Change specializes in the treatment of adolescent girls and adult women in its 24 hour care programs and treats both male and female patients in its multiple outpatient programs. Many of those treated have conditions that have progressed to the point where they are unable to function independently or effectively in their family, work, school or social settings. Center for Change provides excellent eating disorder treatment.
The Mission of Research Efforts at Center for Change
The mission of Center for Change research department is to conduct research and collect data that will (1) document the effectiveness of the Center’s treatment programs, (2) help increase the effectiveness of the Center’s treatment programs, (3) give the Center recognition in the eating disorders treatment field, and (4) contribute to new discoveries and better understanding about how to effectively treat eating disorders.
Values Guiding Center for Change Research
The personnel in Center for Change research department believe that it is essential for professionals who treat patients with eating disorders to monitor the effectiveness and outcomes of their interventions with carefully conducted research. We believe that research is essential for documenting and improving the effectiveness of eating disorder treatment programs, and for increasing helping professionals’ understanding of these disorders. We believe that as the findings of our research, and the research of others, is made available to the treatment staff at Center for Change, the effectiveness of the Center’s treatment programs will continue to increase. We also believe that our research will contribute to other helping professionals’ ability to more effectively treat patients with eating disorders.
Research Department Staff
The Research Department at Center for Change is staffed part-time by several personnel:
Understanding Eating Disorder Treatment Outcome Claims
Understanding Eating Disorder Treatment Outcome Claims
Because there is no consistency in how recovery and improvement rates are calculated from treatment center to treatment center in North America, it is difficult to make precise comparisons between them concerning their effectiveness. In addition, some treatment centers make exaggerated claims about the percentage of their patients who recover during treatment (e.g., one well-known treatment center published claims on its website that approximately 98% of patients achieve recovery). Reputable scientific studies cast serious doubt on such claims.
In a comprehensive review of the long-term outcome studies of treatment for anorexia nervosa published in the American Journal of Psychiatry, Steinhausen (2002) concluded that less than 50% of patients with AN recover, 33% improve, and 20% remained chronically ill. In comprehensive review of the treatment outcome studies of bulimia nervosa, also published in the American Journal of Psychiatry, Steinhausen & Weber (2009) concluded that approximately 45% of patients with bulimia nervosa recover, 27% improve considerably, and nearly 23% have a chronic protracted course (didn’t improve). Several other reviewers have arrived at similar recovery estimate percentages for anorexia nervosa and bulimia nervosa (e.g., Richards, Baldwin, Frost, Clark-Sly, Berrett, & Hardman, 2000; Steinhausen, 1995; Yager, 1989). Recovery rates for binge eating disorder are currently being reviewed.
As you look for an eating disorder treatment center for your loved one be cautious if you encounter claims that virtually all patients recover or are cured by a treatment program. It is unlikely that such claims are accurate. They are undoubtedly not based on reputable scientific evidence.
Center for Change Outcome Research Program
Center for Change Outcome Research Program
Since Center for Change opened its doors in 1996, we have conducted outcome research to evaluate and improve the effectiveness of our treatment program. We have published reports of our research in professional journals and books (e.g., Richards, Hardman, & Berrett, 2007). 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. We also conduct periodic follow-up surveys with former patients from 3 months to 5 years after completion of treatment to assess their long-term progress and recovery rates. Below is a brief summary of the major findings of our treatment outcome research.
Outcomes at Completion of Inpatient/Residential Treatment
Two scientifically validated measures of attitudes and beliefs about eating, dieting, and body shape are administered when patients are admitted and discharge from CFC: the Eating Attitudes Scale and Body Shape Questionnaire. Data from CFC’s 15 year treatment outcome study have repeatedly confirmed that patients show clinically significant improvement on both of these measures suggesting that, on the average, patients acquire much healthier attitudes and beliefs about food, dieting, and body shape during their inpatient/residential stay at CFC.
