Cited by 24Eating Disorders and BehaviorsCounseling, Therapy, and Family DynamicsNutrition, Health and Food Behavior

The DOI matches its Crossref record; 69 of the 70 references it cites were found in a registry or an index; 2 of the 329 sources its claims cite were checked for support.

Paper 1: a systematic synthesis of narrative therapy treatment components for the treatment of eating disorders

Open access
Heywood, Lauren, Conti, Janet, Hay, Phillipa·2022·Journal of Eating Disorders

Abstract

Background: There are presently a number of eating disorder treatment interventions that have a research-evidence base to support their effectiveness. However, rates of attrition and treatment outcomes demonstrate that there is no one-size fits all for the treatment of eating disorders. Narrative therapy is a promising, but under-researched, intervention for the treatment of eating disorders (EDs). The aim of this study was to conduct a narrative synthesis of the literature to explore the content and use of narrative therapy in the treatment of EDs. Method: Data were extracted from 33 eligible included studies following systematic search of five data bases. Data included aims and objectives, sample characteristics, treatment details and components of narrative therapy, which informed the narrative synthesis. The study is reported according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Narrative therapy interventions for EDs consisted of several components including the narrative worldview; unpacking the problem story; finding, thickening the meaning and performance of stories hidden by the problem story; and safety considerations. A notable proportion of the extracted articles discussed components of unpacking problem stories, and finding and re-authoring openings (or unique outcomes) that were hidden by problematic stories. Relatively fewer papers discussed the processes by identity shifts were performed or lived out, including in the eating practices of those with a lived ED experience. Furthermore, few papers addressed how therapists established client safety within the narrative framework when working with EDs. Conclusion: This narrative synthesis found that narrative practitioners utilise a variety of narrative therapy techniques in working with individuals with a lived ED experience. The current literature has emphasis on specific narrative therapy techniques used in ED treatments, with some aspects of the narrative worldview and safety considerations left undiscussed. Additional research is needed to explore how identity shifts in narrative therapy are performed and lead to measurable behavioural changes, and to consider how safety considerations can be established within the narrative worldview. Plain English summary: There are a number of psychological therapies for eating disorders that have research evidence-base. These treatments, however, do not work for everyone as indicated by drop-out rates and eating disorders running a severe and enduring course for some people. Narrative therapy is a therapeutic intervention that has been reported as a promising intervention for people with an eating disorder. The focus of narrative therapy is to engage the person in finding identities hidden by problem-saturated identities and in the performance of these hidden identities. In this review, we have explored the use of narrative therapy for eating disorders to identify what aspects of this therapy are currently being used and which components are less referenced in the literature. Findings from this study support the need for further research into narrative therapy components in the treatment of eating disorders, particularly how hidden identities are performed and safety considerations are integrated into this therapeutic intervention.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative synthesis of 33 studies mapped narrative therapy components used in eating disorder treatment, finding strong emphasis on unpacking problem stories and finding/thickening hidden stories. It concludes that further research is needed on how identity shifts are performed or lived out and how safety considerations are integrated into the narrative worldview.

Key findings

  • Across 33 included texts, all included at least one aspect of unpacking problem stories; deconstruction was referenced in 31 papers, externalisation in 30, and experience-near naming in 21.
  • Narrative worldview appeared in 28 articles, finding hidden openings/unique outcomes in 28, and thickening hidden/revealed stories in 30; letter and creative writing appeared in 12, while safety considerations appeared in only 6 of 33.
  • Few papers addressed how identity shifts were performed or lived out, including in eating practices; only half mentioned ways identity shifts were performed, and most lacked discussion of meaningful ED symptom outcomes.
  • Quality appraisal found only 2 papers cited ethics approval; most studies had small samples or case-study designs, and many were written by narrative therapists delivering the treatment, indicating possible selection and performance/confounding bias.

Methods

  • Narrative synthesis registered with Open Science and reported per PRISMA; searched PsychINFO, MEDLINE, EMBASE, SocIndex, and ProQuest Dissertations and Theses plus an author’s personal library, covering 1979 to 4 July 2021.
  • From 1434 database records plus 11 library records, 33 texts were included after screening; inclusion required English publication, focus on narrative therapy intervention content, and a sample in treatment for any ED, including books and case studies.
  • Data extracted included aims/objectives, sample characteristics, treatment details, and narrative therapy components; quality was assessed with adapted Downs & Black and Joanna Briggs Institute checklists, and findings were synthesised into categories A–E.

