Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial

Zipfel, Stephan; Wild, Beate; Groß, Gaby; Friederich, Hans‐Christoph; Teufel, Martin; Schellberg, Dieter; Giel, Katrin Elisabeth; Zwaan, Martina de; Dinkel, Andreas; Herpertz, Stephan; Burgmer, Markus; Löwe, Bernd; Tagay, Sefik; Wietersheim, Jörn von; Zeeck, Almut; Schade‐Brittinger, Carmen; Schauenburg, Henning; Herzog, Wolfgang

doi:10.1016/s0140-6736(13)61746-8

Cited by 380 publications

(367 citation statements)

References 30 publications

Supporting

Mentioning

336

Contrasting

Unclassified

Order By: Relevance

“…Patients were followed up at 13 months post randomisation and at 22 months post randomisation. Thirteen-month BMI outcomes in the Zipfel et al 131 study were between 17.6 kg/m 2 (focal psychodynamic therapy) and 17.4 kg/m 2 (CBT and optimised TAU), whereas our 12-month BMI outcomes were 18.0 kg/m 2 in MANTRA and 17.7 kg/m 2 in SSCM. Thus, our BMI improvements stand up well in this international comparison.…”

Section: Comparison Of Main Findings With Those Of Other Trialscontrasting

confidence: 58%

“…Perhaps the findings from the present study can be compared most easily against the large German psychotherapy trial by Zipfel et al, 131 which compared focal psychodynamic therapy, CBT and optimised TAU in outpatients with AN. Patients in this trial had comparable baseline BMIs (between 16.6 and 16.8 kg/m 2 ), but received a somewhat higher 'dose' of psychotherapy (40 sessions over 10 months).…”

Section: Comparison Of Main Findings With Those Of Other Trialsmentioning

confidence: 80%

“…Additionally, this cut-off point was also used in previous studies by our group and others. 128,130,131 …”

Section: Inclusion Criteriamentioning

confidence: 99%

“…This definition is in line with other studies' definitions of treatment adherence. 127,131 Overall, 66.9% of participants were treatment completers, with 75% of MANTRA participants and 59% of SSCM participants completing treatment [χ 2 (1) = 1.19; p = 0.28].…”

Section: Participant Flow and Recruitmentmentioning

confidence: 99%

See 3 more Smart Citations

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

show abstract

Section: Comparison Of Main Findings With Those Of Other Trialscontrasting

confidence: 58%

Section: Comparison Of Main Findings With Those Of Other Trialsmentioning

confidence: 80%

“…Additionally, this cut-off point was also used in previous studies by our group and others. 128,130,131 …”

Section: Inclusion Criteriamentioning

confidence: 99%

Section: Participant Flow and Recruitmentmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

show abstract

“…Although results from different functional neuroimaging studies are inconsistent and sometimes conflicting,239 there might be altered reactivity in the brain reward system in response to perceived food stimuli in people with altered eating patterns, including anorexia nervosa and obesity 240, 241. Therefore, cognitive behavioural therapy may serve as a treatment for patients with an eating disorder like anorexia nervosa 242. Recently, a randomized controlled trial was conducted in obese subjects, receiving behavioural therapy for 6 months in order to reduce weight.…”

Section: Compromised Dietary Intakementioning

confidence: 99%

Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective

Sanders¹,

Kneppers²,

Bool³

et al. 2015

Journal of Cachexia, Sarcopenia and Muscle

119

101

View full text Add to dashboard Cite

Cachexia and muscle wasting are well recognized as common and partly reversible features of chronic obstructive pulmonary disease (COPD), adversely affecting disease progression and prognosis. This argues for integration of weight and muscle maintenance in patient care. In this review, recent insights are presented in the diagnosis of muscle wasting in COPD, the pathophysiology of muscle wasting, and putative mechanisms involved in a disturbed energy balance as cachexia driver. We discuss the therapeutic implications of these new insights for optimizing and personalizing management of COPD‐induced cachexia.

show abstract

Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa

Hay

Claudino

Touyz

et al. 2015

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

There was a suggestion in one trial that focal psychodynamic therapy might be superior to TAU, but this is in the context of TAU performing poorly. An alternative control condition of dietary advice alone appeared to be unacceptable, but again this is based on just one trial. Owing to the risk of bias and limitations of studies, notably small sample sizes, we can draw no specific conclusions about the effects of specific individual psychological therapies for anorexia nervosa in adults or older adolescents. Larger RCTs of longer treatment duration and follow-up are needed.

show abstract

Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial

Cited by 380 publications

References 30 publications

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective

Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa

Contact Info

Product

Resources

About