Outcome on Patient Relationships with Food
In Figure 1 it can be seen that scores falling below the line drawn horizontally across the graph fall into the normal range (women without eating disorders score 30 and below on the Eating Attitudes Test (EAT). Thus, on the average, when they have completed inpatient/residential treatment, Center for Change patients’ concerns about food, dieting, and weight are much decreased and their condition much improved and within the normal range for women.
Outcome on Patient Relationships with Their Bodies
In Figure 2 it can be seen that on the average, when they complete inpatient treatment, CFC patients’ concerns about their body shape and size are much less intense, are much improved and are at the normal range for women. (*Note: women without eating disorders score 110 and below on the BSQ.)
Outcome on Patient’s Mental and Emotional Health, Sense of Well-Being, and Healthiness of Relationships
The patients’ levels of psychological, relationship, and social role distress as measured by the standardized and widely used Outcome Questionnaire (OQ-45) also significantly decline. In Figure 3 it can be seen that after participating in the CFC inpatient/residential program, on the average, patients’ psychiatric symptoms, interpersonal relationship distress, and social role conflict were all much less intense, within a “normal range” and comparable to those without diagnosable mental or emotional illness. Thus, their levels of depression and anxiety improve to normal levels and they show large improvements in their interpersonal relations and feelings about their ability to perform normal social roles.
The improvements in CFC patients’ psychological well-being reported here are based on approximately 500 patients and more than 10 years of treatment outcome data. These data collectively provide strong evidence that the majority of Center for Change patients get 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 make large improvements in their eating behaviors, beliefs, and attitudes as well as in their psychological, social, and spiritual functioning and well-being. These data provide evidence that the CFC inpatient/residential program successfully helps the majority of patients make a “jump start” toward a healthier life by helping them make important and healthy changes in their symptoms, beliefs, and behaviors in the short period of treatment at Center for Change.
Long-Term/Follow-Up Outcome Data at Center for Change
The following long-term outcome report documents how former Center for Change (CFC) patients say they are functioning after they have been discharged from the CFC in-patient and residential treatment programs. The statistical analyses and conclusions presented below are based on a sample of CFC patients who responded to the CFC’s long term follow-up phone survey (N = 487) and a sub-sample of patients who also completed and mailed in the Eating Attitudes Test, Outcome Questionnaire, and Spiritual Well-Being Scale (N = 243). This sample of patients included those who had been admitted to and discharged from the CFC between 1996 and 2008. They were contacted and participated in the long term follow-up survey between 1999 and 2009. The average length of time after discharge when the long-term follow-up phone survey was conducted with this sample of patients was 13.4 months (Standard deviation = 11.2 months) and the range was 2.0 months to 65 months (5 years, 5 months).
According to former CFC patients’ responses to a psychometrically validated CFC long-term outcome phone survey, 54.5% of them were recovered, 38.8% had improved, and only 6.8% had not improved. The 6.8% percentage of former CFC patients who reported that they had not improved is lower than the 20 – 23% not improved percentages at other treatment centers which were reported by Steinhausen (2002) and Steinhausen & Weber (2009). The CFC recovery rates were equally positive for patients with anorexia nervosa and bulimia nervosa and are based on follow-up surveys conducted from 1 – 5 years after patients had completed inpatient treatment. Table 1 summarizes and illustrates how CFC recovery estimates compare with those reported by Steinhausen (2002) and Steinhausen and Weber (2009). It is clear from comparisons of CFC long-term treatment outcome data with outcome data reported in the scientific literature that outcomes at CFC compare very favorably and stronger than other well-established, respected eating disorder treatment centers in North America that were included in the studies listed above.
Richards, P. S., Baldwin, B., Frost, H., Clark-Sly, J., Berrett, M. E., & Hardman, R. K. (2000). What works for treating eating disorders? Conclusions of 28 outcome reviews. Eating Disorders: Journal of Treatment and Prevention, 8, 189-206.
Steinhausen, H. (2002). The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry, 159, 1284-1293.
Steinhausen, H. & Weber, S. (2009). The outcome of bulimia nervosa: Findings from one-quarter century of research. American Journal of Psychiatry, 166, 1331-1341.
