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      Cognitive behavioural therapy for eating disorders: how do clinician characteristics impact on treatment fidelity?

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          Abstract

          Background

          Clinicians routinely report not practising evidence-based treatments with eating disorders. There has been limited research investigating the impact of adaptable clinician characteristics such as self-efficacy and therapeutic optimism in this area. This study evaluated if there is a relationship between clinician therapeutic optimism, self-efficacy and the provision of evidence-based practice in the treatment of bulimia nervosa and binge eating disorder.

          Method

          A survey developed for this study was administered to 100 psychologists who were recruited online via a range of organisations affiliated with psychology and/or eating disorders. The survey measured demographic factors, eating disorder treatment knowledge, treatment fidelity, the use of individual treatment components and a range of clinician characteristics including self-efficacy and therapeutic optimism.

          Results

          Results demonstrated that clinician self-efficacy was positively associated with and predicted treatment fidelity. Therapeutic optimism had significant low correlations with treatment fidelity but did not predict treatment fidelity.

          Conclusion

          These findings would suggest that strengthening clinician self-efficacy is useful in improving evidence-based practice in the treatment of binge eating disorder and bulimia nervosa and may also have implications in the training of clinicians. The study also demonstrated that the use of a range of knowledge translation strategies are valuable in enhancing clinician adherence to evidence-based practice. Further research with direct measures of treatment fidelity is needed to clarify these findings.

          Electronic supplementary material

          The online version of this article (10.1186/s40337-018-0208-0) contains supplementary material, which is available to authorized users.

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          Most cited references38

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          How Many Subjects Does It Take To Do A Regression Analysis.

          S Green (1991)
          Numerous rules-of-thumb have been suggested for determining the minimum number of subjects required to conduct multiple regression analyses. These rules-of-thumb are evaluated by comparing their results against those based on power analyses for tests of hypotheses of multiple and partial correlations. The results did not support the use of rules-of-thumb that simply specify some constant (e.g., 100 subjects) as the minimum number of subjects or a minimum ratio of number of subjects (N) to number of predictors (m). Some support was obtained for a rule-of-thumb that N ≥ 50 + 8 m for the multiple correlation and N ≥104 + m for the partial correlation. However, the rule-of-thumb for the multiple correlation yields values too large for N when m ≥ 7, and both rules-of-thumb assume all studies have a medium-size relationship between criterion and predictors. Accordingly, a slightly more complex rule-of thumb is introduced that estimates minimum sample size as function of effect size as well as the number of predictors. It is argued that researchers should use methods to determine sample size that incorporate effect size.
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            The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis.

            This meta-analysis examined the efficacy of cognitive-behavioral therapy (CBT) for eating disorders.
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              Evidence-based treatment and therapist drift.

              Cognitive-behavioural therapy (CBT) has a wide-ranging empirical base, supporting its place as the evidence-based treatment of choice for the majority of psychological disorders. However, many clinicians feel that it is not appropriate for their patients, and that it is not effective in real life-settings (despite evidence to the contrary). This paper addresses the contribution that we as clinicians make to CBT going wrong. It considers the evidence that we are poor at implementing the full range of tasks that are necessary for CBT to be effective--particularly behavioural change. Therapist drift is a common phenomenon, and usually involves a shift from 'doing therapies' to 'talking therapies'. It is argued that the reason for this drift away from key tasks centres on our cognitive distortions, emotional reactions, and use of safety behaviours. A series of cases is outlined in order to identify common errors in clinical practice that impede CBT (and that can make the patient worse, rather than better). The principles behind each case are considered, along with potential solutions that can get us re-focused on the key tasks of CBT.
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                Author and article information

                Contributors
                Caroline.Brown@my.acap.edu.au
                +61-2-8236 8048 , Kathryn.NicholsonPerry@acap.edu.au
                Journal
                J Eat Disord
                J Eat Disord
                Journal of Eating Disorders
                BioMed Central (London )
                2050-2974
                1 September 2018
                1 September 2018
                2018
                : 6
                : 19
                Affiliations
                ISNI 0000 0004 0616 7645, GRID grid.459318.2, Australian College of Applied Psychology, Discipline of Psychological Science, ; 255 Elizabeth St, Sydney, NSW 2000 Australia
                Author information
                http://orcid.org/0000-0003-3105-7125
                Article
                208
                10.1186/s40337-018-0208-0
                6119328
                30186605
                46c7a065-1492-4484-99a5-8a61a0c7c1b2
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 March 2018
                : 19 July 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                cognitive behavioral therapy,eating disorders,knowledge translation strategies,self-efficacy,therapist drift,treatment fidelity

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