2015 p. 366 [45] as; the integration of theories and techniques of two or more psychotherapies into a new conceptualisation of change or treatment approach. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. statement and Fichter MM, Quadflieg N, Crosby RD, Koch S. Long-term outcome of anorexia nervosa: results from a large clinical longitudinal study. Lancet Psychiatry. Eating Disorders 2020;8(1):1110. SSCM Thus, evidence points to MI as a promising inclusion in ED treatment, a condition which is considered ego-syntonic and therefore met with ambivalence and resistance to change. 2017;50(9):101830. Further consideration could be given to the therapeutic relationship; and re-framing SSCM with theoretical integration to incorporate complimentary therapeutic aspects of therapies such as MI and PCT, by way of supporting patient-driven outcomes. Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia, University of Sydney InsideOut Institute, Camperdown, NSW, Australia, School of Psychology, Western Sydney University, Penrith, Australia, Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, NSW, 2560, Australia, You can also search for this author in Correspondence to Waller GD, Raykos BP. It is person-centred and therefore less directive than other therapies, demanding a sophisticated skillset of the clinician [8]. SSCM has not been adequately translated to the clinical treatment setting but does lend to a multidisciplinary treatment team whereby the primary therapist is the co-ordinator of the complex medical care needs in collaboration with the persons doctor. 1). Br J Psychiatry. Health Expect Int J Pub Part Health Care Health Pol. 8600 Rockville Pike eating disorders 2015;1:15074. Hence, the conceptual model for SSCM can be used to frame the therapy, which may also be adaptable to other EDs by modifying the agreed target symptoms, within CM outputs. The lack of treatment clutter allows room to explore problems before prematurely fixing them and positions the patient as change agent [10]. Integration in psychotherapy: reasons and challenges. 8600 Rockville Pike A limitation to the expansion of SSCM in this context is that it was developed as an atheoretical control therapy [10]. [Answered!] Specialist Supportive Clinical Management (SSCM) is a promising treatment for eating disorders. Treasure J, Zipfel S, Micali N, Wade T, Stice E, Claudino A, et al. Overall, there was more clinical management content for participants with a good outcome relative to participants with a poor outcome, National Library of Medicine You may feel like you are in control one day, and completely out of control the next. Curr Opin Psychiatry. Miller WR. Anorexia nervosa. You'll learn about nutrition and how your eating habits cause your symptoms. SSCM was first developed as an aetiological, atheoretical, manualised control psychological therapy for a three-armed treatment trial of underweight participants with AN [7]. Curr Opin Psychiatry. SSCM is collaborative and flexible to peoples needs, offering them treatment choices and to progress at their own pace. J Psychother Integr. Its effects may vary for diagnostic groups, age and therapy types but are significant. 1 and a defined theoretical basis, SSCM has scope to remain true to its philosophies and flexibly tailored to the needs and preferences of a person living with AN and the therapist delivering it, within a treatment non-negotiable framework that also prioritises their safety. Objective: In the Mosaic trial [17], the SSCM group improved more in terms of reduced obsessionally on the Obsessive Compulsive Inventory, than in the MANTRA armso SSCM may be a therapy that enables more flexibility by being flexible of itself. Gutierrez E, Carrera O. Anorexia nervosa treatments and Occams razor. Speculation on aspects of potency would benefit from further testing. Br J Psychiatry. Psychological Med. What is Sscm therapy? eCollection 2020. Part of PH, ST and JC are Editors of this Journal. Compared to other comparator therapies to date, SSCM is a simpler therapy without unique or novel theoretically derived strategies. Psychiat Clin N Am. Eating In contemporary dietetic practice and especially when working in ED treatment, patient-centred care (PCC) and counselling skills (including motivational interviewing) are endorsed as part of an Accredited Practising Dietitians (APD) skill-set [41]. It may be helpful for individuals who have not seen success from standard eating disorder treatments. In summary, we propose an expansion of the aetiological SSCM AN model to include the AN Trap (see Fig. 2022 May;55(5):717-722. doi: 10.1002/eat.23697. In the most recent of these meta syntheses Karlson et al. Hay P, McIntosh V, Bulik C. Specialist supportive clinical management for severe and enduring anorexia nervosa. Current evidence-based treatments for adult anorexia nervosa (AN) have limitations, with high attrition, very poor outcomes for 20% of people, and no clearly superior manualised therapy for adults with AN. WebAdults Eating disorders Print this page LPFT eating disorder service film Watch on The team provides a county wide service for both men and women over the age of 16, who need help, support and treatment for an eating disorder such as: anorexia nervosa and bulimia nervosa. For example, in response to a patient who offers an interpersonal dilemma within their SP, the therapist may appropriately use self-disclosure in describing an approach to interpersonal difficulties by setting boundaries. Epub 2019 Sep 16. Epub 2012 Dec 10. Laura Kiely. 