Steinhausen, H. (1995). The course and outcome of anorexia nervosa. In K. D. Brownell & C. G. Fairburn (Eds.). Eating disorders and obesity: A comprehensive handbook (pp. 234-237). New York: The Guilford Press.
Yager, J. (1989). Psychological treatment for eating disorders. Psychiatric Annals, 19 (9), 477-482.
Patient Satisfaction: “Sense of Being Helped in Recovery”
According to the long-term outcome phone survey, the vast majority of patients feel that they are helped through their treatment at Center for Change. As can be seen in Figure 4, over 80% of patients feel that they were helped “very much” or “much” during their stay at Center for Change. Less than 5% of patients feel that they were helped very little or not at all. Thus, nearly all those who receive treatment at Center for Change feel positively about their experience, in terms of “being helped overall” in treatment at Center for Change and in their progress toward recovery.
The vast majority of Center for Change patients achieve large improvements during their inpatient/residential stay at CFC. At the conclusion of treatment, most CFC patients score in normal ranges in their attitudes about food, weight, and body shape. By treatment conclusion, most CFC patients also score in the normal ranges on measures of emotional, relationship, and spiritual well-being. At long-term follow-up, over 50% of CFC patients consider themselves recovered and nearly 40% consider themselves partly recovered. These eating disorder treatment outcomes are equivalent and often superior to other responsible, scientifically valid reports of patient improvement that have been reported in the research literature. Center for Change is a place of hope and healing. Well designed and conducted scientific treatment outcome research has documented that this is true.
Recent, Current, and Ongoing Research at Center for Change
Summary of Research Department Accomplishments
Summary of Research Department Accomplishments
During the past 15 years, the Research Department at Center for Change has published 3 books, 5 book chapters, and 16 professional journal articles. Members of the Research Department and their collaborators have also presented research at numerous professional conferences. Center for Change has also sponsored 10 doctoral dissertations. The Research Department also provides regular treatment outcome reports to Center for Change administration and clinical leadership to assist in clinical program and performance improvement. A listing of publications and other scholarly contributions by members of the Research Department and their collaborators can be found below:
Richards, P. S., Hardman, R. K., & Berrett, M. E. (2007). Spiritual Approaches in the Treatment of Women with Eating Disorders. American Psychological Association: Washington, D. C.
Richards, P. S., Hardman, R. K., & Berrett, M. E. (2000). Spiritual renewal: A journey of healing and growth. Center for Change: Orem, Utah.
Harper, T. O. P., Ford, J., Berrett, M. E., Hardman, R. K., & Richards, P. S. (2001). Eating disorders: Physical, social, and emotional consequences: A high school curriculum about anorexia, bulimia, and compulsive eating. Foundation for Change/Center for Change/Walz Communications: Orem, Utah. (Winner of a 2002 Telly Award).
Richards, P. S., Hardman, R. K., Berrett, M. E., & Lea, T. (2014). Religious and spiritual assessment of trauma survivors. In D. F. Walker, J. Aten, & C. Courtois (Eds.). Spiritually Oriented Trauma Psychotherapy. Washington, DC: American Psychological Association.
Richards, P. S., Weingarten-Litman, S., Berrett, M. E., & Susov, S. (2013). Religion and spirituality in the etiology and treatment of eating disorders. In K. I. Pargament, A. Mahoney, & E. Shafranske (Eds.). APA Handbook of Psychology, Religion, and Spirituality (Vol. II, pp. 319 – 333). Washington, DC: American Psychological Association.
Berrett, M. E., Hardman, R. K., & Richards, P. S. (2010). The role of spirituality in eating disorder treatment and recovery. In Maine, M., Bunnell, D., McGilley, B. (Eds.). Special Issues in the Treatment of Eating Disorders: Bridging the Gaps (pp. 367-385). Maryland Heights, MO: Elsevier.
Hardman, R. K., Richards, P. S., Berrett, M. E. (2008). The role of faith and spirituality in recovery from eating disorders. In M. S. Williams, W. D. Belnap, & J. P. Livingstone (Eds.). Matters of the Mind: Latter-day Helps for Mental Health. Deseret Book, Salt Lake City, Utah.
