sscm eating disorders
2015;3(S1):O1-O. Book By using this website, you agree to our It requires an experienced psychotherapist to deliver it as SSCM addresses both the symptom of the ED (food and exercise behaviours) as well as life issues causing difficulty to a person (psychotherapy), as presented by the patient. Clipboard, Search History, and several other advanced features are temporarily unavailable. 1). A meta-analysis of 20 studies by Graves et al. Google Scholar. The primary focus of SSCM for anorexia nervosa is the resumption of normal eating and the restoration of weight. Sscm government site. Specialist Supportive Clinical Management (SSCM) was designed as a control treatment but has evolved as a valid first line treatment. The .gov means its official. Eddy K, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, Edkins K, Krishna M, Herzog DB, Keel PK, Franko DL. Compared to other comparator therapies to date, SSCM is a simpler therapy without unique or novel theoretically derived strategies. 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. Web1. ST is a mental health adviser to the Commonwealth Department of Veteran's Affairs. 2017;50(4):32340. [Answered!] Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions? Child Adol Psych Cl. J Constr Psychol. 2015;9(3):17384. Further consideration about the practicalities of translating this model from the clinical trial to treatment setting are required in order to adapt SSCM to the treatment setting and are shown in Fig. PH, ST and JC are Editors of this Journal. Thus, it does not currently have a defined theoretical basis, being a pre-requisite for TI and integrative efforts could be misconstrued as eclectic. 2022 Mar 7;10(1):32. doi: 10.1186/s40337-022-00557-2. The TA is a complex concept and measured in varied ways [32, 33]. Treatment methods for eating disorders vary and often change, based on the 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. 2016;29(2):16583. WebObjective: Specialist Supportive Clinical Management (SSCM) is a psychotherapy comprising a clinical manage-ment focus addressing anorexia nervosa (AN) symptoms and a supportive therapy component. Psychol Med. Google Scholar. The therapists focus is on evocation by reflecting and exploring and this is required to take time. Please enable it to take advantage of the complete set of features! Waller GD, Raykos BP. McIntosh VVW, Carter JD, Jordan J, Loughlin A. Int J Eat Disord. 2018;55(4):30315. Therefore, progress is emphasised to be slow and steady rather than rapid and impressive, to promote ongoing self-efficacy. As an extension to this VRA model, there are more comprehensive iterations of this type such as the Regularity, Adequacy, Variety, Eating Socially and Spontaneity (RAVES) model [39], which is an obvious inclusion within an updated iteration of SSCM. It is less prescriptive than other manualised therapies and therefore could be offered to people more than once, building hopefulness. The currently available evidence-based outpatient treatments for adult anorexia nervosa (AN) have consistently returned disappointing results whereby outcomes are poor and dropout rates are high [1,2,3,4,5]. 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. In the absence of a clinician led agenda for homework and monitoring expectations, SSCM by its nature is easier to adapt the pace to be person-centred and responsive. On becoming a person: a therapists view of psychotherapy. Given the authors of SSCMs speculation about the therapeutic relationship as an aspect its potency [10] and its contribution to outcomes particularly with AN and individual psychotherapies such as SSCM [33] as well as being important to patients, an overt description of the key qualities to support this are offered within the proposed conceptual model in Fig. Two psychological therapies, specialist supportive clinical management (SSCM), and cognitive behavior therapy for anorexia nervosa (CBT-AN) have limited (one randomized controlled Collaborative dietetic and psychological care in Interprofessional Enhanced Cognitive Behaviour Therapy for adults with Anorexia Nervosa: a novel treatment approach. There has been limited attention to the TA as it relates to ED treatment. SSCM-SE trial [19]. 2014;15(3):38891. WebSpecialist Supportive Clinical Management (SSCM) is an evidence-based therapy designed for treatment of severe and enduring eating disorders. 2015 ANZAED Conference: Riding the Waves to Recovery, This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, http://creativecommons.org/licenses/by/4.0, http://creativecommons.org/publicdomain/zero/1.0/. 