Publications by authors named "Anna Konstantellou"

9 Publications

  • Page 1 of 1

Radically open dialectical behaviour therapy adapted for adolescents: a case series.

BMC Psychiatry 2021 Sep 22;21(1):462. Epub 2021 Sep 22.

Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.

Background: Overcontrol is a transdiagnostic cluster of traits associated with excessive psychological, behavioural and social inhibitory control. It is associated with psychiatric diagnoses of depression, restrictive eating disorders and/or obsessive-compulsive personality disorder. Radically Open Dialectical Behaviour Therapy is a transdiagnostic treatment for maladaptive overcontrol. This case series evaluates an adolescent adaption (RO-A) for a transdiagnostic group of adolescents identified as overcontrolled.

Methods: Twenty-eight adolescents were consecutively referred for RO-A from two different National and Specialist Child and Adolescent Mental Health Services between June 2017 and February 2020. Baseline self-report measures assessed overcontrol characteristics, relationship and attachment quality and mental health symptoms of depression and eating disorders, which were repeated at discharge.

Results: Adolescents in this case series reported high rates of depression (78.6%), self-harm (64.3%) and eating disorders (78.6%). Most (85.7%) had two or more mental health diagnoses and all had previous mental health treatments before starting RO-A. The mean number of RO-A sessions attended was 18 group-based skills classes and 21 individual sessions over a mean period of 34 weeks. Significant improvements with medium and large effect sizes were reported in cognitive flexibility (d = 1.63), risk aversion (d = 1.17), increased reward processing (d = .79) and reduced suppression of emotional expression (d = .72). Adolescents also reported feeling less socially withdrawn (d = .97), more connected to others (d = 1.03), as well as more confident (d = 1.10) and comfortable (d = .85) in attachment relationships. Symptoms of depression (d = .71), eating disorders (d = 1.06) and rates of self-harm (V = .39) also significantly improved. Exploratory correlation analyses suggest improvements in overcontrol are moderately to strongly correlated with improvements in symptoms of depression and eating disorders.

Conclusions: This case series provides preliminary data that RO-A may be an effective new treatment for adolescents with overcontrol and moderate to severe mental health disorders like depression and eating disorders. RO-A led to improved management of overcontrol, improved relationship quality and reduced mental health symptoms. Further evaluation is indicated by this case series, particularly for underweight young people with eating disorders. More rigorous testing of the model is required as conclusions are only tentative due to the small sample size and methodological limitations.
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http://dx.doi.org/10.1186/s12888-021-03460-3DOI Listing
September 2021

The experience of intolerance of uncertainty for parents of young people with a restrictive eating disorder.

Eat Weight Disord 2021 Jul 22. Epub 2021 Jul 22.

Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK.

Purpose: This study aimed to explore how parents of young people with a restrictive eating disorder (ED) experience and manage uncertainty.

Methods: Seventeen parents of young people with a restrictive ED were recruited from multi-family therapy groups run within a specialised ED clinic. Five focus groups were conducted asking parents about their experience of uncertainty both prior and after the onset of their child's illness.

Results: Data were analysed using interpretative phenomenological analysis which yielded seven superordinate themes. (1) Anorexia nervosa and uncertainty, (2) Positive and negative experiences of uncertainty (3), Helpful and unhelpful ways of coping with uncertainty, (4) Parent's self-efficacy and uncertainty (5), Needs of parents, (6) Parents' perceptions of intolerance of uncertainty in their children and (7) Impact of uncertainty on family life.

Conclusion: Parents caring for young people with a restrictive ED exhibit a strong intolerance of uncertainty, particularly in relation to their child's illness. This 'negative uncertainty' was thought to reduce their confidence as parents in how they managed their child's ED. Targeting high levels of intolerance of uncertainty in parents caring for young people with an ED could be beneficial for supporting parents when faced with their child's illness, increasing parental self-efficacy, decreasing accommodating behaviours and ultimately contributing to improved treatment outcomes.

Level Of Evidence: Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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http://dx.doi.org/10.1007/s40519-021-01256-8DOI Listing
July 2021

Is this the 'new normal'? A mixed method investigation of young person, parent and clinician experience of online eating disorder treatment during the COVID-19 pandemic.

J Eat Disord 2021 Jun 30;9(1):78. Epub 2021 Jun 30.

Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK.

Introduction: Prior to the COVID-19 pandemic, research in virtual care for young people with eating disorders was preliminary and implementation rare. This study explored the experience of young people, parents and clinicians when therapy was transitioned to virtual provision as a result of the UK lockdown in March 2020.