Hardman, R. K., Berrett, M. E., & Richards, P. S. (2004). A theistic inpatient treatment approach for eating disorder patients: A case report. In P. S. Richards and A. E. Bergin (Eds.), Casebook for a spiritual strategy in counseling and psychotherapy (pp. 55-73). Washington, DC: American Psychological Association.
Peer-Reviewed Journal Articles
Simon, W., Lambert, M. J., Busath, G., Vazquez, A., Berkeljon, A., Hyer, K., Granley, M., & Berrett, M. (2013). Effects of providing patient progress feedback and clinical tools to psychotherapists in an inpatient eating disorders treatment program: A randomized controlled study. Psychotherapy Research, 23 (3), 287-300. http://dx.doi.org/10.1080/10503307.2013.787497
Richards, P. S., & Berrett, M. E. (2010). Treating clients of diverse religious and spiritual beliefs: What independent practitioners should know. Independent Practitioner: Bulletin of Psychologists in Independent Practice (APA Division 42), 30, 231-235.
Richards, P. S., Smith, M. H., Berrett, M. E., O’Grady, K. A., & Bartz, J. D. (2009). A theistic spiritual treatment approach for women with eating disorders. Journal of Clinical Psychology: In Session, 65, 172-184.
Gillett, K. S., Harper, J. M., Larson, J. H., Berrett, M. E., & Hardman, R. K. (2009). Implicit family process rules in eating-disordered and non-eating disordered families. Journal of Marital and Family Therapy, 35 (2), 159-174.
Edgington, S., Richards, P. S., Erickson, M. J., Jackson, A. P., & Hardman, R. K. (2008). Perceptions of Jesus Christ’s atonement among Latter-day Saint women with eating disorders and perfectionism. Issues in Religion and Psychotherapy, 32, 25-39.
Berrett, M. E., Hardman, R. K., O’Grady, K. A., & Richards, P. S. (2007). The role of spirituality in the treatment of trauma and eating disorders: Recommendations for clinical practice. Eating Disorders: Journal of Treatment and Prevention, 15, 373-389.
Richards, P. S., Berrett, M. E., Hardman, R. K., & Eggett, D. L. (2006). Comparative efficacy of spirituality, cognitive, and emotional support groups for treating eating disorder inpatients. Eating Disorders: Journal of Treatment and Prevention, 14, 401-415.
Richards, P. S., Smith, T. B., Schowalter, M., Richard, M., Berrett, M. E., & Hardman, R. K. (2005). Development and validation of the Theistic Spiritual Outcome Survey. Psychotherapy Research, 15 (4), 457-469.
Hawkins, N., Richards, P. S., & Granley, H. M., & Stein, D. (2004). The impact of exposure to the thin-ideal media image on women. Eating Disorders: Journal of Treatment and Prevention, 12, 35-50.
Smith, M. H., Richards, P. S., & Maglio, C. J. (2004). Examining the relationship between religious orientation and eating disturbances. Eating Behaviors, 5, 171-180.
Jeppson, J. E., Richards, P. S., Hardman, R. K., & Granley, H. M. (2003). Binge and purge processes in bulimia nervosa: A qualitative investigation. Eating Disorders: Journal of Treatment and Prevention, 11, 115-128.
Hardman, R. K., Berrett, M. E., & Richards, P. S. (2003). Spirituality and ten false pursuits of eating disorders. Counseling and Values, 48, 67-78.
Smith, F. T., Richards, P. S., Fischer, L., & Hardman, R. K. (2003). Intrinsic religiousness and spiritual well-being as predictors of treatment outcome among women with eating disorders. Eating Disorders: Journal of Treatment and Prevention, 11, 15-26.
Richards, P. S., Baldwin, B., Frost, H., Hardman, R., Berrett, M., & Clark-Sly, J. (2000). What works for treating eating disorders: A synthesis of 28 outcome reviews. Eating Disorders: Journal of Treatment and Prevention, 8, 189-206.
