Page 61 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 3 61
stay reduced after implementing CBT-E. The inpatient program is derived from outpatient-based CBT-E and retains all CBT-E main strategies, provided in individual sessions, psychoeducational group meetings and a weekly review meeting between patient and her / his therapists (Dalle Grave, Bohn, Hawker & Fairburn, 2008). A physical exercise group is also part of the program. Within this CBT-E framework of outpatient care by default and inpatient care as short as possible, day care is no longer needed.
Implementation of CBT-E
In early 2015, after training all staff, irrespective of their discipline, the treatment center transformed both inpatient and outpatient units into CBT-E based programs. Two inpatient units were combined into one, in which TAU modules incompatible with CBT-E (e.g. a schema therapy group) were terminated. As CBT-E is individual- ly based, outpatient therapy groups were phased out during a 6-month period, and terminated. In the outpatient unit, the only psychological treatment offered is CBT-E focused. The two daycare units were also terminated. A detailed description of the implementation plan and the CBT-E inpatient program, has been provided in a previ- ous publication (Van den Berg et al., 2017).
Therapist Training
During 2012-2014, 40 staff members (psychologists, psychotherapists, psychia- trists, nurse practitioners, psychiatric nurses, dieticians and a psychomotor thera- pist) were employed throughout the treatment center. Psychological treatment was delivered by 24 therapists (psychologists, psychotherapists, psychiatrists and nurse practitioners), other staff members delivered partial treatment interventions in the inpatient and daycare units. No uniform treatment manuals were used and no struc- tured supervision was offered.
During 2015-2017, CBT-E was delivered by 44 therapists; including the 40 colleagues from the 2012-2014 episode. In contrast to the TAU episode, during 2015- 2017, psychiatric nurses, dieticians and a psychomotor therapist delivered psycho- logical treatments as well. All therapists successfully completed the web based CBT-E training provided by Centre for Research on Eating Disorders at Oxford, worked through the guide (Fairburn, 2008), and all but five colleagues attended a 2-day work- shop run by C. Fairburn. To familiarize them with CBT-E interventions and ensuring adherence, all therapists attended weekly, 2-hour peer intervision, taking place in three parallel groups of around 12 colleagues each, supervised by senior therapists, throughout the experimental period. Making sure all patients are discussed, case