2015;25(3):36582. Its PCT orientation may also render the treatment suited to delivery by counselling orientated mental health practitioners, representing its adaptability to a range of clinicians. Touyz S, Le Grange D, Lacey H, Hay P, Smith R, Maguire S, et al. In SSCM dietetic support is offered in a flexible way that is responsive to individual needsbe it to inform part of the assessment phase or included alongside the treatment intervention or the dietitian as consultant to the primary therapist. Accessibility The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. In addition, this paper positions SSCM as a treatment that may be strengthened by other modalities and may also be adapted to the treatment of other eating disorders (ED), not just AN. Psychotherapy relationships that work III. PMC Conceptualising specialist supportive clinical management (SSCM): current evidence and future directions, https://doi.org/10.1186/s40337-022-00557-2, https://www.health.gov.au/sites/default/files/documents/2021/04/a-national-framework-for-recovery-oriented-mental-health-services-guide-for-practitioners-and-providers.pdf, https://www.riveroakhealth.com.au/helpful-resources, https://dietitiansaustralia.org.au/wp-content/uploads/2021/11/Eating-Disorders-Role-Statement-2017.2.pdf, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Please enable it to take advantage of the complete set of features! Behavioral interventions in the treatment of eating disorders. 2013 Dec;43(12):2477-500. doi: 10.1017/S0033291712002620. SSCM utilises well established clinical management for AN (with a sustained focus on normalised eating and weight restoration) coupled with supportive therapy principles and strategies. Developments in the psychological treatment of anorexia nervosa and their implications for daily practice. The Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC): comparison of the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) With Specialist Supportive Clinical Management (SSCM) in Outpatients With Broadly Defined Anorexia Nervosa: a randomized controlled trial. An official website of the United States government. It would be beneficial to understand SSCM better and how and why it may work, which this paper proposes. 2021 Jan;43(1):85-94. doi: 10.1016/j.clinthera.2020.11.006. 1. Often interpersonal difficulties (like social withdrawal and low self-esteem) work to maintain an eating disorder and dealing with these problems can greatly help with BMC Psychol. SSCM adopts a person and a symptom focus. Eating disorders ANZAED Virtual 2021 Workshop: An Introduction to Specialist PubMed Central 2021;54(10):186574. government site. Commonwealth of Australia; 2013. Schmidt U, Oldershaw A, Jichi F, Sternheim L, Startup H, McIntosh V, et al. sharing sensitive information, make sure youre on a federal Specialist Supportive Clinical Management (SSCM) is a promising treatment 2016;17(1):549. Psychol Med. 2015;9(3):17384. Current Therapeutic Approaches to Anorexia Nervosa: State of the Art. Keegan E, Byrne S, Hay P, Touyz S, Treasure J, Schmidt U, McIntosh VVW, Wade TD. SSCM sets target symptoms in relation to and in collaboration with the individual patient and has shown adaptability to include other outputs such as quality of life [19]. The therapist offers their full support to remain alongside and committed to the person in an empathic, non-judgmental, and encouraging way, via a therapeutic alliance, as the person navigates their way out of an eating disorder, which may take time. 2020 Mar 24;11:206. doi: 10.3389/fpsyt.2020.00206. -, Byrne S, Wade T, Hay P, Touyz S, Fairburn CG, Treasure J, et al. MeSH Attempts to bring previously unconscious material to awareness are not encouraged which is key to SSCM remaining pragmatic and directional. SSCM combines clinical management like giving information, advice and encouragement with a supportive therapeutic style. New York: Routledge; 2016. 1994;48(4):50518. 1, whereby beyond is added to the termination phase. 2021 Feb 15;11:538997. doi: 10.3389/fpsyt.2020.538997. Conceptualising specialist supportive clinical management (SSCM): current evidence and future directions. These may include; the implicit person-centred orientation (supported by lack of treatment mandates such as homework and specific modules allowing flexibility, time and responsiveness and also the collaborative formulation of target symptoms), a pragmatic and directional (as distinct from directive) orientation whereby the therapy maintains direction in a patient-led way. Treating severe and enduring anorexia nervosa: a randomized controlled trial. The place of relapse and recovery within treatment could be accepted as a clinical reality for a condition in which recovery may take time [1, 6] as seen in the phase 3 of treatment of Fig. 2017;78(2):1849. For example, when consistent with a patients goals, the therapist may ask what are your best reasons for improving