Methods: A mixed-method approach was used in this study. Online questionnaires that included a mixture of rating (Likert scale) and free-text response questions were completed by 53 young people with any eating disorder, 75 parents and 23 clinicians. Questions focused on the experience of online treatment as well as the impact on engagement, perceived treatment efficacy and preferences around treatment mode in the future. Likert scale questions were analysed using a summary approach. Free-text responses were analysed qualitatively using reflexive thematic analysis.

Results: Responses to rating scale questions indicate satisfaction with treatment, good engagement and ability to manage technology. Young people who had transitioned care, rather than started care virtually in lockdown, rated therapy as less effective. However, individual accounts of experience were more varied. Reflexive thematic analysis of free-text responses identified key themes of 1) Making it work, 2) Home as a therapeutic space, and 3) Disrupted connection and 4) Into the future.

Conclusions: These results have implications for ongoing care during the pandemic and for future implementation of virtual care in the treatment of young people with eating disorders. Particular issues arising are the trade-off between accessibility and therapeutic engagement and depth and need for consideration of equal access to treatment in socially unequal societies.
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http://dx.doi.org/10.1186/s40337-021-00429-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243044PMC
June 2021

Same, same but different: Attention bias for food cues in adults and adolescents with anorexia nervosa.

Int J Eat Disord 2019 06 26;52(6):681-690. Epub 2019 Mar 26.

Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.

Objective: Attention processing for food may be biased in people with Anorexia Nervosa (AN). However, previous studies have had inconsistent results. This is likely to be due to indirect assessment of attention, which does not inform on the underlying attention processes, and/or the heterogeneity of participants across studies, testing either adults or adolescents with AN, that is, people at very different developmental and illness stages.

Method: Eye-tracking was employed as a direct assessment of attention during a visual probe task with food versus non-food pictures. Attention bias for food was measured in 39 adults and 34 adolescents with AN and in 53 adults and 31 adolescents without AN.

Results: All participants had a direction bias for food, specifically for high-calorie food. However, adults with AN subsequently avoided maintaining attention on food versus non-food cues, compared to adults without AN. Adolescents with or without AN demonstrated increased attention maintenance on food versus non-food cues, and, contrary to our hypothesis, did not differ in their attention bias for food cues. Accordingly, adults with AN differed significantly from adolescents with AN in attention maintenance for food cues: while adolescents with AN showed significantly increased attention maintenance on food stimuli, adults avoided maintaining attention on food cues.

Discussion: Adults with AN may apply attention strategies to facilitate restrictive eating. This strategy is absent in adolescents with AN. This difference in food-related attention bias between adolescents and adults with AN suggests that attention biases develop over time as the illness progresses.
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http://dx.doi.org/10.1002/eat.23064DOI Listing
June 2019

The experience of intolerance of uncertainty for young people with a restrictive eating disorder: a pilot study.

Eat Weight Disord 2019 Jun 16;24(3):533-540. Epub 2019 Feb 16.

Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK.

Purpose: Research is consistently reporting elevated levels of intolerance of uncertainty (IU) in individuals with an eating disorder (ED). Less is known about the phenomenology of uncertainty for this clinical group. The present study aims to advance our understanding of the relationship between IU and restrictive EDs by providing insight into young people's subjective experiences of uncertainty.

Methods: Thirteen young people with a restrictive ED were recruited from multi-family therapy groups run within the Maudsley Centre for Child and Adolescent Eating Disorders at the South London and Maudsley NHS Foundation Trust. Three focus groups were conducted asking young people to discuss their views, experiences and coping strategies when faced with uncertainty.

Results: Data were analysed using interpretative phenomenological analysis which yielded five superordinate themes: (1) young people perceived uncertainty as something negative; (2) high levels of anxiety and stress were identified as primary responses to uncertainty; (3) ED behaviours were given a functional role in reducing uncertainty; (4) need to control various aspects of young peoples' lives was of high importance; (5) young people discussed how they struggled to find ways to cope with uncertainty and often used behaviours associated with the eating disorder psychopathology as coping strategies.

Conclusion: Young people's experiences of what uncertainty is like for them revealed a dynamic interplay between ED symptoms and fear of uncertainty. Findings support IU as a relevant concept for young people suffering from a restrictive ED and indicate that further exploration of IU from both theoretical and clinical perspectives could be fruitful.

Level Of Evidence: V.
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http://dx.doi.org/10.1007/s40519-019-00652-5DOI Listing
June 2019

Impact of ASD Traits on Treatment Outcomes of Eating Disorders in Girls.

Eur Eat Disord Rev 2017 03 6;25(2):123-128. Epub 2017 Jan 6.

National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, UK.