Richards, P. S., Hardman, R., Frost, H., Clark-Sly, J., Berrett, M., & Anderson, D. (1998). Spiritual issues and interventions in the treatment of patients with eating disorders. AMCAP Journal, 23, 121-144.
Richards, P. S., Hardman, R., Frost, H., Clark-Sly, J., Berrett, M., & Anderson, D. (1997). Spiritual issues and interventions in the treatment of patients with eating disorders. Eating Disorders: Journal of Treatment and Prevention, 5, 261-279.
Richards, P. S., Berrett, M. E., McBride, J. A., & Sanders, P. W. (2014). Using Internet-Based Adaptive Testing Technologies for Eating Disorder Treatment Planning and Outcomes Assessment. Paper presented at the Academy of Eating Disorders International Conference on March 28, 2014, in New York City, NY.
Smith, M., Passmore, K., Richards P. S., Hawks, S., & Madanat, H. (2013). Investigation of intuitive eating with patients in an eating disorder inpatient treatment program: A two-year prospective study. Presented at the International Conference on Eating Disorders (ICED) of the Academy for Eating Disorders (AED) on May 2, 2013 in Montreal, Canada
Richards, P. S., O’Grady, K. A., Berrett, M. E., Hardman, R. K., & Bartz, J. D., Johnson, J., Olson, M. (2008). Exploring the role of spirituality in treatment and recovery from eating disorders: A qualitative survey study. Paper presented at the Academy of Eating Disorders International Conference on Eating Disorders, “Bridging science and practice: Prospects and challenges,” May 16, 2008, Seattle, Washington.
Richards, P. S., & Hardman, R. K. (2006). Healing the wounded hearts: A spiritual approach for treating women with eating disorders. Invited plenary session presented at the semi-annual convention of the Association of Mormon Counselors and Psychotherapists, Salt Lake City, Utah, March 31, 2006.
Plowman, S., Williams, M., & Richards, P. S. (2005). Self-esteem as a predictor of treatment outcome among women with eating disorders. Paper presented at the annual convention of the American Psychological Association, Washington, DC, August 20, 2005.
Granley, H. M., Richards, P. S., & Nielsen, S. L. (2002). Relationship of early termination with psychotherapy outcomes. Paper presented at the annual convention of the American Psychological Association, August, 2002, Chicago, Illinois.
Smith, F. T., Richards, P. S., Fischer, L., & Hardman, R. K. (2002). Intrinsic religiousness and spiritual well-being as predictors of treatment outcome among women with eating disorders. Paper presented at the annual convention of the American Psychological Association, August, 2002, Chicago, Illinois.
Smith, M. H., Richards, P. S., & Maglio, C. J. (2002). Examining the relationship between religious orientation and eating disturbances. Paper presented at the annual convention of the American Psychological Association, August, 2002, Chicago, Illinois.
Richards, P. S., Hardman, R. K., & Berrett, M. E. (2001). Evaluating the efficacy of spiritual interventions in the treatment of eating disorder patients: An outcome study. Paper presented at the annual convention of the American Psychological Association, August 24, 2001, San Francisco, California.
Hardman, R. K., Richards, P. S., Cloyd, J. H., & Wagnon, K. (2001). Prevalence of dysfunctional eating behaviors and beliefs among high school students: Implications for school counselors and school psychologists. Paper presented at the annual convention of the American Psychological Association, August 24, 2001, San Francisco, California.
Richards, P. S. (2000). Using spiritual interventions in an eating disorder inpatient treatment setting: Is it ethical, does it help, and why should we care? Paper presented at the semi-annual convention of the Association of Mormon Counselors and Psychotherapists, October 5, 2000, Salt Lake City, Utah.
Richards, P. S., & Smith, T. B. (2000). Development and validation of the Spiritual Outcome Scale. Paper presented at the annual convention of the Society for Psychotherapy Research, Chicago, Illinois, June 23, 2000.
