Improving Mother and Infant Interactions Through Video Feedback

Reprinted from Eating Disorders Review
May/June 2006 Volume 17, Number 3
©2006 Gürze Books

Eating disorders are common among women of childbearing age and can have a significant impact upon their relationship with their children. For example, mothers with eating disorders are more likely to be involved in major mealtime conflicts with their infants, which can lead to lower infant weights.

Alan Stein, FRCPsych, of the University of Oxford, and a group of researchers recently evaluated the effects of video-feedback treatment versus supportive counseling among 80 mothers who were attending routine well-baby clinics. The infants were 3 to 6 months of age. The women were 18 to 45 years old and all met Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) diagnostic criteria for BN or a similar eating disorder, such as a bulimic subtype of an eating disorder not otherwise specified (Am J Psychiatry 2006;163:899).

Two treatment groups

The mothers were randomly assigned to one of two interventions: a video-feedback program (40 mothers), or a control treatment of supportive counseling only (40 mothers). Both groups had 13 one-hour treatment sessions presented in the mothers’ homes.

Mothers in both groups were given a self-help manual, adapted for the postnatal period from two established treatments that contained information about eating problems and explained the program’s six steps through guided cognitive behavioral self-help. The manuals aimed to help the mothers gain control over their eating, reduce episodes of vomiting and laxative abuse, and reduce extreme concerns about shape and weight. Both groups were assessed before treatment began, when the infants were 4 to 6 months old, and after treatment, when infants were 13 months of age.

Video-feedback treatment

Video-feedback intervention to promote positive parenting is relatively new, and is designed to prevent or reduce conflicts and enhance interactions between mothers and infants, primarily during mealtimes. The visual feedback helps mothers recognize and respond to their infants’ cues and also improves awareness of infants’ developing skills and needs.

A therapist videotaped the mother and infant at home during mealtimes, usually at the principal solid meal of the day. At the next visit, the therapist and mother watched and discussed selected segments of the previous video session that highlighted the infant’s signals.

The control group: support only

Treatment in the control group was aimed at giving the mother support with empathetic listening. This helped her reflect on self-selected aspects of her life and related feelings. The aim was to encourage and support any changes she initiated, helping her develop a sense of self-empowerment and self-confidence.

Feedback had unique benefits

Seventy-seven mothers completed the study. The group that received video feedback showed significantly less conflict than the group that received supportive counseling alone, according to scores on the conflict rating scale. Marked or severe conflicts were noted for 23.7% of the mother-infant pairs in the video-feedback group and 53.8% of those in the control group. Children in the video-feedback group also showed significantly more autonomy during mealtimes; in addition, there was evidence of greater help given to the infants and a higher level of appropriate nonverbal response to infant cues in the video feedback group. There was no difference between treatment groups in appropriate verbal responses to cues and no difference in the terms of maternal intrusiveness (this one factor was reduced by about 30 % in both groups at the end of the study).

The estimated 73% reduction in the odds of a marked or severe conflict in the video-feedback group was striking and important because of the central role of mealtime interaction in the mother-infant relationship, especially in the face of a maternal eating disorder. Infant-mother conflict and lessening of infant initiatives and autonomy can make mealtimes an unpleasant experience for an infant, with lasting negative impressions around food.

According to the authors, one of the reasons that video feedback is particularly suited to studying mothers with eating disorders and possibly also to studying those with postnatal depression is that these disorders often involve a narrowed focus of attention to issues surrounding the eating disorder, including body shape, weight, and eating. This may in turn impair the mother’s ability to respond, especially to her infant’s attempts to communicate with her. Video-feedback treatment focuses the mother’s attention away from her eating preoccupations and back to her infant.

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