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Research

InsideOut is Australia’s national institute for research, translation and clinical excellence in eating disorders with global research partnerships. We aim to transform the prevention, early intervention and treatment landscape for eating disorders in Australia, and ultimately find a cure.

Research at InsideOut

InsideOut leads the Australian National Research and Translation Strategy 2020-2030 and conducts innovative, leading research including world-first trials on psychotherapy for people with severe and enduring Anorexia Nervosa, oxytocin for those with Anorexia Nervosa, online treatment programs for people with Bulimia Nervosa, Binge Eating Disorder and sub-clinical presentations, and cannabidiol & psychedelics for treatment of people with complex and enduring Anorexia Nervosa.

Since 2018 we have attracted more than $5.5m in research funding, and we have published more than 200 research papers on eating disorder aetiology, prevention and treatment. We regularly present our findings at national and international conferences.

The Institute is currently leading the Medical Research Future Fund (MRFF) funded Mainstream National Centre for Research & Translation in Eating Disorders. It will build the first comprehensive population-based surveillance system of people with eating disorders, to track detection and intervention across the national health system and monitor outcomes; establishing a national continuous lived experience lifetime survey for people with eating disorders, their family and carers; undertake translation-focused testing for scalable models of care for mainstream health; establish translation hubs in NSW, VIC and QLD to embed research expertise linked to front-line health system design and delivery; and, develop health system and economic models to inform decision making about interventions.

The Institute’s senior researchers, postdocs and PhD students are running numerous other projects in collaboration with partners around Australia and internationally. These have a current focus on early intervention, treatment innovation, translation of evidence-based treatment and improving treatment access, efficacy and equity for all Australians.

Current research

International Eating Disorders Genetics Initiative

QIMR Berghofer, University of North Carolina Chapel Hill

InsideOut in collaboration with QIMR Berghofer and researchers in the USA, Sweden and Denmark are conducting world-first genome-wide association studies to identify the genes associated with Anorexia Nervosa (the ANGI study) and other eating disorders (the EDGI study). Identifying genetic and neurochemical pathways will allow us to better understand the interaction between the biological, psychological and social influences on eating disorders and revolutionise our approach to treatment and early intervention in high-risk groups.

Establishment of National Translation Hubs: New research hubs in VIC and QLD

In partnership with CEDD, QuEDS & QIMR

As part of the Million Minds MRFF Mainstream Research Program we are partnering with clinical and research leads in states across Australia to locate research capacity within frontline service settings. This will establish the infrastructure for the growth of the research workforce nationally and help close the translation gap by co-locating clinical and research expertise. Our first hubs go live in Melbourne and Brisbane in early 2021.

The role of the gut microbiome in eating disorders

Charles Perkins Centre Gut Microbiome and Nutritional Ecology nodes, QIMR Berghofer, Brain & Mind Centre

These studies seek to examine the role of the microbiome, gut-brain axis and polygenic risk profile in the establishment of the vicious cycle in anorexia nervosa. Comprised of three studies the program will examine biological and psychological processes in dieting, full syndrome anorexia nervosa and an animal model for anorexia nervosa

Anorexia Nervosa Gene Project

QIMR Berghofer with support from the Warman Foundation

This study is looking at the genetic foundations of the full clinical spectrum of anorexia nervosa - both atypical and full syndrome to elucidate any differences in the genetic contributions and potential differences in the contribution of polygenic risk scores

Establishing a high-risk screener suitable for headspace and general practice pathways

Headspace Australia

InsideOut recently designed and validated a new high risk screening tool for early identification of disordered eating behaviour in all ages and genders. Early screening may be key to improving early intervention rates (currently, only 1 in 4 people with an eating disorder is receiving treatment), ultimately driving reduced morbidity and mortality. The screener is currently being trialled in primary care and Headspace clinics across Australia.

