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Title: Exploring therapist factors and the use of implementation intentions among clinicians practicing family based treatment with children and adolescents with eating disorders
Author: Benson, Elizabeth
ISNI:       0000 0004 9358 2117
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2020
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Family Based Treatment (FBT) is a recommended therapy for children and adolescents living with an eating disorder; it is founded on research evidence, and is most effective when it is delivered according to the manual. Routine and regular weighing of clients is an essential component of FBT (Lock & le Grange, 2013). Despite the importance of weighing, nearly half of therapists delivering FBT do not weigh as suggested by the manual (Kosmerly et al., 2015). Deviation from the model might be a result of factors relating to the therapist, as opposed to being driven by the client's needs. Therefore, this thesis aimed to a) review the literature to better understand whether and how therapist factors influence the delivery of FBT, and b) investigate whether asking FBT therapists to make implementation intentions (a specific 'if-then' plan that states exactly when, where, and how a behaviour will be carried out (Gollwitzer, 1993)) could support them to adhere to evidence-based weighing. Ultimately, the project hoped to inform how clinicians can be supported to deliver FBT in accordance with protocol, to the benefit of the client. The first part of this thesis identified nineteen studies to be included in a literature review. Findings suggested that therapists' emotions (e.g. whether they felt anxious), cognitions (e.g. whether they believed FBT could meet the needs of certain clients), and behaviours (e.g. if family members could be engaged with the treatment) were linked to a) whether treatment was carried out in line with protocol, b) how well the client engaged in the treatment, and c) the extent of the client's eating disorder symptoms. Other factors, such as when parents felt empowered, and where a team had access to training and support also positively impacted on outcomes for the client. However, the methods used by several studies included in the review were criticised, therefore conclusions should be interpreted with caution. The second part of this study aimed to investigate whether prompting FBT clinicians to set a goal intention and form an implementation intention would help them to increase weighing behaviour. This study randomly allocated eighty-four FBT therapists to one of two conditions: 1) 'experimental' (participants were asked to make an implementation intention) or 2) 'control' (participants continued providing FBT as usual) condition. All participants completed an online survey, at three time points. Participants were asked questions relating to their general anxiety, specific anxiety about weighing, intentions to weigh, and the percentage of their clients that they weighed. Only the experimental group were given information about the importance of weighing, and asked to form an implementation intention to weigh their clients. Findings showed that clinicians experienced an increase in anxiety about weighing once they had made an implementation intention. Furthermore, forming implementation intentions only increased weighing behaviour among clinicians who already had strong intentions to weigh their clients. Future research is needed to explore further ways in which FBT therapists can be supported to work in line with the research evidence. Together, these findings help us to begin to understand therapist's experience of delivering FBT, and how we might better support therapists to carry out FBT in line with the manual.
Supervisor: Waller, Glenn ; Webb, Thomas Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available