What Patients Expect from Treatment

In a small study, patients with
anorexia nervosa had positive attitudes.

Patients with anorexia nervosa (AN) encounter a number of obstacles during treatment, including denial, little motivation to change, a struggle to gain self-control even while striving for thinness, and ambivalence about change. In addition, the disease reduces cognitive abilities, and patients often have comorbidities and difficulties with processing emotions.

Little is known about these patients’ expectations of treatment, according to Drs. Gunilla Paulson-Karlsson and Lauri Nevonen, of Obrero University and the Academy of Health and Medical Sciences, Obrero, Sweden. To learn more, the authors conducted a small qualitative study to explore what AN patients expected during treatment (Journal of Multidisciplinary Healthcare 2012; 5:169).

The final study group included 15 women between 18 and 25 years of age who were seeking help for AN after being referred by the Swedish Health Service or following self-referral. All participants were then placed on a treatment waiting list. The women were contacted by telephone and briefly informed about the study and asked to participate in an interview study at the eating disorders unit. Dr. Paulson-Karlsson interviewed all participants individually during a single 30- to 40-minute interview, which was audiotaped and transcribed by an independent secretary. After a short time on the waiting list, all patients were offered individual cognitive behavioral therapy.

Patient desires: adequate information, therapy, and help with everyday life

The women expressed their expectation that they be assessed and informed about their illness, the seriousness of the illness, and its effects on their bodies. They also wanted to know details about the treatment that was offered and some patients wanted specific therapies for their illness, and the opportunity to talk about their situation. They particularly wanted to be supported and advised about working with tasks in their daily life. They expressed weariness with their preoccupation with food and the constant need to control what they eat, and expected to gain control over their eating disorder, rather than being controlled by it. Overall, the participants expected to bring about a change in their lives, to recover from AN, and to achieve a good life with work, studies, hobbies and good interpersonal relationships.

All the women expressed various expectations of reducing their AN symptoms, getting professional help, and that one day they would be well. While many clinicians feel that AN patients in particular are poorly motivated at the beginning of treatment and have a reputation for being difficult to treat, reluctant to enter treatment, and resistant to change, with low expectations of recovery, the Swedish researchers found a very different pattern. In their study, patients expressed a high degree of expectation in terms of getting adequate therapy, reducing negative physical and psychological symptoms, and gaining a full recovery. They anticipated changing distorted thoughts, eating behaviors, leading a normal, healthy life, and meeting a therapist who is knowledgeable and experienced in treating eating disorders.

The authors did list a number of limitations to their study, including the small sample size. In addition, they underscored that the positive expressed motivation before actual assessment did not indicate what the patients’ motivation to change would be once they were in treatment. In addition, 8 of the study participants had contacted the eating disorders unit themselves, and 3 had previous treatment experience. All participants were young adults with hopes and dreams of possible futures but with negative experiences with AN, which was affecting their everyday life and relationships with friends.

The authors stress that patients’ expectations and motivations should always be discussed both before treatment and continually afterward, to enhance the therapeutic relationship.