Body exposure, its forms of delivery and potentially associated working mechanisms: How to move the field forward

Background Body image disturbance (BID) is a hallmark feature of eating disorders (EDs) and has proven to be involved in their etiology and maintenance. Therefore, the targeting of BID in treatment is crucial, and has been incorporated in various treatment manuals. One of the most common techniques in the treatment of BID is body exposure (BE), the confrontation with one’s own body. BE has been found to be effective in individuals with EDs or high body dissatisfaction. However, BE is applied in a multitude of ways, most of which are based on one or a combination of the hypothesized underlying working mechanisms, with no differential effectiveness known so far. Method The aim of this paper is to selectively review the main hypothesized working mechanisms of BE and their translation into therapeutic approaches. Results and Conclusion Specifically, we underline that studies are needed to pinpoint the proposed mechanisms and to develop an empirically informed theoretical model of BE. We provide a framework for future studies in order to identify working mechanisms and increase effectiveness of BE.

Challenging rigidity in Anorexia (treatment, training and supervision): questioning manual adherence in the face of complexity

Background Anorexia Nervosa is a debilitating illness. While there have been many advancements to treatment protocols and outcomes for people with eating disorders, the field acknowledges there remains considerable room for improvement. This timely Special Edition of the Journal of Eating Disorders has invited those of us in the field to consider a range of topics in aid of this task, including potential modifications and implementation of evidence-based practice, specific and common psychotherapy factors, treatment manuals, adherence and individualising treatment approaches for individuals and families. Body In this paper, we briefly outline the key manualised treatments currently available to treat children, adolescents and adults with Anorexia Nervosa, considering the benefits, potential reasons for adaptations and limitations. We then review the current evidence for training strict adherence to treatment manuals which is often a key focus in training and supervision, questioning the association of increased treatment adherence with improved therapeutic outcome. We then summarise some key evidence behind other therapeutic factors which have been demonstrated to affect outcome regardless of which manual is implemented, such as readiness to change and therapeutic alliance. Conclusion The paper concludes with implications and considerations for future research, clinical guidelines, training and supervision, highlighting the need to consider the therapeutic relationship and processes alongside manual content to conduct best evidence-informed practice.

Formulation in eating disorder focused family therapy: why, when and how?

In the broadest sense, formulation, or case conceptualisation, is the process of collaborative sense-making. It is something all clinicians are doing constantly, whether formally and consciously or not. Most clinicians are familiar with the general principals and need to formulate as it is a core part of clinical training across most disciplines. Treatment manuals often discuss formulation, but the practical steps involved and the process of developing, building upon and revising formulations are not always provided. In clinical practice, the active use and continued development of formulation during treatment is not always prioritised, especially beyond the initial assessment. This could be due to a number of reasons, such as a potential lack of clarity, understanding or confidence in the use of formulation across treatment, a lack of dedicated time and reflective space for formulation in the context of increasingly busy clinical settings, or a perception that it may be less necessary in the context of treatment approaches that are more structured and prescriptive. This article outlines the use of formulation in family therapy for child and adolescent eating disorders, provides guidance on how to actively include formulation more throughout treatment and discusses why this might be useful.

From Research to Practice: Designing a Treatment Program for Individuals Convicted of Child Sexual Exploitation Material

The term evidence-based is increasingly found in treatment manuals and program titles designed for individuals convicted of a sexual offense. However, whether the presented evidence truly qualifies as “evidence-based” is questionable. I will share my experience as the clinical director for a private outpatient agency where we designed a program based on the existing peer-reviewed literature on individuals convicted of Child Sexual Exploitation Material (CSEM) offenses. I will describe the steps that we followed in developing a workgroup to explore and apply the knowledge from research to our clinical practice. We adapted the term evidence-informed to acknowledge that the program relied on existing literature in combination with the experiences and expertise of our clinical team. A fictitious case that reflects an amalgamation of facts is presented to demonstrate the assessment and treatment processes. Implications for organizational consensus to conduct program evaluation and research are discussed.

Rationale, Foundations, and Goals of CALM

This chapter introduces the Managing Cancer and Living Meaningfully (CALM) treatment manual. It summarizes the intent and purpose of the manual, which outlines the essential features of the CALM intervention and provides clinical examples to elucidate its implementation. Although it has been challenging to manualize the key therapeutic elements of a semi-structured intervention such as CALM, treatment manuals are essential to ensure the reliability and integrity of treatment delivery.

Treating a Cluster of Internalizing Disorders With the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: A Case Study

Psychotherapy outcome research rarely focuses on the ideographic application of treatment manuals, though some modules might prove markedly more important for a client than others. Clients in need of psychoeducation, emotion regulation skills, and changes in maladaptive patterns of thinking might balk at portions of the Unified Protocol for the Treatment of Emotional Disorders that seem irrelevant to their concerns. The current case study focused on emotion dysregulation and perfectionism given their role in anxiety, depression, obsessions, and compulsions. The Overall Anxiety Severity and Impairment Scale (OASIS), Overall Depression Severity and Impairment Scale (ODSIS), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) confirmed qualitative reports and therapist observations of improvement. Additional sessions focused on fostering self-compassion and processing the termination of a romantic relationship rather than completing every section of the manual. This case demonstrates that flexible adaptation of a transdiagnostic treatment manual, in conjunction with a strong working alliance and other non-specifics of therapy, can produce beneficial outcomes even when other modules are not applied. These results might support ideographic application of select modules from treatment manuals and support a symptoms approach to psychotherapy.