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Therapist written goodbye letters: evidence for therapeutic benefits in the treatment of anorexia nervosa

Published online by Cambridge University Press:  17 March 2020

Jess Simmonds ,
Karina L. Allen ,
Caitlin B. O’Hara ,
Savani Bartholdy ,
Beth Renwick ,
Alexandra Keyes ,
Anna Lose ,
Martha Kenyon ,
Hannah DeJong  and
Hannah Broadbent
...Show all authors
Jess Simmonds*
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Karina L. Allen
Affiliation:
Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK School of Psychology, University of Western Australia, Perth, Australia
Caitlin B. O’Hara
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Savani Bartholdy
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Beth Renwick
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Alexandra Keyes
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Anna Lose
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Martha Kenyon
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Hannah DeJong
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Hannah Broadbent
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Rachel Loomes
Affiliation:
Oxford Adult Eating Disorder Service, Warneford Hospital, Oxford, UK
Jessica McClelland
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Lucy Serpell
Affiliation:
Hope Wing, Porters Avenue Health Centre, Dagenham, Essex, UK
Lorna Richards
Affiliation:
The Phoenix Wing, St Ann’s Hospital, Tottenham, London, UK
Eric Johnson-Sabine
Affiliation:
The Phoenix Wing, St Ann’s Hospital, Tottenham, London, UK
Nicky Boughton
Affiliation:
Oxford Adult Eating Disorder Service, Warneford Hospital, Oxford, UK
Linette Whitehead
Affiliation:
Oxford Adult Eating Disorder Service, Warneford Hospital, Oxford, UK
Janet Treasure
Affiliation:
Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Tracey Wade
Affiliation:
School of Psychology, Flinders University, Adelaide, Australia
Ulrike Schmidt
Affiliation:
Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
*
*Corresponding author. Email: [email protected]
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Abstract

Background:

Despite their use in clinical practice, there is little evidence to support the use of therapist written goodbye letters as therapeutic tools. However, preliminary evidence suggests that goodbye letters may have benefits in the treatment of anorexia nervosa (AN).

Aims:

This study aimed to examine whether therapist written goodbye letters were associated with improvements in body mass index (BMI) and eating disorder symptomology in patients with AN after treatment.

Method:

Participants were adults with AN (n = 41) who received The Maudsley Model of Anorexia Treatment for Adults (MANTRA) in a clinical trial evaluating two AN out-patient treatments. As part of MANTRA, therapists wrote goodbye letters to patients. A rating scheme was developed to rate letters for structure and quality. Linear regression analyses were used to examine associations between goodbye letter scores and outcomes after treatment.

Results:

Higher quality letters and letters that adopted a more affirming stance were associated with greater improvements in BMI at 12 months. Neither the overall quality nor the style of goodbye letters were associated with improvements in BMI at 24 months or reductions in eating disorder symptomology at either 12 or 24 months.

Conclusions:

The results highlight the potential importance of paying attention to the overall quality of therapist written goodbye letters in the treatment of AN, and adopting an affirming stance.

