Treatment Non-Completion of a Compassion-Focused Therapy Eating Disorder Programme: A Mixed Methods Study

Literature Review: The systematic review aimed to identify factors associated with treatment non-completion for bulimia nervosa (BN). Three electronic databases (PsychINFO, Medline and Web of Science) were searched for articles published from January 2001 to August 2015. Sixteen papers met the inclusion criteria. The findings indicated a number of possible factors associated with treatment non-completion for BN, however demographic variables have consistently been found not to be associated with treatment non-completion. Given the significant methodological limitations evidenced across the reviewed studies, the conclusions remain tenuous and preclude clear recommendations for clinical practice. Research Report: The current research aimed to explore factors associated with treatment non-completion from a Compassion-Focused Therapy for Eating Disorders (CFT-E) programme. A mixed method approach was adopted. The quantitative approach examined whether demographic variables and self-report measures predicted failure to engage in treatment. Participants were 403 patients referred to an eating disorder service who had completed the pre-programme assessment and either commenced treatment or failed to engage. Focus group interviews were used to qualitatively explore barriers and facilitators of treatment engagement among 10 participants who had completed treatment. The findings indicated that shame, eating concern and restraint concern were significant predictors of failure to engage in CFT-E. Thematic analysis of the focus group interviews indicated four main themes related to facilitators of treatment engagement: positive experiences of therapists, being in a supportive group, developing a compassionate understanding of an eating disorder and support beyond treatment; and four main themes related to barriers to treatment engagement: the demands of treatment, difficulties exploring an eating disorder, comparison with other patients, and making the transition from an eating disorder to recovery. Implications for future research and clinical practice are considered. Critical Appraisal: Reflections and a critical appraisal of the research process are presented.