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Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa.

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Title: Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa.
Authors: Jewell, Tom, Herle, Moritz, Serpell, Lucy, Eivors, Alison, Simic, Mima, Fonagy, Peter, Eisler, Ivan
Source: European Child & Adolescent Psychiatry. Jul2023, Vol. 32 Issue 7, p1241-1251. 11p. 2 Diagrams, 2 Charts.
Subjects: Anorexia nervosa treatment, Family psychotherapy, Confidence intervals, Self-evaluation, Attachment behavior, Treatment effectiveness, Descriptive statistics, Psychosocial factors, Emotion regulation, Odds ratio, Therapeutic alliance, Parents, Outpatient services in hospitals, Evaluation, Adolescence
Abstract: Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20–0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one's feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00–1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome. [ABSTRACT FROM AUTHOR]
Copyright of European Child & Adolescent Psychiatry is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa.
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  Data: <searchLink fieldCode="AR" term="%22Jewell%2C+Tom%22">Jewell, Tom</searchLink><br /><searchLink fieldCode="AR" term="%22Herle%2C+Moritz%22">Herle, Moritz</searchLink><br /><searchLink fieldCode="AR" term="%22Serpell%2C+Lucy%22">Serpell, Lucy</searchLink><br /><searchLink fieldCode="AR" term="%22Eivors%2C+Alison%22">Eivors, Alison</searchLink><br /><searchLink fieldCode="AR" term="%22Simic%2C+Mima%22">Simic, Mima</searchLink><br /><searchLink fieldCode="AR" term="%22Fonagy%2C+Peter%22">Fonagy, Peter</searchLink><br /><searchLink fieldCode="AR" term="%22Eisler%2C+Ivan%22">Eisler, Ivan</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22European+Child+%26+Adolescent+Psychiatry%22">European Child & Adolescent Psychiatry</searchLink>. Jul2023, Vol. 32 Issue 7, p1241-1251. 11p. 2 Diagrams, 2 Charts.
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  Data: <searchLink fieldCode="DE" term="%22Anorexia+nervosa+treatment%22">Anorexia nervosa treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Family+psychotherapy%22">Family psychotherapy</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Self-evaluation%22">Self-evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Attachment+behavior%22">Attachment behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Psychosocial+factors%22">Psychosocial factors</searchLink><br /><searchLink fieldCode="DE" term="%22Emotion+regulation%22">Emotion regulation</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Therapeutic+alliance%22">Therapeutic alliance</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Outpatient+services+in+hospitals%22">Outpatient services in hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation%22">Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescence%22">Adolescence</searchLink>
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  Data: Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20–0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one's feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00–1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Child & Adolescent Psychiatry is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1007/s00787-021-01930-3
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 11
        StartPage: 1241
    Subjects:
      – SubjectFull: Anorexia nervosa treatment
        Type: general
      – SubjectFull: Family psychotherapy
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Self-evaluation
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      – SubjectFull: Attachment behavior
        Type: general
      – SubjectFull: Treatment effectiveness
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      – SubjectFull: Descriptive statistics
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      – SubjectFull: Psychosocial factors
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      – SubjectFull: Emotion regulation
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      – SubjectFull: Odds ratio
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      – SubjectFull: Therapeutic alliance
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      – SubjectFull: Adolescence
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      – TitleFull: Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa.
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              Text: Jul2023
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              Y: 2023
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