National Surveillance System

InsideOut is working with epidemiologists and national data linkage specialists to evaluate 15 years of national health system data to establish the first national comprehensive and population-based surveillance system of people with EDs. This is based on administrative health data from the State, Commonwealth and youth mental health platforms, headspace and newly developed Innowell (ProjectSynergy) platform that span the various access points to the health system in the screening, diagnosis and treatment of individuals with EDs.

National Lived Experience Lifetime Survey

InsideOut is establishing a National Eating Disorder Lived Experience Lifetime Survey, similar in scope to longitudinal feedback studies in other major illness groups such as Multiple Sclerosis. This project reflects a growing body of literature which privileges the sharing of consumer knowledge and experience in informing clinical research and practice, so we can better understand illness, carer and financial burden, treatment and research gaps and quality of life over the illness journey.

Trialling Cannabidiol (CBD) in Treatment for Anorexia Nervosa in Children and Adolescents

Lambert Initiative, SCHN, Royal Children's Hospital Melbourne

InsideOut in collaboration with the Lambert Initiative and national clinical partners is conducting an open label-pilot trial exploring the safety and efficacy of cannabidiol (CBD) to treat anxiety in young people with anorexia nervosa (AN) as they undergo Maudsley family-based therapy (FBT). It is hypothesised that if anxiety can be reduced while treatment is administered outcomes will improve.

Trialling psilocybin for treatment-refractory anorexia nervosa

St Vincent's Melbourne, School of Psychology University of Sydney

InsideOut with national partners is conducting a pilot study of psilocybin in combination with psychotherapy for treatment-refractory anorexia nervosa.

Telemedicine delivery of Maudsley Family Based Therapy for Anorexia Nervosa

University of California San Francisco, regional & rural Local Health Districts, the Warman Foundation

InsideOut in collaboration with University of California San Francisco are conducting a pilot researching telemedicine delivery of Maudsley Family Based Therapy for Anorexia Nervosa into the home of rural and regional families in NSW.

Implementation of Evidence Based Treatment in Hospital-to-Community Pathways for Children and Adolescents with Anorexia Nervosa

Sydney Children's Hospital Network, Sydney Local Health District, South East Sydney Local Health District and Northern Sydney Local Health District

InsideOut in collaboration with Sydney Children's Hospital Network, Sydney Local Health District, South East Sydney Local Health District and Northern Sydney Local Health District have been funded by the Medical Research Futures Fund (MRFF) through Sydney Partners to examine the translation of evidence based treatment for children and adolescents with Anorexia Nervosa within NSW districts. The trial will determine barriers and enablers for the embedding of evidence based care in hospital and community settings and develop mechanisms to support it.

The impact of COVID-19 on Australians living with an eating disorder or body image concerns: a national study

COVID-19 and its attendant restrictions have had a unique impact on individuals suffering from mental illness. InsideOut conducted a national survey evaluating the impact of COVID-19 on Australians with eating disorders and body image concerns, including behaviour and mental health symptom change, impact of social isolation and other circumstances associated with the pandemic, and access to treatment/changes in treatment modality

National Health Economics Evaluation

Boden Institute

As part of the Mainstream initiative, InsideOut in collaboration with Sydney Economics is developing health system and economic models to inform decision making about effective, cost-effective and equitable access to healthcare for this population. This involves evaluating costs, outcomes and cost-effectiveness of evidence based versus non-evidence-based pathways to care; assessing the effects of health policy changes at state and national levels on individuals with EDs accessing care (including recent Medicare changes); and evaluating the pattern of and factors driving changing inequalities in care access over time.

Microlearning for GPs

RISe and Psyche Foundation

Microlearning is a branch of e-learning delivered in short modules (or units) and incorporating videos, games and puzzles to achieve specific learning outcomes in very short periods of time – flexible and has proven very effective for time-poor General Practitioners. This is the first trial of microlearning for GPs in eating disorders. Funded by the Psyche Foundation.

