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Emotion Regulation in Eating Disorders: How Can Art Therapy Contribute to Treatment Outcome?

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ClinicalTrials.gov Identifier: NCT04265131
Recruitment Status : Completed
First Posted : February 11, 2020
Last Update Posted : December 23, 2022
Sponsor:
Collaborator:
University Ghent
Information provided by (Responsible Party):
University Hospital, Ghent

Study Description
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Brief Summary:

Eating disorders are difficult to treat. Some forms of treatment have already been found to be effective, nevertheless chronicity is a major problem. For example, both cognitive behavioral therapy and family therapy (FBT; family-based treatment) appear to be effective treatment methods, in which FBT distinguishes itself primarily in its long-term effect. However, eating disorders persist in 20 to 25 percent of cases, only 46 percent of patients with Anorexia Nervosa fully recover and one third only partially improve. Since the mortality rate of this mental disorder is particularly high, it is necessary to keep looking to improve treatment. Because emotion regulation problems play an important role in the cause and maintenance of an eating disorder, more emotion-focused therapies may improve treatment outcome. Dialectical Behavioral Therapy is a treatment that has a strong focus on emotions regulation, but so far only limited evidence has been found for the effectiveness of this type of therapy in eating disorders. Some studies show that art therapy (AT; art therapy) can contribute to a more adaptive regulation of emotions. However, this type of therapy has not been studied in the context of eating disorders yet. AT is an experiential form of therapy in which art techniques and supplies (including drawing, painting, clay, etc.) are used methodically with a therapeutic purpose. The idea that creative expression can perpetuate or improve mental well-being has been accepted worldwide for many years. Despite the long history of practical applications, to date little evidence exist on the effectiveness of this form of treatment. There's growing worldwide interest in scientific research and the emphasis on evidence-based practice (EBP) for this form of treatment. In a recent study, Lock and colleagues compare AT with cognitive remediation therapy (CRT) and the added value of both in a sample of adolescents with anorexia nervosa combines with obsessive-compulsive problems. Both CRT and AT are offered in this study in combination with family based therapy (FBT). The group in which the combination of FBT and AT was offered yielded better results than those in which FBT is combined with CRT.

Study hypothesis: the investigators expect that complementing treatment as usual (TAU) with art therapy (AT) will lead to a decrease in emotion regulation problems in patients with an eating disorder in comparison with TAU only, without AT.


Condition or disease Intervention/treatment Phase
Eating Disorders Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other: art therapy Not Applicable

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 22 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description:

The participants are consecutively assigned in two conditions: a within-subjects design. Those from the experimental group receive standard treatment (TAU) with AT as an extra variable. AT is an experiential form of therapy in which art techniques and supplies (including drawing, painting, clay, etc.) are used methodically with a therapeutic purpose. TAU means that individual verbal therapy takes place on a regular basis, whereby the frequency varies depending on the severity of the eating disorder and the patient's request for help. Cognitive-behavioral therapy is provided with elements of dialectical behavioral therapy, and there is also the possibility of family or couple counseling by a family-based therapist. The participants in the control group only receive this standard treatment (TAU), without AT. Waves will be used: a control group will also become an experimental group at a later stage.

In this way the investigators can investigate the additional added value of AT.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Emotion Regulation in Eating Disorders: How Can Art Therapy Contribute to Treatment Outcome? A Feasibility Study
Actual Study Start Date : October 25, 2019
Actual Primary Completion Date : June 30, 2021
Actual Study Completion Date : June 30, 2021
Arms and Interventions
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Arm Intervention/treatment
Experimental: Experimental group
art therapy is delivered on top of treatment as usual (TAU). TAU means that individual verbal therapy takes place on a regular basis, whereby the frequency varies depending on the severity of the eating disorder and the patient's request for help. Cognitive-behavioral therapy is provided with elements of dialectical behavioral therapy, and there is also the possibility of family or couple counseling by a family-based therapist.
 Other: art therapy
Art therapy is a form of psychotherapy that uses creative methods of expression through art media, such as pencils, clay, paint etc.


