Feedback versus no feedback in improving patient outcome in group psychotherapy for eating disorders (F-EAT): Protocol for a randomized clinical trial

Background: Continuous feedback on patient improvement and the therapeutic alliance may reduce the number
of dropouts and increase patient outcome. There are, however, only three published randomized trials on the effect
of feedback on the treatment of eating disorders, showing inconclusive results, and there are no randomized trials
on the effect of feedback in group therapy. Accordingly the current randomized clinical trial, initiated in September
2012 at the outpatient clinic for eating disorders at Stolpegaard Psychotherapy Centre, aims to investigate the
impact of continuous feedback on attendance and outcome in group psychotherapy.
Methods/design: The hypothesis is that continuous feedback to both patient and therapist on treatment progress
and alliance will increase attendance and treatment outcome. The trial is set up using a randomized design with a
minimum of 128 patients allocated to either an experimental or control group at a ratio of 1:1. The experimental
group will receive standard treatment (systemic and narrative group psychotherapy) with feedback intervention,
whereas the control group will receive standard treatment only. The participants are diagnosed with bulimia
nervosa, binge eating disorder, or an eating disorder not otherwise specified, according to the DSM-IV. In the experimental
group feedback to the participants, based on the Outcome Rating Scale (ORS) and the Group Session Rating Scale
(GSRS), is actively added to standard treatment. The ORS assesses areas of life functioning known to change as a result
of therapeutic intervention. The GSRS assesses key dimensions of effective therapeutic relationships. In the control
group, the patients fill out the Outcome Rating Scale only, and feedback is not provided.
The primary outcome is the rate of attendance to treatment sessions. The secondary outcome is the severity of eating
disorder symptoms. Exploratory outcomes are the level of psychological and social functioning, and suicide or self-harm.
This is measured with the ORS, Symptom Check List, WHO-Five Wellbeing Index, Sheehan Disability Scale and a
modified version of the Self-Harm Inventory.
Discussion: If the results will confirm the hypothesis, this trial will support feedback as a way to improve group
treatment attendance for outpatients with eating disorders.