The longitudinal dieting study in young people

Charles Perkins Centre Gut Microbiome and Nutritional Ecology nodes, QIMR Berghofer, Brain & Mind Centre

A significant gap in knowledge in understanding the process and outcomes of dieting in a population who report very high levels of it – young people. Dieting is the single strongest predictor of the onset of an eating disorder. The natural physiology of dieting will be followed during this longitudinal study, assessing psychological, physiological and behavioural responses, in those who frequently engage in dieting (16-25 years). Our aim is to identify underlying biological and psychological changes in response to dieting, how these impact dieting adherence, dieting outcomes and to determine if any markers of risk (i.e., through neuro, endocrine, gut microbes, physiology) can be determined for unhealthy dieting and the onset of an eating disorder.

The Junior CASIAN for Children & Adolescents with Anorexia Nervosa

Kings College London, Birmigham Eating Disorder Service

InsideOut in collaboration with our partners at the Kings College London, and Birmigham Eating Disorder Service are conducting a research trial developing a child and adolescent version of the CASIAN instrument used to stage Anorexia Nervosa in Adults. The instrument once validated will be used to identify kids early in the illness progression so as to help them gain access to services early and maximise remission rates.

Binge Eating eTherapy: An Online CBT Program for Bulimia Nervosa

TRGS, headspace, Community Mental Health teams and Peter Beaumont Unit, University of Western Sydney, Butterfly Foundation

InsideOut in collaboration with headspace, Community Mental Health teams and Peter Beaumont eating disorder service is examining the effectiveness of a online 10 session CBT guided self-help program for individuals aged 16 and over with Bulimia Nervosa, as part of routine clinical pathways in these settings in a randomised controlled trial.

Suicidality in Anorexia Nervosa: Risk and Protective factors

Project Air, University of Wollongong, University of Western Sydney

InsideOut, in collaboration with Project Air, the University of Wollongong and the University of Western Sydney, are researching suicidality in Anorexia Nervosa.

Binge Eating eTherapy: An Online CBT Program for Binge Eating Disorder

Deakin University

InsideOut in collaboration with Deakin University Melbourne is examining the effectiveness of a online 10 session CBT guided self-help program for individuals aged 16 and over with Binge Eating Disorder.

Compulsive Exercise in Eating Disorders and Muscle Dysmorphia

University of Melbourne, Clinical Psychology Unit USYD

InsideOut in collaboration with the University of Melbourne is studying compulsive exercise in people with eating disorders and muscle dysmorphia. This is a mixed methods approach in an under-researched area designed to explore the experiences of compulsive exercise in people with muscle dysmorphia, This research will be used to inform the development of an adapted psychological treatment to reduce compulsive exercise cognitions.

Publications

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Translating evidence-based treatment for digital health delivery: a protocol for family-based treatment for anorexia nervosa using telemedicine.

Family-based treatment (FBT) is an efficacious outpatient intervention for young people diagnosed with Anorexia Nervosa (AN). To date, treatment to protocol has relied on standard face-to-face delivery.

9 Oct, 2020

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Are poor set-shifting and central coherence associated with everyday function in anorexia nervosa? A systematic review

The current review gathers existing evidence regarding whether poor performance on tests of cognitive flexibility and detail-oriented processing are associated with difficulties in everyday function for people with Anorexia Nervosa.

29 Mar, 2021

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Eating disorders in the time of COVID-19

We have all been stunned by the speed of this viral pandemic. At the time of writing, one fifth of the world is under lockdown. The main foci have been on the public health effort to contain the spread of the virus, and the care of individuals with acute infection. We, in eating disorders, must have a broader brief. Not only must we help care for those sufferers who contract COVID-19, we must also address the impact –psychological, financial and social - on those that do not. The peculiarities of COVID-19 and the reaction of the public and governments to it, have particular relevance for people living with an eating disorder and those who care for them.

21 Apr, 2020

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Prevalence and management of people with eating disorders presenting to primary care: a national study.

Primary care practitioners are well placed to support diagnosis and appropriate treatment of eating disorders as they are often the first point of contact with the health care system.

15 Mar, 2021

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