some of your food choices, in a way that you feel able? SSCM also has a commitment to the reversal of starvation as a known maintaining factor, comprehensive bio-psychosocial assessment including comorbidity (which may require additional treatment), the therapeutic alliance in which specific attention is given to minimize patient defences or resistance, multidisciplinary inputs, psychoeducation (pro re nata) and the concurrent symptom and person focus. What is Sscm therapy? WebSince then, SSCM has been included in other clinical trials, with results comparable to those of other evidence based treatments, and eating disorder specialist services in New Zealand and other countries are now using SSCM as a first-line treatment for anorexia nervosa. Proceedings of the 2015 Australia and New Zealand Academy for Eating Disorders (ANZAED) Conference: Riding the Waves to Recovery. Int J Eat Disord. Specialist supportive clinical management for anorexia nervosa: Analysis of therapy content and relation to outcome. In the original trial for SSCM [7], therapy content was dictated by patients, however for research integrity, therapists were constrained to avoid specific strategies or foci of IPT or CBT [15]. eCollection 2020. Motivational interviewing helping people change. 2016;71(8):82030. Psychol Med. Child Adol Psych Cl. The NOURISHED randomised controlled trial comparing mentalisation-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of J Constr Psychol. In this review SSCM was treated as a control psychological therapy [7, 17, 18] and was not directly tested against other specialised and manualised psychological therapies in a single meta-analysis. 2012;200(1):111. volume10, Articlenumber:32 (2022) ST is a mental health adviser to the Commonwealth Department of Veteran's Affairs. Privacy [33], using a range of ED diagnoses and treatment modalities used temporal analysis to measure effect size of the quality of the therapeutic alliance (TA) on outcomes (weight and ED cognitions) at different time points. In recognition of the potential benefit of taking time as shown in Fig. Karlsson S, Friberg W, Rask M, Tuvesson H. Patients experiences and perceptions of recovering from anorexia nervosa while having contact with psychiatric care: a literature review and narrative synthesis of qualitative studies. A closer focus on the adequacy of intake may be required where target symptoms are not adequately progressing to wellness. SSCM therapy transcripts from ten participants in the original clinical trial of SSCM for anorexia nervosa were examined using thematic and content qualitative analyses. What does the Maudsley Anorexia Nervosa Treatment for Adults involve? The site is secure. Norcross JC, Goldfried MR. WebSpecialist supportive clinical management (SSCM) is for outpatients who are recovering from anorexia nervosa, as it takes an approach with an aim of the patient returning to normal eating behaviours within their own environment. No homework is mandated by the therapist [9]. Specialist Supportive Clinical Management (SSCM The level of therapist sophistication to deliver upon the supportive psychotherapy component is explored and future directions are offered. J Eat Disord. This site needs JavaScript to work properly. He is a founding member and former chair of the Faculty of Eating Disorders at the Royal College of Psychiatrists. Eating Disorders SSCM, within the proposed conceptualisation can be understood as a humanistic and relational therapy, rendering it consistent with aspects of motivational interviewing [49] and PCT [28] and could be enhanced by incorporating them more comprehensively. This paper clarifies areas of misunderstanding by describing what SSCM is and what it is not, particularly in relation to commentary about its constituent characteristics. To enhance adaptability to individual clinicians, the SP component of this model could be re-defined more broadly as multimodal, patient-directed therapiesas per the expanded Fig. Anorexia nervosa; Conceptualisation; Eating disorder; Evidence-based treatment; Meta-analysis; Pedagogy; Person-centred therapy; Psychotherapy; Theoretical integration; Therapeutic alliance. Trials. Thus, SSCM could be further strengthened as a treatment by expansion through theoretical integration (TI). Google Scholar. SSCM Theoretical Expansion of SSCM to Incorporate Strengths of Other Modalities In addition, this paper positions SSCM as a treatment that may be strengthened by other modalities and may also be adapted to the treatment of other eating disorders (ED), not just AN. Espndola CR, Blay SL. To effectively deliver this model within a relational framework, the therapist is required to be an active person in the treatment who skilfully uses role modelling and self-disclosure. 2017;22(5):58294. 2020 Apr;28(2):156-159. doi: 10.1177/1039856219875024. Specialist Supportive Clinical Management (SSCM) is a promising treatment for eating disorders. ST has chaired the Australian Takeda Binge Eating Disorder Clinical Advisory Committee for the Takeda Group of Companies. Treasure J, Stein D, Maguire S. Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? Keywords: Treatment of Eating Disorders in Adults and Adolescents Treatment of Eating Disorders in Adults and Adolescents Epub 2016 Aug 27. Jordan J, McIntosh VVW, Bulik CM. Some of the commentaries and descriptors used for SSCM, however, do not reflect the content or principles of SSCM. Psychiat Res. The past few decades have seen a shift towards TI more broadly in psychotherapy [43, 44] whereby TI is defined by Castonguay et al. Eisler I, Simic M, Fonagy P, Bryant-Waugh R. J Eat Disord. WebSpecialist Supportive Clinical Management (SSCM) is an evidence-based therapy designed for treatment of severe and enduring eating disorders. Accessibility Robinson P, Hellier J, Barrett B, Barzdaitiene D, Bateman A, Bogaardt A, et al. Despite SSCM having 70 percent fewer sessions (Mentalization Based Therapy 88 sessions and SSCM maximum 26 sessions) and limitations of the trial including high follow up attrition (40%), there were no between group differences found in the main outcomes. 2023 BioMed Central Ltd unless otherwise stated. https://doi.org/10.1186/s40337-022-00557-2, DOI: https://doi.org/10.1186/s40337-022-00557-2. -, Steinhausen H-C. Treasure J, Willmott D, Ambwani S, Cardi V, Clark Bryan D, Rowlands K, et al. WebEating Disorder Services for adults aged 18 or above which offer specialist, intensive expert help to people at a relatively early stage of their disorder are likely to be both effective and cost-effective in (a) providing early treatment, (b) reducing the need for long-term Within the proposed expansion of SSCM in Fig. official website and that any information you provide is encrypted Nat Rev Dis Prim. In Australia, the most accessible training is for CBT, followed by SSCM and MANTRA. 2005;162(4):7417. Treatment They found that early symptom improvement was related to early to mid TA measures with low to moderate effect size, however causality is not implicated, but rather a bidirectional relationship between the two variables. Bethesda, MD 20894, Web Policies 2022 Mar 7;10(1):32. doi: 10.1186/s40337-022-00557-2. The aim of the therapy is to help the SSCM combines clinical management like giving information, advice and encouragement with a supportive therapeutic style. In this context, clinicians may also seek to fix the illness, which is frequently resisted by the person with a lived experience and poses a risk to the therapeutic relationship. Specialist Supportive Clinical Management (SSCM) is a promising treatment for eating disorders. WebSpecialist supportive clinical management (SSCM) SSCM involves talking to a therapist Treatment methods for eating disorders vary and often change, based on the patient's age and level of care needed. 2016 Oct;49(10):958-962. doi: 10.1002/eat.22555. Conti JE. The proposed re-conceptualisation of SSCM in the context of its evidence may strengthen it as a treatment overall, position it as adaptable for treatment of other eating disorders and make it more accessible to clinicians. Specialist supportive clinical management for anorexia The https:// ensures that you are connecting to the Psychotherapy integration has the potential to contribute new treatment directions, which are much needed in eating disorder treatment, without replicating the work of other established therapies [43]. Australas Psychiatry. enduring anorexia nervosa: a randomized controlled Whilst the potency of SSCM therapy is incompletely understood, as outlined in this paper there are putative factors at play, such as SSCMs unique approach to dietetic intervention, treatment goals, investment in the therapeutic relationship within all phases of treatment and its directional but patient-driven orientation. This would fit within the person-centred and responsive conceptulisation of SSCM and also recognises the probable importance of specific treatment factors for specific disorders. Int J Eat Disord. Specialist Supportive Clinical Management for anorexia The workshop is suitable for new and experienced clinicians working in the public sector or in In addition to these studies in AN [4, 7, 17,18,19] Robinson and colleagues [22] have conducted a transdiagnostic RCT with SSCM as a comparative therapy in a study of 68 people with an ED (6% with AN) and personality disorder. SSCM is a unique and valid first line treatment for AN and would benefit from further expansion in line with emerging understandings of AN to strengthen it as a treatment. 2020;216(2):97104. An exploratory examination of executive functioning as an outcome, moderator, and predictor in outpatient treatment for adults with anorexia nervosa. The therapist is required to be astute to negative transference early on and this is not explored, which serves to maintain treatment direction. Specialist Supportive Clinical Management (SSCM) was designed as a control treatment but has evolved as a valid first line treatment. Managing severe and enduring anorexia nervosa: a clinicians guide. The proposed iteration in this paper (see Fig. The qualitative ED literature consistently reports that patients value the therapeutic relationship in treatment as supportive to recovery [26, 30, 31, 34]. SSCM has been an active control therapy in randomised controlled trials for AN, but has proven to be an effective therapy in its own right. Specialist Supportive Clinical Management for anorexia nervosa: what it is (and what it is not). Macdonald P, Hibbs R, Corfield F, Treasure J. SSCM has a specific view about transference and negative transference in the therapeutic relationship. The few established treatments for anorexia nervosa have limited success rates with high patient dropout. What does specialist supportive clinical management involve? J Psychother Integr. ST has chaired the Australian Takeda Binge Eating Disorder Clinical Advisory Committee for the Takeda Group of Companies. The future of psychotherapy integration: a roundtable. This paper positions SSCM as a manualised therapy for adult AN with six unique features, namely (1) a philosophy which is person-centred, non-prescriptive, and informed by the person's strengths and values, (2) a focus on the person through inclusion of supportive psychotherapy and problem (clinical management), within target symptoms as defined in relation to AN, (3) a flexible and responsive therapy that could be delivered by a variety of clinicians with experience treating AN (4) a commitment to reversing starvation though a directional approach and a defined yet flexible stance on dietetic intervention (5) a commitment to the therapeutic relationship within all three phases of treatment, and (6) a therapy 'uncluttered' by specific mandates. Cochrane Database Syst Rev. While patients consider structure to treatment as supportive, care needed to be individualised, flexible, engaging and personal to be accepted by patients [31]. Specialist Supportive Clinical Management for anorexia The commitment to the therapeutic relationship may account for some of its potency [35] and good treatment retention (76%) as found in the Touyz et al. A randomised controlled trial of three psychological treatments for anorexia nervosa. Before Careers. SSCM may be reemployed and or more exploratory psychotherapies enlisted beyond SSCM treatment and accepted as part of the treatment course to retain hopefulness. Furthermore, given the promise of this treatment and the time since development (1997) [15], it could be further expanded to reflect developments in the field [16] and contribute to the treatment repertoire for AN and possibly other EDs. 2015;23(4):31826. A secondary meta-analysis endorses SSCM as a promising treatment. 2020;9(3):630. ANZAED Virtual 2021 Workshop: An Introduction to Specialist Supportive Clinical Management (SSCM) for Eating Disorders. SSCM-SE differs in having a focus on quality of life (QoL) improvement rather than mandatory weight regain. SSCM occurs on the polar end of a psychotherapy continuum, working with issues already conscious for the person. I dont think anorexia is the way out: reconstruction of meaning in womens narratives of anorexia nervosa over 10 years. 2012;201(5):3929. It would be beneficial to understand SSCM better and how and why it may work, which this paper proposes. Specialist supportive care therapist manual 1997. Front Psychiatry. Eating disorders This is because eating disordered behaviours are a self-perpetuating maintaining factor (complicated by their endorsement by society), and this is the rationale for the expanded aetiological modelthe AN or ED trap (see Fig. Given expressed confusion about SSCM, a deeper understanding of its key therapeutic processes could inform the development of a conceptualised model. London: Constable; 2004. Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. Int J Eat Disord. Jansingh A, Danner UN, Hoek HW, van Elburg AA. McIntosh VVW, Jordan J, Carter FA, Luty SE, McKenzie JM, Bulik CM, et al. Eddy K, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, Edkins K, Krishna M, Herzog DB, Keel PK, Franko DL. Speculation on aspects of potency would benefit from further testing. Therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa. https://www.riveroakhealth.com.au/helpful-resources. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. He is a member of the Technical Advisory Group (TAG) for Eating Disorders of the Australian Government's Department of Health. As a library, NLM provides access to scientific literature. WebSpecialist supportive clinical management (SSCM) SSCM involves talking to a therapist who'll help you understand what's causing your eating disorder. The concurrent and distinct focus on the person and the problem not only serves to externalise AN but also potentially strengthens a person to build their life without AN, by addressing life issues as they present by the individual. There has been speculation about how this relatively straightforward therapy works. Maudsley Therapy for Adults with Anorexia Nervosa, Regularity, Adequacy, Variety, Eating Socially and Spontaneity, Specialist supportive clinical management. The https:// ensures that you are connecting to the Glynn LHMS, Moyers TBPD. In addition, there is a limited repertoire of endorsed treatments, all of which are manualized therapies and recent attempts to identify which of these may be a superior treatment for adult anorexia nervosa (AN) have failed e.g. The purpose of psychoeducation and motivational strategies are to support a person to make an informed decision about their ongoing commitment to engaging in ED behaviours.
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