Background: In face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptomreduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy(web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists.Objective: This study aimed to investigate TA ratings measured at interim and after treatment, separately for patients andtherapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings;and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion.Methods: A secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eatingdisorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder nototherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping AllianceQuestionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclasscorrelations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists.A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predictedeating disorder pathology and therapy completion.Results: For treatment completers (128/170, 75.3%), the HAQ-total scores and HAQ-Helpfulness scores for both patients andtherapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7%), all HAQ scores decreasedsignificantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightlybetter after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatmentwere associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patientscores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulnessscores of therapists were positively associated with treatment completion.Conclusions: Our study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Ofparticular importance is patients’ confidence in their abilities as measured with the HAQ-Helpfulness subscale when predictingposttreatment eating disorder pathology and treatment completion.
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The recreational use of nitrous oxide (N2O; laughing gas) has largely expanded in recent years. Although incidental use of nitrous oxide hardly causes any health damage, problematic or heavy use of nitrous oxide can lead to serious adverse effects. Amsterdam care centres noticed that Moroccan–Dutch young adults reported neurological symptoms, including severe paralysis, as a result of problematic nitrous oxide use. In this qualitative exploratory study, thirteen young adult Moroccan–Dutch excessive nitrous oxide users were interviewed. The determinants of problematic nitrous oxide use in this ethnic group are discussed, including their low treatment demand with respect to nitrous oxide abuse related medical–psychological problems. Motives for using nitrous oxide are to relieve boredom, to seek out relaxation with friends and to suppress psychosocial stress and negative thoughts. Other motives are depression, discrimination and conflict with friends or parents. The taboo culture surrounding substance use—mistrust, shame and macho culture—frustrates timely medical/psychological treatment of Moroccan–Dutch problematic nitrous oxide users. It is recommended to use influencers in media campaigns with the aim to decrease the risks of heavy nitrous oxide use and improve treatment access. Outreach youth workers can also play an important role in motivating socially isolated users to seek medical and or psychological help.
BackgroundSubstance use disorders (SUDs) are prevalent in the general population, tend to follow a chronic course, are associated with many individual and social problems, and often have their onset in adolescence. However, the knowledge base from prospective population surveys and treatment-outcome studies on the course of SUD in adolescents is limited at best. The present study aims to fill this gap and focuses on a subgroup that is particularly at risk for chronicity: adolescents in addiction treatment. We will investigate the rate of persistent SUD and its predictors longitudinally from adolescence to young adulthood among youth with DSM-5 SUD from the start of their addiction treatment to 2 and 4 years following treatment-entry. In addition to SUD, we will investigate the course of comorbid mental disorders, social functioning, and quality of life and their association with SUD over time.Methods/designIn a naturalistic, multi-center prospective cohort design, we will include youths (n = 420), who consecutively enter addiction treatment at ten participating organizations in the Netherlands. Inclusion is prestratified by treatment organization, to ensure a nationally representative sample. Eligible youths are 16 to 22 years old and seek help for a primary DSM-5 cannabis, alcohol, cocaine or amphetamine use disorder. Assessments focus on lifetime and current substance use and SUD, non-SUD mental disorders, family history, life events, social functioning, treatment history, quality of life, chronic stress indicators (hair cortisol) and neuropsychological tests (computerized executive function tasks) and are conducted at baseline, end of treatment, and 2 and 4 years post-baseline. Baseline data and treatment data (type, intensity, duration) will be used to predict outcome – persistence of or desistance from SUD.DiscussionThere are remarkably few prospective studies worldwide that investigated the course of SUD in adolescents in addiction treatment for longer than 1 year. We are confident that the Youth in Transition study will further our understanding of determinants and consequences of persistent SUD among high-risk adolescents during the critical transition from adolescence to young adulthood.Trial registrationThe Netherlands National Trial Register Trial NL7928. Date of registration January 17, 2019.
