Paper 2: a systematic review of narrative therapy treatment outcomes for eating disorders—bridging the divide between practice-based evidence and evidence-based practice

Abstract Background Narrative therapy has been proposed to have practice-based evidence however little is known about its research evidence-base in the treatment of eating disorders. The aim of this study was to conduct a systematic review of the outcome literature of narrative therapy for eating disorders. Method Treatment outcome data were extracted from 33 eligible included studies following systematic search of five data bases. The study is reported according to Preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. Results Of the identified 33 studies, 3 reported positive outcomes using psychometric instruments, albeit some were outdated. Otherwise, reported outcomes were based on therapy transcript material and therapist reports. The most commonly reported treatment outcome was in relation to shifts in identity narratives and improved personal agency with a trend towards under-reporting shifts in ED symptoms. Some improvements were reported in interpersonal and occupational engagement, reduced ED symptoms, and improved quality of life, however, there was an absence of standardized measures to support these reports. Conclusions This systematic review found limited support for narrative therapy in the treatment of eating disorders through practice-based evidence in clinician reports and transcripts of therapy sessions. Less is known about systematic treatment outcomes of narrative therapy. There is a need to fill this gap to understand the effectiveness of narrative therapy in the treatment of EDs through systematic (1) Deliveries of this intervention; and (2) Reporting of outcomes. In doing so, the research arm of narrative therapy evidence base will become more comprehensively known.

摘要：研究背景 叙事疗法（narrative therapy）虽已被证实具备基于临床实践的证据基础，但目前学界对其用于进食障碍（eating disorders，ED）治疗的研究证据体系仍缺乏系统认知。本研究旨在针对叙事疗法治疗进食障碍的疗效文献开展系统综述。
研究方法 本研究通过系统检索5个数据库，从符合纳入标准的33项研究中提取治疗疗效数据。本研究严格遵循《系统综述与元分析首选报告条目（PRISMA）指南》进行报告。
研究结果 在纳入分析的33项研究中，有3项研究采用心理测评工具报告了阳性疗效，不过部分测评工具已较为陈旧。其余研究的疗效结论均基于治疗会谈转录文本与治疗师的自评报告。最常被报道的治疗疗效聚焦于身份叙事的转变与个人能动性的提升，而ED症状改善的相关报道则存在明显的报道不足趋势。另有部分研究报告了人际与职业参与度提升、ED症状减轻及生活质量改善，但上述结果均缺乏标准化测评工具的实证支持。
研究结论 本系统综述发现，基于临床医师报告与治疗会谈转录文本的实践证据，叙事疗法用于进食障碍治疗的支持证据较为有限。目前关于叙事疗法的系统性治疗疗效的相关研究仍较为匮乏。亟需填补这一研究空白，通过以下两大维度明确叙事疗法治疗进食障碍的临床疗效：（1）该干预措施的标准化实施规范；（2）疗效报告的统一标准。唯有如此，叙事疗法的证据研究体系才能得到更为全面的梳理与认知。