Externally Funded Research Grant
John M. Templeton Foundation ($30,000). Awarded November, 1998. Research study entitled “Evaluating the Efficacy of Spiritual Interventions in the Treatment of Eating Disorder Patients: An Outcome Study.”
Completed Doctoral Dissertations/Theses Supported by Center for Change
Caoili, C. (2015). The role of spirituality in treatment and recovery from eating disorders. Dissertation submitted to the Department of Counseling Psychology and Special Education, Brigham Young University, Provo, Utah.
Jorgenson, A. M. (2009). Family predictors of long-term outcome following inpatient treatment for eating disorders. Dissertation submitted to the Department of Counseling Psychology and Special Education, Brigham Young University, Provo, Utah.
Plowman, S. (2007). Self-esteem as a predictor of treatment outcome among women with eating disorders. Dissertation submitted to the Department of Counseling Psychology and Special Education, Brigham Young University, Provo, Utah.
Tobler, S. B. (2007). Women’s perceptions of parents, peers, romantic partner and God as predictive of symptom severity for eating disorders at an impatient treatment facility. Dissertation submitted to the Department of Counseling Psychology and Special Education, Brigham Young University, Provo, Utah.
Smith, M. (2006). Images of parents, self, and God as predictive of symptom severity among women beginning inpatient treatment for eating disorders. Dissertation submitted to the Department of Counseling Psychology and Special Education, Brigham Young University, Provo, Utah.
Cloyd, J. (2005). The Eating Disorder Survey: Psychometric characteristics and validity of a self-report eating disorder instrument for adolescents. Dissertation submitted to the Department of Counseling Psychology and Special Education, Brigham Young University, Provo, Utah.
Edgington, S. C. (2003). Perceptions of the atonement among perfectionistic Latter-Day Saint women with eating disorders. Doctoral Dissertation, Brigham Young University, Dissertation Abstracts International-B, 64/12, p. 6326, June 2004.
Gillett, K. S. (2003). Implicit family process rules in eating-disordered and non-eating disorder families. Unpublished thesis (M.S.), Brigham Young University, Department of Marriage and Family Therapy, Provo, Utah.
Radpour-Wiley, M. L. (2002). Personality variables among women with diagnosable eating disorders: An MMPI study. Doctoral dissertation, Brigham Young University, Dissertation Abstracts International-B, 63/02, p. 1045, August 2002.
Smith, F. T. (2001). Intrinsic religiosity, religious affiliation, and spiritual well-being as predictors of treatment outcome among women with eating disorders. Doctoral Dissertation, Brigham Young University, Dissertation Abstracts International-B, 62/04, p. 2079, October 2001.
Jeppson, J. E. (1999). A qualitative investigation of binge and purge processes in bulimia nervosa. Doctoral Dissertation, Brigham Young University, Dissertation Abstracts International-B, 60/08, p. 4227, February 2000.
Professional Clinical Training Presentations by Center for Change Research and Clinical Staff
Various members of Center for Change staff have presented professional clinical training presentations at hundreds of regional and national conferences. Findings in our research have contributed to the development of these valuable clinical training events.
More on the book Spiritual Approaches in the Treatment of Women with Eating Disorders, P. Scott Richards, Randy K. Hardman, Michael E. Berrett, American Psychological Association, Washington DC, 2007, (304 pages):
Investigation of Intuitive Eating with Patients in an Eating Disorder Inpatient Treatment Program: A Two-year Prospective Study
Investigation of Intuitive Eating with Patients in an Eating Disorder Inpatient Treatment Program: A Two-year Prospective Study
Melissa Smith, Kimberly Passmore, P. Scott Richards, Steve Hawks and Hala Madanat
In 1995 the book, Intuitive Eating, by Evelyn Tribole and Elyse Resch was published. This book proposed an alternative approach to maintaining physical health for those stuck in the cycle of repeated, ineffective, and damaging yo-yo dieting. Intuitive eating is characterized by eating based on physiological hunger and satiety cues rather than situational and emotional cues. Several psychologists, nutritionists, and health science professionals have argued that this style of eating is adaptive and research studies have shown that it is associated with positive self-esteem, body image, and weight maintenance and/or loss, as well as reduced cardiovascular risk and greater pleasure and less anxiety associated with eating. Nevertheless, there is limited evidence concerning the effectiveness of intuitive eating with eating disorder patients. Controversy exists in the eating disorders field concerning the question of whether it is possible for patients with eating disorders to learn how to eat intuitively, and whether attempting to teach this skill is helpful or harmful. We conducted a two-year prospective study where we evaluated whether teaching intuitive eating to patients in an eating disorder inpatient treatment program was effective.