Keywords

anorexia nervosaeating disordersgoodbye letterspsychotherapytreatment
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 4 , July 2020 , pp. 419 - 431
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Allan, S., & Gilbert, P. (1995). A social comparison scale: psychometric properties and relationship to psychopathology. Personality and Individual Differences, 19, 293–299.CrossRefGoogle Scholar
Allen, K. L., O’Hara, C. B., Bartholdy, S., Renwick, B., Keyes, A., Lose, A., … & Loomes, R. (2016). Written case formulations in the treatment of anorexia nervosa: evidence for therapeutic benefits. International Journal of Eating Disorders, 49, 874–882.CrossRefGoogle ScholarPubMed
Bacigalupe, G. (1996). Writing in therapy: a participatory approach. Journal of Family Therapy, 18, 361–373.CrossRefGoogle Scholar
Bohn, K., & Fairburn, C. G. (2008). The clinical impairment assessment questionnaire (CIA). Cognitive Behavioral Therapy for Eating Disorders, 1–3.Google Scholar
Bolton, G. (2004). Writing Cures: An Introductory Handbook of Writing in Counselling and Psychotherapy. Hove: Psychology Press.CrossRefGoogle Scholar
Brockmeyer, T., Friederich, H.C., & Schmidt, U. (2017). Advances in the treatment of anorexia nervosa: a review on established and emerging interventions and process outcome research. Psychological Medicine, 1–37.Google Scholar
Byrne, S., Wade, T., Hay, P., Touyz, S., Fairburn, C., Treasure, J., … & Fursland, A. (2017). A randomised controlled trial of three psychological treatments for anorexia nervosa. Psychological Medicine, 29, 1–11.Google Scholar
Cooper, Z., Cooper, P. J., & Fairburn, C. G. (1989). The validity of the eating disorder examination and its subscales. British Journal of Psychiatry, 154, 807–812.CrossRefGoogle ScholarPubMed
Cooper, Z., & Fairburn, C. (1987). The eating disorder examination: a semi‐structured interview for the assessment of the specific psychopathology of eating disorders. International Journal of Eating Disorders, 6, 1–8.3.0.CO;2-9>CrossRefGoogle Scholar
Denman, C. (2001). Cognitive–analytic therapy. Advances in Psychiatric Treatment, 7, 243–252.CrossRefGoogle Scholar
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory: development and validation of a short version. Psychological Assessment, 14, 485.CrossRefGoogle ScholarPubMed
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348.CrossRefGoogle ScholarPubMed
Hamill, M., Ried, M., & Reynolds, S. (2008). Letters in cognitive analytic therapy: the patient’s experience. Psychotherapy Research, 18, 573–583.CrossRefGoogle ScholarPubMed
Howlett, S., & Guthrie, E. (2001). Use of farewell letters in the context of brief psychodynamic-interpersonal therpay with irratible bowel syndrome patients. British Journal of Psychotherapy, 18, 52–67.CrossRefGoogle Scholar
Ingrassia, A. (2003). The use of letters in NHS psychotherapy: a tool to help with engagement, missed sessions and endings. British Journal of Psychotherapy, 19, 355–366.CrossRefGoogle Scholar
Kamins, M. L., & Dweck, C. S. (1999). Person versus process praise and criticism: implications for contingent self-worth and coping. Developmental Psychology, 35, 835.CrossRefGoogle ScholarPubMed
Lose, A., Davies, C., Renwick, B., Kenyon, M., Treasure, J., & Schmidt, U. (2014). Process evaluation of the maudsley model for treatment of adults with anorexia nervosa trial. Part II: Patient experiences of two psychological therapies for treatment of anorexia nervosa. European Eating Disorders Review, 22, 131–139.CrossRefGoogle ScholarPubMed
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343.CrossRefGoogle ScholarPubMed
Martin, M. M., & Anderson, C. M. (1998). The cognitive flexibility scale: three validity studies. Communication Reports, 11, 1–9.CrossRefGoogle Scholar
McCombie, C., & Petit, A. (2011). An audit of goodbye letters written by clients in cognitive analytic therapy. Reformulation, Summer, 42–45.Google Scholar
McIntosh, V. V., Jordan, J., & Bulik, C. M. (2010). Specialist supportive clinical management for anorexia nervosa. In The Treatment of Eating Disorders: A Clinical Handbook (ed. Grilo, M. & Mitchell, J. E.), pp. 108–129. New York, USA: Guilford Press.Google Scholar
NICE (2017). Eating disorders: recognition and treatment. NICE Clinical Guidelines. Retrieved from: https://www.nice.org.uk/guidance/ng69Google Scholar
