Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial

Schmidt, Ulrike; Oldershaw, Anna; Jichi, Fatima; Sternheim, Lot; Startup, Helen; McIntosh, Virginia V.W.; Jordan, Jennifer; Tchanturia, Kate; Wolff, Geoffrey; Rooney, Michael K.; Landau, Sabine; Treasure, Janet

doi:10.1192/bjp.bp.112.112078

Cited by 150 publications

(156 citation statements)

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“…The degree of BMI change observed in the MOSAIC trial is comparable to that found in our earlier single-centre pilot RCT (total n = 72), which used identical study inclusion criteria and which also compared MANTRA and SSCM, 136 suggesting that these treatments can be disseminated to other UK centres with relatively brief initial training (2 days) of therapists and booster training (1 day).…”

Section: Comparison Of Main Findings With Those Of Other Trialssupporting

confidence: 60%

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

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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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.

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Section: Comparison Of Main Findings With Those Of Other Trialssupporting

confidence: 60%

“…A treatment workbook is given to each patient (see data supplement DS1 in Schmidt et al 126,136 for details). This has both core and optional chapters, thus the information contained in the manual can be tailored to the requirements of each patient.…”

Section: Maudsley Model Of Anorexia Nervosa Treatment For Adultsmentioning

confidence: 99%

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

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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“…SSCM is derived from the typical supportive approach of specialists to the management of AN. Both studies showed sustained improvements in eating disorder features and weight and no significant differences between MANTRA and SSCM (McIntosh et al, 2005;Schmidt et al, 2012;Touyz et al, 2013). In the first of these RCTs (Schmidt et al, 2012) the mean BMI increase from baseline to 12 months post-randomization (end of treatment) for MANTRA and SSCM respectively was 1.37 kg/m 2 and 1.22 kg/m 2 .…”

mentioning

confidence: 99%

“…Both studies showed sustained improvements in eating disorder features and weight and no significant differences between MANTRA and SSCM (McIntosh et al, 2005;Schmidt et al, 2012;Touyz et al, 2013). In the first of these RCTs (Schmidt et al, 2012) the mean BMI increase from baseline to 12 months post-randomization (end of treatment) for MANTRA and SSCM respectively was 1.37 kg/m 2 and 1.22 kg/m 2 . In the later multi-centre RCT (the MOSAIC Study; Schmidt et al, 2015), the mean BMI increase at the same time point was 1.75 kg/m 2 for MANTRA and 1.36 kg/m 2 for SSCM.…”

mentioning

confidence: 99%

“…MANTRA has been the focus of two randomised controlled trials (RCTs) (Schmidt et al, 2012 involving 72 and 142 participants respectively, both of which involved a comparison with Specialist Supportive Clinical Management (SSCM) (McIntosh et al, 2005(McIntosh et al, , 2010. SSCM is derived from the typical supportive approach of specialists to the management of AN.…”

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confidence: 99%

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A randomised controlled trial of three psychological treatments for anorexia nervosa

et al. 2017

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

Hay

Claudino

Touyz

et al. 2015

Cochrane Database of Systematic Reviews

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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.

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Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial

Cited by 150 publications

References 35 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

A randomised controlled trial of three psychological treatments for anorexia nervosa

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

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