(PS8-A1) Clinical Experiences in Conducting Empirically Supported Treatments for Eds

Background: Given the persistent and dangerous nature of eating disorders (EDs) and data suggesting subpar outcomes for up to 50% of patients receiving cognitive behavioral therapies (CBT), it is important to characterize factors that may contribute to poor outcomes. Data suggests that despite the availability of empirically supported treatments (ESTs) for EDs, these approaches are infrequently used as prescribed, potentially contributing to poor outcomes.  It therefore may be the case that ESTs are designed in homogenous populations that are less likely to be seen in diverse real-world clinical settings, thus limiting the usefulness of ESTs. However despite a need to examine factors contributing to poor outcomes, few studies have explored barriers to implementing these treatments in real-world clinical settings. Accordingly, this study aimed to solicit clinician feedback on barriers to implementing enhanced CBT (CBT-E), with the larger goal of informing future clinical research that is relevant to real-life practice.

Measures: Participants (N =108) were clinicians and trainees who have used, or currently use, CBT-E to treat EDs and were asked to report on demographics, variables that limit their success in treating EDs, and techniques utilized from the CBT-E manual.

Results: The sample was majority female (75%) White (73%), and trained in clinical psychology (37%). The largest proportion of respondents (31%) had 5-10 years of experience conducting psychotherapy. Clinicians endorsed the frequency and usefulness of 28 CBT-E techniques on a Likert-type scale ranging from 0 (never/least useful) to 100 (always/most useful). Preliminary results suggest that psychoeducation was the most frequently endorsed CBT-E technique (M=93.1, SD=19.5) and most useful (M=91.4, SD=18.4). Surveys to address mind reading was the least frequently endorsed technique (M=23.2, SD=28.1) and using imagery to rescript body image memories was the least useful technique (M=31.3, SD=34). Of the 69 items rated as barriers in using CBT-E for the treatment of EDs (rated on a Likert-type scale from 0=not at all; 100=is a major challenge), patients’ unwillingness to follow a meal plan/nutritional guide was rated the most impactful barrier to success (M=77.5, SD=26.2), followed by severity of eating disorder symptoms (M=73.7, SD=26.5) and medical instability/risk (M=73.5, SD=27.8).

Discussion:  Several findings of our study replicated previous research, indicating that clinicians most frequently use psychoeducation techniques from CBT manuals. Other frequently endorsed barriers to treatment elucidated the unique nature of treating EDs, such as unwillingness to follow a meal plan/nutritional guide and medical instability/risk. This study expands on previous research that identified frequent therapist drift from adhering to CBT-E manuals in treating eating disorders. Findings identified specific barriers to implementing CBT-E in real world settings, and future research should aim to explore ways to minimize frequently reported barriers.