Change in eating‐disorder psychopathology network structure in patients with anorexia nervosa treated with intensive cognitive behavior therapy

Abstract

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.

Network-Based Methods for Psychometric Data of Eating Disorders: A Systematic Review

“…assessment of treatment outcome (Calugi et al, 2021; Elliott et al, 2020; Hagan et al, 2021; Hilbert et al, 2020; Olatunji et al, 2018; Smith et al, 2019).…”

“…Hence, results about these metrics should be interpreted with care. As an additional proof about this fact, many articles reported betweenness and closeness centrality as not satisfying the minimum stability results and did not include their estimation in the network description (Aloi et al, 2021; Calugi et al, 2021; Forrest et al, 2018; Monteleone et al, 2020; Rodgers et al, 2018; Smith et al, 2019; Vanzhula et al, 2019). Others decided instead to take these measures into account but did not assess their stability (Forbush et al, 2016; Olatunji et al, 2018).…”

“…Many other studies only estimated and compared the centrality of symptoms at different time points. A change in the role of certain symptoms was found, with the strongest at baseline being fearing weight gain, dietary rules (Calugi et al, 2021), eating disorder-related impairment, self-esteem and shape concern (Hilbert et al, 2020), and the strongest at discharge being dietary restraint (Calugi et al, 2021; Hilbert et al, 2020), food preoccupation, feelings of fatness and discomfort seeing its own body (Calugi et al, 2021). Smith et al (2019) only computed centrality measures of the admission network, finding that the strongest symptoms were: shape and weight-related concentration difficulties, general concentration difficulties, guilt about eating, desire to lose weight, and nervousness .…”

“…Finally, having found a significant variation in the network structures, Calugi et al (2021) also tested the change in weight of links from admission to discharge. He identified few connections that were stronger at baseline than at discharge, namely feelings of fatness and desiring weight loss , BMI and vomiting to control shape or weight , and others whose relationship grew at discharge, namely food preoccupation and desiring weight loss , fear of losing control overeating and vomiting to control shape or weight , feelings of fatness and dissatisfaction with weight and shape .…”

Cognitive Behavioural Therapy for an Adolescent with Anorexia Nervosa

“…Therefore, it can be concluded that, in this case, the cognitive–behavioural approach was successful in treating a case of anorexia nervosa, which is consistent with other findings in different areas, such as hospitals [ 19 ]. However, this approach has not always received the same support in scientific literature [ 6 ], despite it also being true that attempts have been made to discover enriched variations of this therapy [ 20 ] in pursuit of a more efficient type of therapy. This has been the case with enhanced cognitive behaviour therapy, of which insufficient studies exist at present to determine its efficacy, though the results obtained thus far have shown promise [ 21 ].…”