Latent trajectories of symptom change during cognitive-behavior therapy predict post-treatment worsening of symptoms: a preliminary examination among outpatients with bulimia-spectrum eating disorders

Abstract

Purpose Up to 44% of individuals with bulimia nervosa (BN) experience worsening of symptoms after cognitive behavior therapy (CBT). Identifying risk for post-treatment worsening of symptoms using latent trajectories of change in eating disorder (ED) symptoms during treatment could allow for personalization of treatment to improve long-term outcomes Methods Participants ( N = 56) with BN-spectrum EDs received 16 sessions of CBT and completed digital self-monitoring of eating episodes and ED behaviors. The Eating Disorder Examination was used to measured ED symptoms at post-treatment and 3-month follow-up. Latent growth mixture modeling of digital self-monitoring data identified latent growth classes. Kruskal–Wallis H tests examined effect of trajectory of change in ED symptoms on post-treatment to follow-up symptom change. Results Multi-class models of change in binge eating, compensatory behaviors, and regular eating improved fit over one-class models. Individuals with high frequency-rapid response in binge eating ( H (1) = 10.68, p =0 .001, η 2 = 0.24) had greater recurrence of compensatory behaviors compared to individuals with low frequency-static response. Individuals with static change in regular eating exhibited greater recurrence of binge eating than individuals with moderate response ( H (1) = 8.99, p = 0.003, η 2 = 0.20). Conclusion Trajectories of change in ED symptoms predict post-treatment worsening of symptoms. Personalized treatment approaches should be evaluated among individuals at risk of poor long-term outcomes. Level of evidence IV, evidence obtained from multiple time series. Trial registration ClinicalTrials.gov registration number NCT03673540, registration date: September 17, 2018. Supplementary Information The online version contains supplementary material available at 10.1007/s40519-021-01348-5.

Latent profiles of dietary restraint among individuals with binge‐spectrum eating disorders: Associations with eating disorder symptom severity

“…This study does not provide any information regarding whether different profiles of dietary restraint are differentially associated with treatment response, but we anticipate that the present findings could have important clinical implications. Existing research indicates that cognitive behavior therapy for B‐EDs (CBT‐E) is effective for reducing dietary restraint among individuals with high levels of baseline dietary restraint, which is associated with improvements in binge eating for these patients (Accurso et al, 2016; Linardon, 2018b; Presseller et al, 2022). This may be due to the emphasis in CBT‐E on reducing dietary restraint.…”

Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years

“…More severe ED symptomatology along with comorbidity at baseline predicted poor outcome (Castellini et al, 2013;de Vos et al, 2023;Hilbert et al, 2019;Montourcy et al, 2018;Presseller et al, 2022).…”

“…Latent class analysis such as GMM is increasingly being used to examine change during psychotherapy for ED and its relation to long‐term outcome. The number of distinct subgroups with differing trajectories of change vary from two (Presseller et al, 2022), three (de Vos et al, 2023; Espel‐Huynh et al, 2020; Hilbert et al, 2019; Makhzoumi et al, 2017), four (Austin et al, 2021; Melchior et al, 2016), to five classes (Castellini et al, 2013; Lebow et al, 2019; Montourcy et al, 2018). The studies followed patients during treatment, focusing on how distinct symptom profiles (Castellini et al, 2013; Montourcy et al, 2018) or different response patterns were related to outcome, finding that rapid response (Espel‐Huynh et al, 2020; Hilbert et al, 2019; Melchior et al, 2016) and early weight gain (Austin et al, 2021; Makhzoumi et al, 2017) were positive prognostic factors.…”

“…The studies followed patients during treatment, focusing on how distinct symptom profiles (Castellini et al, 2013; Montourcy et al, 2018) or different response patterns were related to outcome, finding that rapid response (Espel‐Huynh et al, 2020; Hilbert et al, 2019; Melchior et al, 2016) and early weight gain (Austin et al, 2021; Makhzoumi et al, 2017) were positive prognostic factors. More severe ED symptomatology along with comorbidity at baseline predicted poor outcome (Castellini et al, 2013; de Vos et al, 2023; Hilbert et al, 2019; Montourcy et al, 2018; Presseller et al, 2022). However, long‐term outcome was limited to a timeframe of 3–18 months post‐treatment, except for a 6‐year follow‐up (Castellini et al, 2013) that used latent transition analyses and found moderate stability of profiles in a transdiagnostic sample of ED patients.…”

“…However, from a clinical perspective, four classes brought more nuance to poor outcome, which is where improvements are needed. Unfortunately, patients who show deterioration over time despite treatment efforts often are ignored(Presseller et al, 2022). A three-class solution would comprise a class with "continuous improvement" (n = 49, 58.3%, probability = .933), a class with "low-symptomatic scores" below clinically relevant area, yet with a significant decline over time (n = 21, 25%, probability = .942), and a "high and stable" class (n = 14, 16.7%, probability = .955) with high scores and no significant change throughout the follow-up period.For the four-class model, the entropy score was 0.862, indicating that the patients fit well into the different classes.…”