Limitations

  • Stated: the most frequent quality limitation was lack of evidence for ethics approval; most articles had small participant numbers, often case studies; only half mentioned how identity shifts were performed; few focused on eating patterns or relationship with the body; many were authored by narrative therapists delivering the treatment, risking selection and performance/confounding bias.
  • Stated: researcher judgements were used to assess quality and contribution, and all studies meeting selection criteria were retained regardless of quality score.
  • Evident from the text: the synthesis maps intervention components and practice-based evidence but does not establish treatment effectiveness or quantify outcomes.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s40337-022-00635-5

Cites

69 of 69 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 Flow chart of search strategy
Fig. 1 Flow chart of search strategyCC BY · PubMed Central

Verification

Claims the paper makes

42 Not checked yet · 41 Own result · 40 Sources not found · 18 Check pending · 11 No basis given · 10 No full text of the sources · 8 Own interpretation · 4 Own method · 1 Partly supported · 1 Couldn’t confirm · accuracy not yet measured

Verify all 30 references — free account
  • Probably not a substantial claim. 64
  • It may state two separate claims as one. 24
76 of 76
  • The paper relies on this without support.

    There are few comprehensive systematic reviews on the content or treatment outcomes studies of narrative therapy conducted to treat eating disorders.

    “Despite this, there are few comprehensive systematic reviews on the content or treatment outcomes studies of narrative therapy conducted to treat EDs.”
  • The paper relies on this without support.

    There does not currently exist a manualised approach to using narrative therapy in the treatment of eating disorders.

    “Likewise, there does not currently exist a manualised approach to using narrative therapy in the treatment of EDs.”
  • The paper relies on this without support.

    Each study meeting selection criteria provided relevant qualitative data regardless of its quality assessment score.

    “All the studies meeting selection criteria were retained as it was thought that each study provided relevant qualitative data, regardless of their quality assessment score.”
  • The paper relies on this without support.

    The identified articles are a representative and comprehensive sample of narrative therapy for eating disorders.

    “Aspects of the narrative worldview were expressed in 28 of the identified articles.”
    “All of the identified articles included one aspect of narrative therapy that unpacked the dominant problem story.”
  • The paper relies on this without support.

    The components described in the articles accurately reflect the practice of narrative therapy.

    “The findings of this synthesis indicated that the underlying philosophies and frameworks of narrative therapy (i.e., ‘the narrative worldview’) were evident and well-embedded in the in the delivery of narrative interventions and practice of subsequent techniques across the selected studies.”
  • The paper relies on this without support.

    The presence of a component in an article indicates it is a component of narrative therapy.

    “Thirty of the articles included reference to the practice of externalisation in unpacking the problem story.”
  • The paper relies on this without support.

    There is a current paucity of research synthesising narrative therapy interventions for EDs.

    “Specifically, this paper was developed in response to the current paucity of research synthesising narrative therapy interventions for EDs thus far.”
  • The paper relies on this without support.

    The broader spirit or worldview that informs narrative therapy practices includes the use of experience near naming, where the client is positioned as the expert on how the problem is talked about.

    “This includes the use of experience near naming, where the client is positioned as the expert on how the problem is talked about (e.g. as a “dark tunnel” rather than through the medical language of “illness”).”
  • The paper relies on this without support.

    The narrative worldview positions the person as the expert of their life and holds that the problem, not the person, is the problem.

    “This therapeutic process is informed by the narrative worldview where the person is (1) positioned as the expert of their life; and (2) not the problem but rather the problem is the problem.”
  • The paper relies on this without support.

    The exploration of the nature and effectiveness of narrative therapy for the treatment of EDs is an emerging area of research.

    “The exploration of the nature and effectiveness of narrative therapy for the treatment of EDs is an emerging area of research.”
10 of 10

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Citations

Cites

Show all 70 references

Research works printed but not linked: 34

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Metadata

Authors
Heywood, L., Conti, J., & Hay, P.
Affiliations
Western Sydney University (AU)
Corresponding author
Conti, Janet
Venue
Journal of Eating Disorders
Published
2022-09-08
Volume
10
Issue
1
Pages
137-137
ISSN
2050-2974 (ISSN-L)
OpenAlex
W4295079420
Cited by
24
References
70
Citations by year
2026: 10 · 2025: 2 · 2024: 7 · 2023: 3 · 2022: 2
FWCI
0.47
Type
journal article
Language
en
Open access
Locations
  • Journal of Eating Disorders (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Macquarie University
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
narrative therapy, eating disorders, identity transition, client safety, secret identity, treatment discontinuation, dietary habits, therapeutic relationship, therapist supervision, therapist burnout

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