Outcome Measures
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Primary Outcome Measures :
  1. Change in Difficulties in Emotion Regulation Outcome Measures [ Time Frame: The outcome measure will be assessed in phase 1= baseline outcome, phase 2= 6 weeks after baseline , phase 3 = 3 weeks after phase 2, phase 4= 3 weeks after phase 3 and phase 5 = 6 weeks after phase 4 ]
    Measured with "Difficulties in Emotion Regulation Scale" (DERS). This questionnaire contains 36 items that are surveyed on 6 different subscales for clinically relevant emotion regulation problems. Items are scored on a five-point scale from 1 (almost never) to 5 (almost always).

  2. Change in Cognitive Emotion Regulation [ Time Frame: phase 1= baseline outcome, phase 2= 6 weeks after phase 1, phase 3 = 3 weeks after phase 2, phase 4= 3 weeks after phase 3 and phase 5 = 6 weeks after phase 4 ]
    Measured with Cognitive Emotion Regulation Questionnaire (CERQ). This questionnaire with 36 items, in which is assessed what someone thinks in stressful situations.

  3. Change in the the psychological background of the eating disorder. [ Time Frame: phase 1= baseline outcome, phase 2= 6 weeks after phase 1, phase 4= 6 weeks after phase 2 and phase 5 = 6 weeks after phase 4 ]
    Measures with Eating disorder inventory-3 (EDI-3). This self-report questionnaire consists of 2 parts. On the one hand a diagnosis list, based on the DSM-5, on the other hand questions regarding the psychological background of eating disorder.

  4. Change in emotion regulation in art therapy. [ Time Frame: phase 3 (=9 weeks after baseline outcome measure outcome 1,2 and 3) and phase 4= 3 weeks after phase 3 ]
    Measures with "Expression And Emotion Regulation in Art Therapy Scale" (SERATS) This is a short questionnaire with 9 items asking for emotion regulation in art therapy.


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • The participant is diagnosed with an eating disorder by a psychiatrist at the outpatient department of Ghent University Hospital Eating Disorders.
  • At the start of the study, the participant is being treated by a psychiatrist or psychologist at the outpatient department of Eating Disorders at UZ Gent.
  • The participant is informed about the purpose of the research and informed consent.

Exclusion Criteria:

  • The candidate has already had a hospitalization and so art therapy at the eating disorders department at UZ Gent.
  • Lower intelligence with an estimated IQ score lower than 85- The candidate participant is a minor at the start of the study.
  • The candidate is struggling with a psychotic problem, as determined by the treating physician or psychologist.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04265131


Locations
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Belgium
Ghent University
Ghent, Belgium, 9000
Sponsors and Collaborators
University Hospital, Ghent
University Ghent
More Information
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Publications:
van den Broek, E., Keulen-de Vos, M., & Bernstein, D. P. (2011). Arts therapies and schema focused therapy: A pilot study. The Arts in Psychotherapy, 38(5), 325-332.
Gatta, M., Gallo, C., & Vianello, M. (2014). Art therapy groups for adolescents with personality disorders. The Arts in Psychotherapy, 41(1), 1-6.
Slayton, S. C., D'Archer, J., & Kaplan, F. (2010). Outcome studies on the efficacy of art therapy: A review of findings. Art therapy, 27(3), 108-118.
Van Lith, T. (2016). Art therapy in mental health: A systematic review of approaches and practices. The Arts in Psychotherapy, 47, 9-22.
Gratz, K. L., & Roemer, L. (2004). Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54
Garnefski, N., & Kraaij, V. (2007). The cognitive emotion regulation questionnaire. European Journal of Psychological Assessment, 23(3), 141-149.
Garner, D. M. (2004). Eating disorder inventory-3 (EDI-3). Professional manual. Odessa, FL: Psychological Assessment Resources.

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Responsible Party: University Hospital, Ghent
ClinicalTrials.gov Identifier: NCT04265131    
Other Study ID Numbers: EC/2019/0785
First Posted: February 11, 2020    Key Record Dates
Last Update Posted: December 23, 2022
Last Verified: December 2022

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by University Hospital, Ghent:
art therapy
emotion regulation
treatment
Additional relevant MeSH terms:
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Anorexia
Bulimia
Feeding and Eating Disorders
Anorexia Nervosa
Binge-Eating Disorder
 Bulimia Nervosa
Mental Disorders
Signs and Symptoms, Digestive
Hyperphagia