- Intuitive Eating Scale (IES; Hawkes, Madanat, & Merrill, 2004), 30-item
- Eating Attitudes Test (EAT) (Garner & Garfinkel, 1979), 40-item
- Body Shape Questionnaire (BSQ) (Cooper, Taylor, Cooper, and Fairburn, 1987), 34-item
- Outcome Questionnaire (OQ-45.2) (Lambert, Okiishi, Finch & Johnson, 1998)
- Theistic Spiritual Outcome Survey (TSOS; Richards, Smith), 17-item
Major Findings and Conclusions
- Significant improvements in eating disorder patients’ ability to engage in intuitive eating behaviors and attitudes.
- The analysis of the IES scores showed that the eating disorder patients’ scores significantly increased between the time they were admitted to the Inpatient treatment program and transitioned into the Residential treatment program. Their scores also significantly increased between the time that they began the Residential treatment program and at the time they were discharged from treatment.
- As a group, the patients’ increases in their ability to eat intuitively were large and clinically significant (the effect sizes were large and ranged from .68 to 1.44). The clinicians perceived that the patients’ attitudes about food grew healthier during treatment (the effect size was large—.89).
- Dieticians also perceived that the patients’ ability to eat intuitively improved during treatment, and that their attitudes toward food and eating became healthier during the course of treatment, although their estimates of patients’ progress on these issues were more reserved (effect sizes ranged from .29 to .58).
- Patients’ scores on the EAT, BSQ, OQ45.2, and TSOS all improved significantly between the time of admission and the time of discharge from the treatment program. These changes were large and clinically significant (three of the effect sizes were large and ranged from 1.02 to 1.91; the TSOS effect size was the only small one at .36).
- Patients’ scores on all of these measures at the time of discharge fell into normal ranges, or close to it.
- At the time patients were discharged from the treatment program, the Hawkes Intuitive Eating Scale (HIES) correlated significantly with other indicators of positive treatment outcomes, including reduced eating disorder symptoms (as measured by the EAT), improvements in patients’ perceptions of their body size and shape (as measured by the BSQ), reductions in psychological symptoms such as depression, anxiety, relationship conflict, and social role conflict (as measured by the OQ-45.2), and improvements in what patients felt about their spirituality and moral congruence (as measured by the TSOS).
- In summary, the findings of our 2-year prospective study provide strong evidence that intuitive eating behavior and attitudes can be taught and learned in an inpatient and residential eating disorder treatment program, and that improvements in patients’ ability to eat intuitively are associated with other important indicators of healing and recovery. That intuitive eating principles can be effectively integrated in a highly structured treatment in light of the many medical, nutritional, and psychological considerations, provides sound evidence for their incorporation in inpatient and residential eating disorder treatment.
Recommendations for Future Research
There is a need to investigate whether intuitive eating skills and attitudes can be learned as effectively for different types of eating disorder patients. For example, do patients with anorexia nervosa, bulimia nervosa, binge-eating disorder differ in their ability to acquire intuitive eating skills, attitudes, and behaviors? Are there differences between adolescent and adult patients in their ability to acquire intuitive eating skills, attitudes, and behaviors?
Cooper, P., Taylor, M., Cooper, Z., & Fairburn, C. (1987). The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders, 6 (4), 485-494.
Garner, D., & Garfinkel, P. (1979). The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9 (2), 273-279.
Hawkes, S. R., Madanat, H. N., & Merrill, R. (2004). Intuitive eating, dietary composition, and the meaning of food in healthy weight promotion. American Journal of Health Education.
