Effectiveness of intensive cognitive behavioral therapy in adolescents and adults with anorexia nervosa

Abstract

Objective This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive behavioral therapy (CBT‐E) in adolescent and adult patients with anorexia nervosa. Methods A total of 150 consecutive patients (74 adolescents and 81 adults) were admitted to a 20‐week intensive CBT‐E program (13 weeks of inpatient followed by 7 weeks of day‐hospital treatment). All patients had responded poorly to previous outpatient treatments and were assessed at admission, end of treatment (EOT), and 20‐ and 60‐week follow‐ups. Results About 70% of eligible patients began the program, and more than 85% completed it. Body mass index (BMI) in adults and BMI‐for‐age percentile in adolescents improved significantly from baseline to EOT, remained stable until 20‐week follow‐up, and slightly decreased from 20‐week follow‐up to 60‐week follow‐up, while remaining in the lower normal range. Eating disorder psychopathology, general psychopathology, and clinical impairment scores decreased significantly at EOT and showed only a slight increase from EOT to follow‐ups. No difference was found between adolescent and adult patients in treatment acceptance, dropout, or any outcome measure. Discussion These findings indicate that intensive CBT‐E seems to be an effective treatment for severely ill adolescent and adult patients with anorexia nervosa.

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

“…The first is that, after treatment, the network becomes less densely connected, both in terms of global strength and the strength of the connections within the networks, a result that confirms the network theory (Borsboom, 2017) suggesting that a reduced density of connections after treatment indicates a treatment-induced psychopathology improvement (i.e., a reduced probability of symptom activation). Moreover, this finding is in line with our findings obtained using inferential statistical analysis that indicated significant improvements in BMI, eating-disorder behaviors and psychopathology after CBT-E, and confirms previous data on the effectiveness of intensive CBT-E (Dalle Grave et al, 2013;Dalle Grave et al, 2020).…”

“…Several studies have confirmed the effectiveness of both outpatient and intensive CBT-E for anorexia nervosa Calugi, Sartirana, Frostad, & Dalle Grave, 2021;Dalle Grave, Calugi, Conti, Doll, & Fairburn, 2013;Dalle Grave, Conti, & Calugi, 2020;Dalle Grave, Sartirana, & Calugi, 2019;Fairburn et al, 2013), but the specific mechanisms producing these improvements in eating-disorder psychopathology are still unknown. In fact, the assessment of eating-disorder features and psychopathology with traditional inferential statistical analysis has revealed no robust predictors of change or relapse.…”

Adolescent Eating Disorder Day Programme Treatment Models and Outcomes: A Systematic Scoping Review

“…Hoste's ( 40 ) description of a FBT-informed DP in the USA heavily emphasizes the importance of the parents by placing them in charge of meals, encouraging parental persistence in the face of their child refusing food, not offering meal replacements and the less-directive role staff play to ensure they do not disempower parents. Alternatively, CBT-E based programmes prioritize involving the young people in decision making throughout the process, emphasizing the voluntary nature of the programme, with the view that this empowers the young person to take control over the process ( 18 ).…”

“…Studies investigating intensive outpatient treatments only (half-days and <5 days per week, or not positioned as alternatives to inpatient treatment) or adjunctive multi-family therapy groups are not included in this review. Programs that report outcomes for combined inpatient and DP treatment are also excluded [e.g., ( 18 – 21 )] as they do not typically function as alternatives to inpatient treatment. Rather they often act as step-down transition programmes between inpatient units and the community and typically aim to reduce admission lengths and readmission rates.…”

Early within-person weight gain and variability during inpatient treatment for anorexia nervosa: Age-dependent effects on treatment outcome

“…Hence, weight restoration is a primary goal for AN treatment, but rapid and continued weight gain is often only achievable with intensive inpatient treatment, especially when body weight is extremely low (e.g., Resmark et al, 2019). Still, a substantial proportion of adolescents and adults receiving inpatient treatment for AN do not achieve remission at end of treatment (Dalle Grave et al, 2020;Isserlin et al, 2020;Schlegl et al, 2016;Schlegl et al, 2014). Thus, it is necessary to identify potential early predictors of treatment outcome to increase treatment success and prevent prolonged inpatient treatment.…”