Objective: This study was designed to compare the change in eating-disorder feature networks in patients with anorexia nervosa after treatment with intensive enhanced cognitive behavior therapy (CBT-E).Methods: Patients seeking treatment for anorexia nervosa were consecutively recruited from January 2016 to September 2020. All patients aged ≥16 years who completed a 20-week intensive CBT-E program (13 weeks of inpatient followed by 7 weeks of day-hospital treatment) were included in the study. Body mass index (BMI) was measured, and the Eating Disorder ExaminationQuestionnaire completed for each patient, both at baseline and the end of treatment.Results: The sample comprised 214 patients with anorexia nervosa. Treated patients showed significant improvements in BMI and eating-disorder psychopathology. Network analysis revealed a significant reduction in the network global and connection strengths at the end of treatment. The most central and highly interconnected nodes in the network at baseline were related to the drive for thinness, but at the end of treatment to body image concerns. Some edge connections were significantly stronger at baseline than at the end of treatment, while others were significantly stronger at the end of treatment than at baseline. Discussion: CBT-E reduces the psychopathology network connectivity over time in patients with anorexia nervosa. The differences in central nodes and edge connections between baseline and end of treatment, not detected by classical inferential analysis, may be informative for understanding the centrality of symptoms in the psychopathology network, and how a specific treatment may act to reduce symptoms and change their connections over time.

Objective: This study aimed to conduct a systematic review on the effects of available treatments for avoidant/restrictive food intake disorder (ARFID).Methods: Literature searches, study selection, method development, and quality appraisal were performed independently by one author, and data were synthesized using a narrative approach. Studies published in English and in peer-reviewed journals that evaluated the outcomes of ARFID treatments in at least three participants were taken into consideration, while non-original studies, editorials and letters to the editor were excluded. Results:The review had three main findings. First, in all of the studies by the end of the treatment there was a significant weight gain in the ARFID participants. Second, weight recovery was maintained at follow-up in a good percentage of participants with an associated improvement of eating behavior and a reduction in anxiety, depression, and fear for the adverse consequences of eating. Third, there was weak or missing evidence regarding the treatment of ARFID in adults and the difference in outcome in the three different ARFID profiles. Eighteen studies were selected and eleven were included. Conclusion:The treatments for ARFID, although promising, have focused only on young participants and addressed the normalization of eating with behavioral procedures, but not the underlying psychopathology. Moreover, the lack of randomized controlled trials with adequate statistical power does not allow to draw conclusions on the difference in the effectiveness of the interventions tested.

Background: The COVID-19 lockdown may have negatively impacted the treatment of obesity. This study aimed to assess the effect of COVID-19 lockdown in patients with obesity treated with intensive residential cognitive behavioral therapy (CBT-OB). Methods: This retrospective case-control study analyzed 129 patients with severe obesity who experienced COVID-19 lockdown in the 6 months after discharge from intensive residential CBT-OB, comparing their outcomes on weight loss, binge-eating episodes, and general health status with those in a sample of patients matched by gender, age, and body mass index given the same treatment before the COVID-19 outbreak as control. Patients were assessed at baseline and by phone interview 6-month follow-up. Results: Both groups had lost more than 9% of their baseline bodyweight and reported a significant decrease in binge-eating episodes and similar general health status at 6-month follow-up. However, control patients achieved a significantly greater weight loss than those who experienced lockdown, although half of lockdown patients reported persisting with CBT-OB procedures after their discharge. Conclusion: Patients with obesity treated with CBT-OB and exposed to COVID-19 lockdown, despite achieving lower weight loss than non-exposed patients, had a healthy weight loss at 6-month follow-up and comparable reduction in binge-eating behaviors.

ObjectiveThis study aimed to compare eating disorder‐specific and nonspecific clinical features in patients with anorexia nervosa before and after intensive enhanced cognitive behavior therapy (CBT‐E) via network analysis.MethodsAll consecutive patients admitted to intensive CBT‐E were eligible, and the sample comprised patients aged ≥16 years who completed a 20‐week intensive CBT‐E program. Body mass index (BMI), Eating Disorder Examination Questionnaire and Brief Symptoms Inventory responses were gathered at baseline and end of treatment, and used to generate statistical networks of the connections between symptoms (nodes) and the strength and centrality thereof.ResultsA total of 214 patients were included. Most nodes had relatively similar centrality compared to other nodes in the networks. “Eating concern” and “phobic anxiety” showed the greatest bridge centrality at both time points. No differences were found between baseline and the end of treatment in either global network or individual connection strengths.ConclusionThese findings suggest that some clinical expressions not specific to eating‐disorder psychopathology remain strongly connected in the generalized network of patients with anorexia nervosa after CBT‐E. Future research should examine whether additional procedures specifically designed to target these symptoms should be integrated into this and other treatments.

Objective This study aimed to assess the impact of the COVID‐19 pandemic on the efficacy of an intensive treatment based on enhanced cognitive behavioral therapy (CBT‐E) in patients with anorexia nervosa. Methods This cohort study analyzed 57 patients with anorexia nervosa who experienced the COVID‐19 pandemic during intensive CBT‐E, comparing their outcomes (body mass index [BMI], eating‐disorder and general psychopathology, and clinical impairment) with those of patients with anorexia nervosa matched by gender, age, and BMI given the same treatment before the COVID‐19 outbreak as controls. Patients were assessed at baseline, at the end of treatment and after 20 weeks of follow‐up. Results More than 75% of patients during the pandemic versus 85% of controls completed the treatment, a difference that was not significant. BMI, eating disorder and general psychopathology and clinical impairment scores improved significantly from baseline to 20‐week follow‐up in both groups. However, the improvement was more marked in controls than in those treated during the COVID‐19 pandemic. Conclusion Patients with anorexia nervosa given intensive CBT‐E during the COVID‐19 pandemic had significantly improved psychopathology, albeit to a lesser extent than patients given the same treatment before the COVID‐19 pandemic. Public significance statement In this study, the outcome of 57 patients with anorexia treated with intensive enhanced cognitive behavior therapy during the COVID‐19 pandemic was compared with a matched group treated before the pandemic hit. The rate of remission from anorexia nervosa was similar between the two groups. However, patients exposed to the COVID‐19 pandemic showed lesser improvement than those not exposed.