Lambert, M.J., Okiishi, J.C., Finch, A.E., & Johnson, L.D. (1998). Outcome assessment: From conceptualization to implementation. Professional Psychology: Research and Practice, 29(1), 63-70.
Richards, P. S., Smith, T. B., Schowalter, M., Richard, M., Berrett, M. E., & Hardman, R. K. (2007). Development and validation of the Theistic Spiritual Outcome Survey. Psychotherapy Research, 17, 643-655.
Melissa H. Smith, PhD, Center for Change, [email protected]
P. Scott Richards, PhD, Brigham Young University, [email protected]
Research was presented at the International Conference on Eating Disorders (ICED) of the Academy for Eating Disorders (AED) on May 2, 2013 in Montreal, Canada, and is in the process of being submitted for peer reviewed publication.
Research Studies Currently in Progress
Research Studies Currently in Progress
Methodologies for Conducting Practice-based Evidence to Improve Patient Outcomes in an Eating Disorder Treatment Center (P. Scott Richards and Michael E. Berrett, Center for Change) *This study was presented at the annual convention of the Academy of Eating Disorders in March, 2014.
The evidence-based practice movement has become an important influence in mental health care systems and policy. Insurance companies, professional organizations, and the general public increasingly are expecting mental health practitioners to use treatment approaches that are supported by research evidence. The eating disorders treatment field is no exception, and recent publications and conference presentations have called for eating disorder professionals to base their practices on evidence-based treatment approaches.
In official resolutions, the American Psychological Association and American Medical Associations have defined research evidence broadly and affirmed that multiple types of research designs contribute to evidence-based practice, including practice-based (effectiveness) research, single-case repeated measurement designs, process-outcome studies, case studies, and randomized controlled trials (APA, 2006). At Center for Change, we have used and will continue to use a variety of research designs in our efforts to help develop the evidence-base concerning the effectiveness of our eating disorder treatment program and approaches. In the present study, we investigate the utility of an online assessment system and clinically adaptive outcome and process measures for (1) tracking on-going patient outcomes, and (2) providing therapists with weekly feedback about patient progress during the course of inpatient and residential eating disorder treatment. We also explore the usefulness of a therapist session checklist for linking treatment interventions and program components with patient progress during the course of treatment.
Role of Spirituality in Treatment and Recovery from Eating Disorders Study (by Carrie Fleischer, Brigham Young University)
Several scholars have recently theorized that the pursuit of pathological thinness manifested in modern-day women with EDs represents a misguided quest to resolve spiritual hunger, or in other words, to satisfy unmet spiritual needs (Richards, Hardman, & Berrett, 2007). Several survey and interview studies with patients and former patients indicate that many women regard spirituality as crucial resources in their treatment and recovery from EDs (Richards, Weinberger-Litman et al., 2011). In fact in a number of survey’s specifically geared towards individuals going through eating disorder treatment stated that the number one write in answer for what would be helpful to treatment was help through pastoral counseling, praying and faith (Richards, Weinberger-Litmen et al., 2011). In one survey it was found that the use of spirituality in the treatment “gave…purpose and meaning, expanded sense of identity and worth, helped (patients) experience feelings of forgiveness towards self and others, and improved relationships with God, family and others” (Richards, Weinberger-Litman et al., 2011, p. 16).
The research that has been conducted to date has furthered our understanding of the importance of faith and spirituality in recovery from eating disorders. These studies form a foundation for further study of themes relating to eating disorders and spirituality. However, more insight is needed into why and how spirituality may aid in client recovery. The research to date lacks in-depth insight about the ways spirituality and religion may promote eating disorder treatment and recovery. The purpose of this qualitative study is to explore in greater depth former eating disorder patients’ perceptions about what role faith and spirituality played in their treatment and recovery. Twelve former eating disorder patients who are considered in recovery have been interviewed and approximately 80 former patients completed an online survey about the role of spirituality in treatment and recovery. The qualitative data is currently being analyzed using qualitative research procedures.