Parry, A., & Doan, R. E. (1994). Story Re-visions: Narrative Therapy in the Postmodern World. New York, USA: Guilford Press.Google Scholar
Rayner, K., Thompson, A. R., & Walsh, S. (2011). Clients’ experience of the process of change in cognitive analytic therapy. Psychology and Psychotherapy: Theory, Research and Practice, 84, 299–313.CrossRefGoogle ScholarPubMed
Rimes, K. A., & Chalder, T. (2010). The Beliefs about Emotions Scale: validity, reliability and sensitivity to change. Journal of Psychosomatic Research, 68, 285–292.CrossRefGoogle ScholarPubMed
Rosen, J. C., Vara, L., Wendt, S., & Leitenberg, H. (1990). Validity studies of the eating disorder examination. International Journal of Eating Disorders, 9, 519–528.3.0.CO;2-K>CrossRefGoogle Scholar
Ryle, A., Bolton, G., Howlett, S., Lago, C., & Wright, J. (2004). Writing by patients and therapists in cognitive analytic therapy. In Writing Cures: An Introductory Handbook of Writing, Counselling and Therapy, pp. 59–71. Hove: Brunner-Routledge.Google Scholar
Ryle, A., & Kerr, I. B. (2003). Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester, UK: John Wiley & Sons.Google Scholar
Schmidt, U., Magill, N., Renwick, B., Keyes, A., Kenyon, M., Dejong, H., … & Yasin, H. (2015). The Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC): comparison of the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) with specialist supportive clinical management (SSCM) in outpatients with broadly defined anorexia nervosa: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 83, 796.CrossRefGoogle ScholarPubMed
Schmidt, U., Renwick, B., Lose, A., Kenyon, M., DeJong, H., Broadbent, H., … & Serpell, L. (2013). The MOSAIC study-comparison of the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) with Specialist Supportive Clinical Management (SSCM) in outpatients with anorexia nervosa or eating disorder not otherwise specified, anorexia nervosa type: study protocol for a randomized controlled trial. Trials, 14, 1.CrossRefGoogle Scholar
Schmidt, U., Ryan, E. G., Bartholdy, S., Renwick, B., Keyes, A., O’Hara, C., … & Dejong, H. (2016). Two‐year follow‐up of the MOSAIC trial: a multicenter randomized controlled trial comparing two psychological treatments in adult outpatients with broadly defined anorexia nervosa. International Journal of Eating Disorders, 49, 793–800.CrossRefGoogle ScholarPubMed
Schmidt, U., Wade, T. D., & Treasure, J. (2014). The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): development, key features, and preliminary evidence. Journal of Cognitive Psychotherapy, 28, 48–71.CrossRefGoogle Scholar
Tchanturia, K., & Hambrook, D. (2010). Cognitive remediation therapy for anorexia nervosa. Treatment of Eating Disorders, 130–150.Google Scholar
Treasure, J., & Schmidt, U. (2013). The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of Eating Disorders, 1, 13.CrossRefGoogle ScholarPubMed
Turpin, C., Adu-White, D., Barnes, P., Chalmers-Woods, DR., Delisser, C., Dudley, J., & Mesbahi, M. (2011). What are the important ingredients of a CAT goodbye letter? Reformulation, Winter, 30–31.Google Scholar
Walker, T., Shaw, J., Turpin, C., Roberts, C., Reid, C., & Abel, K. (2016). A qualitative study of good-bye letters in prison therapy. Crisis, 38, 100–106.CrossRefGoogle ScholarPubMed
Waterman-Collins, D., Renwick, B., Lose, A., Kenyon, M., Davies, C., Serpell, L., … & Schmidt, U. (2014). Process evaluation of the MOSAIC trial: part I. Therapist Experiences of MANTRA and SSCM. European Eating Disorders Review.Google Scholar
White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. Adelaide: WW Norton & Company.Google Scholar
Wojcik, J. V., & Iverson, E. R. (1989). Therapeutic letters: The power of the printed word. Journal of Systemic Therapies, 8, 77.CrossRefGoogle Scholar
Zainal, K. A., Renwick, B., Keyes, A., Lose, A., Kenyon, M., DeJong, H., … & Johnson-Sabine, E. (2016). Process evaluation of the MOSAIC trial: treatment experience of two psychological therapies for out-patient treatment of anorexia nervosa. Journal of Eating Disorders, 4, 2.CrossRefGoogle ScholarPubMed
Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa: aetiology, assessment, and treatment. The Lancet Psychiatry, 2, 1099–1111.CrossRefGoogle Scholar
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