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 borderline personality disorder. The importance of listening to patient preferences when making mental health care decisions. This Mini-Review presents recent research into evidence for psychological treatments for people with severe and enduring anorexia nervosa (SEAN). McIntosh VVW, Carter JD, Jordan J, Loughlin A. Int J Eat Disord. eating disorders Specialist Supportive Clinical Management for Eating disorders Lancet Psychiatry. A randomised controlled trial of three psychological treatments for anorexia nervosa. Specialist supportive clinical management (SSCM MeSH 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/. The https:// ensures that you are connecting to the An ability to In summary, we propose an expansion of the aetiological SSCM AN model to include the AN Trap (see Fig. DietitiansAustralia. McIntosh VV, Jordan J, Carter JD, Luty SE, Carter FA, McKenzie JM, Frampton CM, Joyce PR. (PDF) Specialist Supportive Clinical Management for SSCM has a specific view about transference and negative transference in the therapeutic relationship. Managing severe and enduring anorexia nervosa: a clinicians guide. 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. Understanding the roles of self-esteem, self-compassion, and fear of self-compassion in eating disorder pathology: an examination of female students and eating disorder patients. The workshop is suitable for new and experienced clinicians working in the public sector or in You may feel like you are in control one day, and completely out of control the next. It would be beneficial to understand SSCM better and how and why it may work, which this paper proposes. 2018;31(1):7294. Am J Psychiatry. Implementing service transformation for children and adolescents with eating disorders across England: the theory, politics, and pragmatics of large-scale service reform. It would be beneficial to understand SSCM better and how and why it may work, which this paper proposes. It may be helpful for individuals who have not seen success from standard eating disorder treatments. The use of motivational interviewing in eating disorders: a systematic review. 2019;42(2):18191. Severe and Enduring Eating Disorders 2005;162(4):7417. Commonwealth of Australia; 2013. 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. 2016;17(1):549. Please enable it to take advantage of the complete set of features! 1 philosophy. 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. Federal government websites often end in .gov or .mil. In the context of its flexible and person-centred orientation, there is also the possibility to engage the minutiae of food and nutrition with meal plans and self-monitoring to best serve the individual, per the patient therapist collaboration [42]. and transmitted securely. It offers a broad brush strokes approach with its focus on dietary Variety and Regularity and as well as Adequacy (which could be better described conceptually as the VRA model to dietetic intervention) with supporting clinician resources as needed (see Fig. Specialist Supportive Clinical Management for Anorexia In this seminal trial it was termed Non-Specific Clinical Management (NSCM). It is less prescriptive than other manualised therapies and therefore could be offered to people more than once, building hopefulness. Maudsley Therapy for Adults with Anorexia Nervosa, Regularity, Adequacy, Variety, Eating Socially and Spontaneity, Specialist supportive clinical management. Therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa. Article Laura Kiely. Eating disorders 2017;50(9):10181030. Elliott R, Bohart AC, Watson JC, Murphy D. Therapist empathy and client outcome: an updated meta-analysis. This was seen as a negative by the therapists delivering it. 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. PH, ST and JC are Editors of this Journal. The few established treatments for anorexia nervosa have limited success rates with high patient dropout. J Consult Clin Psych. Specialist Supportive Clinical Management (SSCM) is a psychotherapy with promising potential for the treatment of anorexia nervosa. Rance N, Moller NP, Clarke V. Eating disorders are not about food, theyre about life: client perspectives on anorexia nervosa treatment. SSCM A closer focus on the adequacy of intake may be required where target symptoms are not adequately progressing to wellness. Child Adol Psych Cl. Kiely, L., Touyz, S., Conti, J. et al. Bethesda, MD 20894, Web Policies Specialist supportive clinical management (SSCM) for 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. Before ST has chaired the Australian Takeda Binge Eating Disorder Clinical Advisory Committee for the Takeda Group of Companies. ANZAED Workshops | ANZAED Gutierrez E, Carrera O. Anorexia nervosa treatments and Occams razor. J Psychother Integr. An exploratory examination of executive functioning as an