Reciprocal Influence of Distress and Group Therapeutic Factors in Day Treatment for Eating Disorders: A Progress and Process Monitoring Study

Eating disorders (EDs) are chronic mental illnesses with high levels of psychological, social, and health burden. Day treatment programs (DTP) are effective group-based partial hospital models that have been used to treat EDs for several decades. However, few studies have examined the factors associated with reduced distress in ED patients who participate in DTP groups. Related to this is whether change in distress is preceded by change in positive group processes, or vice versa. In this study we examine the reciprocal relationship between growth of group therapeutic factors and change in distress in an ED sample. Participants were patients with an ED (n=156) who took part in a 12-week DTP at a tertiary care hospital center. On a weekly basis, patients completed progress and process monitoring measures. We hypothesized: (a) positive changes in distress and in group therapeutic factors across weeks of DTP, and (b) a bidirectional relationship between change in distress and group therapeutic factors. We found a significant growth of group therapeutic factors and decline in distress over the 12 weeks of DTP. We also found evidence for a reciprocal relationship between change in group therapeutic factors and change in distress. Group therapists working in DTPs for patients with EDs can enhance the benefits of treatment by focusing on group therapeutic processes, which in turn reduces distress, which then acts to enhance the ability of an individual to benefit from group interactions.