Evidence links high levels of Autism Spectrum Disorder Traits in women with chronicity of anorexia nervosa. This study reports through clinical audit the impact of ASD traits on treatment outcomes of girls who were referred for treatment in a specialist eating disorder service. Presence of current, but not early childhood, ASD traits was elevated in comparison with previously reported community samples. Current ASD traits were correlated with emotional disorders and with need for treatment augmentation (psychiatric inpatient or day patient admission), but this relationship was not significant after the contribution of depression had been controlled for. There was no difference in Morgan Russell Outcomes at discharge for those with high and low current ASD traits. Parent-reported ASD-related developmental difficulties were associated with attenuated change in self-reported cognitive symptoms of AN. This study highlights the need for further understanding of the aetiology, diagnostic significance and predictive utility for future relapse of elevated ASD traits in childhood eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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http://dx.doi.org/10.1002/erv.2497DOI Listing
March 2017

Testing a cognitive model of generalized anxiety disorder in the eating disorders.

J Anxiety Disord 2011 Oct 28;25(7):864-9. Epub 2011 Apr 28.

Section of Family Therapy, Institute of Psychiatry, King's College London, De Crespigny Park, London, UK.

Generalized anxiety disorder (GAD) is one of the most common comorbid disorders found in individuals with eating disorders. Despite this, little is known of shared vulnerability factors between the two disorders. The aim of the present study was to examine the four main components of a cognitive model for GAD in the eating disorders. One hundred and sixty-two females took part. Three groups were formed comprising of 19 participants with an eating disorder and GAD, 70 with an eating disorder without GAD and 73 healthy controls. All completed self-report questionnaires that measured eating attitudes, levels of GAD, intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Participants with an eating disorder and GAD scored the highest on all four components when compared to healthy individuals and on most components when compared to those with an eating disorder. Participants with an eating disorder without GAD scored higher on all components compared to healthy controls. Findings extend our understanding of shared vulnerability factors between the eating disorders and GAD.
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http://dx.doi.org/10.1016/j.janxdis.2011.04.005DOI Listing
October 2011

What does uncertainty mean to women with anorexia nervosa? An interpretative phenomenological analysis.

Eur Eat Disord Rev 2011 Jan-Feb;19(1):12-24

King's College London, UK.

Objective: The objective of this study was to explore the construct of intolerance of uncertainty in patients with anorexia nervosa through focus groups.

Method: Nine women with anorexia nervosa participated in three focus groups in an in-patient, rehabilitation and day care setting. Focus groups probed participants' experiences of uncertainty and the meaning to them of uncertainty on a physical, behavioural, cognitive and emotional level.

Results: Data were analysed using Interpretative Phenomenological Analysis (IPA). Patients experienced uncertainty as stressful and wanted to avoid this at all costs. Prominent sources of uncertainty were fear of negative evaluation by others and feelings of being imperfect. Uncertain situations led participants to feel anxious and 'out of control', resulting in a strong desire for control which manifested in extreme organising and planning.

Discussion: Results suggest that treatment strategies aimed at increasing tolerance of uncertainty in people with anorexia nervosa could be beneficial.
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http://dx.doi.org/10.1002/erv.1029DOI Listing
May 2011

Intolerance of uncertainty and metacognitions in a non-clinical sample with problematic and normal eating attitudes.

Eat Behav 2010 Aug 13;11(3):193-6. Epub 2010 Jan 13.

School of Social Sciences, Brunel University, Uxbridge, Middlesex, UK.

The present study investigates intolerance of uncertainty and metacognitions in individuals with problematic eating attitudes (PEA) and individuals with normal eating attitudes (NEA). It was hypothesised that individuals with PEA will show higher levels of intolerance of uncertainty and metacognitions compared to individuals with NEA, and that the two variables would be positively associated. A non-clinical sample of 116 UK-based university students completed the Eating Attitudes Test (EAT-26), Metacognitions Questionnaire (MCQ-30) and Intolerance of Uncertainty Scale (IUS). Twenty-seven participants formed the PEA group and 89 the NEA group. Results overall supported the hypotheses, participants with PEA scored significantly higher on three of the five metacognition factors, total metacognition score and intolerance of uncertainty compared to participants with NEA. Positive correlations were also found between intolerance of uncertainty and metacognitions. Findings point towards further examining intolerance of uncertainty and metacognitions in the field of eating disorders. Changing metacognitions and targeting high levels of intolerance of uncertainty could contribute to better treatment outcome for individuals with eating disorders.
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http://dx.doi.org/10.1016/j.eatbeh.2010.01.003DOI Listing
August 2010
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