outcome, moderator, and predictor in outpatient treatment for adults with anorexia nervosa. Significant moderators included age, type of ED diagnosis and treatment type, where the TA was more important in predicting outcomes for younger patients, those with AN compared with other EDs and possibly in treatments which view the therapeutic relationship as an aspect of potency with the example of greater importance in supportive psychotherapy compared with CBT. 1). There is an additional focus not just on a clients symptoms, but on improving their enjoyment and quality of life alongside their eating disorder symptoms. Psychother Res. https://doi.org/10.1186/s40337-022-00557-2, DOI: https://doi.org/10.1186/s40337-022-00557-2. 2014;22(2):1319. -, Byrne S, Wade T, Hay P, Touyz S, Fairburn CG, Treasure J, et al. Eur Eat Disord Rev. It requires an experienced psychotherapist to deliver it as SSCM addresses both the symptom of the ED (food and exercise behaviours) as well as life issues causing difficulty to a person (psychotherapy), as presented by the patient. Therefore, the applicability of SSCM for APDs with requisite ED experience in a contemporary understanding of dietetic training and practice, warrants further investigation. What is Sscm therapy? [Answered!] - Eating Disorder Resources Jansingh A, Danner UN, Hoek HW, van Elburg AA. Given the weighting towards clinical focus on education, care and support to provide psychoeducation by way of normalising eating to reduce target symptoms (see Fig. What does specialist supportive clinical management involve? 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. 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. There is now substantive evidence that SSCM is a viable and efficacious psychological therapy for people with AN. 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. On this premise, therapy may continue beyond the 2040 focused sessions. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). He has also received an investigator led grant, completed commissioned reports and participated in educational meetings. Bookshelf LK and PH conceived this publication; ST and JC contributed to the writing and editing. Outcome of eating disorders. Specialist supportive clinical management for anorexia nervosa: Analysis of therapy content and relation to outcome. Front Psychiatry. McIntosh V, Jordan J, Joyce P, McKenzie J, Luty SE, Carter FA, et al. Recovering identity from anorexia nervosa: womens constructions of their experiences of recovery from anorexia nervosa over 10 years. Integration in psychotherapy: reasons and challenges. 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. eating disorders Specialist Supportive Clinical Management - Anorexia Nervosa Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. 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. This is distinct from eclecticism [46] which borrows techniques without attention to how they fit within a revised conceptual model and underpinning theories. 2022 May;55(5):717-722. doi: 10.1002/eat.23697. 2019;22(3):45764. Schmidt U, Oldershaw A, Jichi F, Sternheim L, Startup H, McIntosh V, et al. WebSince then, SSCM has been included in other clinical trials, with results comparable to those Nat Rev Dis Prim. HHS Vulnerability Disclosure, Help SSCM has two distinct components: clinical management, which involves 1for example Person Centred Therapy [28]. Furthermore, a key distinction of SP is that it considers issues that are presently in the persons conscious awareness, thereby maintaining treatment direction and focus. 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. 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. SSCM combines clinical management Outcome of eating disorders. Hay PJ, Claudino AM, Touyz S, Abd Elbaky G, Hay PJ. official website and that any information you provide is encrypted Conclusion: SSCM SSCM demands clinician sophistication to deliver upon its SP orientation including an understanding of treatment nuance to clearly delineate from its exploratory psychotherapy cousins [14]. Int J Eat Disord. You SSCM thus has a robust evidence base and provides an alternative grounded in supportive psychotherapy principles as described by Dewald [14]. 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. This nuanced work is that of an experienced clinician. 2013;43(12):250111. sharing sensitive information, make sure youre on a federal FOIA Dr Paul Robinson, Director of Research and Development - Orri Jordan J, McIntosh VVW, Bulik CM. 2022 May;55(5):717-722. doi: 10.1002/eat.23697. Within the proposed expansion of SSCM in Fig. What does the Maudsley Anorexia Nervosa Treatment for Adults involve? A randomised controlled trial of three psychological treatments for anorexia nervosa.