Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial

Nyman–Carlsson, Erika; Birgegård, Andreas; Engström, Ingemar; Gustafsson, Sanna Aila; Nevonen, Lauri

doi:10.1002/erv.2630

Cited by 16 publications

(25 citation statements)

References 37 publications

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“…In addition, it moderated treatment effects: subjects with weaker BPD benefited more from a therapy centred on ED symptomatology (i.e., enhanced cognitive behaviour therapy for EDs, focused version, CBT‐Ef; see Thompson‐Brenner et al, 2016, for further details), while subjects with stronger BPD benefited more from a therapy including modules on interpersonal problems and mood intolerance (i.e., enhanced cognitive behaviour therapy for EDs, broad version, CBT‐Eb; see Thompson‐Brenner et al, 2016, for further details). The other five studies (Accurso et al, 2016; Castellini et al, 2012; Haynos et al, 2017; Nyman‐Carlsson et al, 2019; Zander, 2016) were not strictly focused on PD; rather, they focused on personality dimensions in a broader sense (see below, from personality subtypes to self‐directedness).…”

Section: Resultsmentioning

confidence: 99%

“…Another study (Nyman-Carlsson et al, 2019), instead, indicated that a high emotion dysregulation significantly predicted adverse outcomes.…”

Section: Emotion Dysregulationmentioning

confidence: 97%

“…were not fully comparable, because assessments in some cases (e.g., Steele et al, 2011) were made at 1.5 month after intake and in other cases at 1 year (e.g., Nyman-Carlsson et al, 2019). Similarly, FU length ranged from a minimum of 1 month (La Mela et al, 2013) to a maximum of 5 years (Rowe et al, 2011).…”

Section: Limitationsmentioning

confidence: 99%

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Is personality the key in cognitive‐behavioural therapy for eating disorders? A review

Fumagalli

Margola

2021

Clin Psychology and Psychoth

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The efficacy of individual cognitive-behavioural therapy (CBT) for eating disorders can be assessed by investigating the potential predictors, mediators and moderators of treatment. The present review focused on personality since its crucial role has been emphasized both by research and practice. Sixteen studies were collected, and data were extracted through a highly operationalized coding system. Overall, personality disorders were the most investigated construct; however, their influence was somewhat contradictory. A more cogent result occurred for borderline personality disorder (BPD) when considered as a moderator (not a predictor nor a mediator).Patients with a more disturbed borderline personality benefited to a greater extent from treatments including booster modules on affects, interpersonal relationships and mood intolerance, rather than symptoms exclusively. Nine additional personality dimensions, beyond BPD, were investigated sparsely, and results regarding them were barely indicative in this review. However, some of these dimensions (e.g., affective lability and stimulus-seeking behaviours) could be traced back to BPD, thereby strengthening evidence of the role of borderline disorder as a moderator.Although research on the relationship between personality and eating disorders needs to be increased and methodologically improved, personality, taken as a whole, emerged as a promising variable for enhancing the efficacy of CBT.

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Section: Resultsmentioning

confidence: 99%

“…Another study (Nyman-Carlsson et al, 2019), instead, indicated that a high emotion dysregulation significantly predicted adverse outcomes.…”

Section: Emotion Dysregulationmentioning

confidence: 97%

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Is personality the key in cognitive‐behavioural therapy for eating disorders? A review

Fumagalli

Margola

2021

Clin Psychology and Psychoth

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“…Due to cognitive and personality characteristics of AN patients [16,41], they are often unwilling to receive treatment themselves. Even if they receive treatment and successfully regain their weight over the course of treatment, they may not make significant improvement in cognitive symptoms and may relapse within a period of time after stopping treatment [42]. CBT has been found to be Fig.…”

Section: Discussionmentioning

confidence: 99%

The effect of group cognitive behavior therapy on Chinese patients with anorexia nervosa: an open label trial

Zou

Huang

et al. 2021

J Eat Disord

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Background The high cost of treatment for anorexia nervosa (AN) and lack of trained specialists have resulted in limited accessibility of effective treatment to patients with AN, which is particularly problematic in China. To increase the accessibility of evidence-based treatment and reduce the cost of treatment, this study aimed to explore the feasibility and efficacy of group cognitive behavior therapy (G-CBT) adapted from enhanced cognitive behavior therapy for eating disorders (CBT-E) in Chinese AN patients. Method A total of 78 patients with AN were assigned to G-CBT or individual outpatient treatment (IOT) and received three months of treatment for AN in each condition. Measures of eating pathology, depression and anxiety were administrated to both intervention groups at three time points: baseline, one month of treatment, and end of treatment; results were compared between groups and over time. Results There were 70 participants included in the final analysis. Both G-CBT and IOT groups showed significant improvement in eating pathology and associated psychopathology (ps < .001) over the course of treatment, but no significant difference in symptom improvement was found between the two groups (ps > .05). G-CBT resulted in additional significant improvement in ED psychopathology over the last two months of treatment, and its overall therapeutic effect was influenced by baseline weight and early symptom improvement. Conclusion Preliminary findings from this open label trial suggest that G-CBT adapted from CBT-E is feasible in an outpatient setting and as effective as IOT in facilitating weight regain and reducing psychopathology in Chinese AN patients with little evidence for the superiority of either intervention. Trial registration: The current study was registered at clinical trials.gov on September 23, 2018 (registration number NCT03684239). Plain English summary People with anorexia nervosa (AN) are known to be unmotivated for treatment and prone to relapse. Recovery from AN often needs intensive, long-term treatment from a specialized multidisciplinary team, which is not accessible for most people in China. Given the increasing incidence of AN and lack of eating disorder (ED) specialists in China, it is important to develop short-term cost-effective treatments for AN. In this study, we explored the feasibility and efficacy of group cognitive behavior therapy (G-CBT) adapted from enhanced cognitive behavior therapy (CBT-E) for people with AN from China. We found that G-CBT was as effective as individual outpatient treatment (IOT) typically provided to AN patients at the research site in facilitating weight regain, improving eating behaviors, and reducing ED and other symptoms. We also found that patients receiving G-CBT made more improvements in cognitive symptoms of the ED, which might help maintain treatment gains and prevent relapse in the long run. This potential long-term advantage of G-CBT needs to be verified in long-term follow-up.

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“…Whilst this lack of difference between treatments in keeping with the common factors view described earlier in the chapter, the study is underpowered and thus conclusions about common versus specific factors cannot be drawn. Predictors of outcome were reported in a separate study (Nyman-Carlsson et al, 2019). In the family therapy group, lower interoceptive deficits predicted higher weight gain, whilst bulimic behaviour and emotion dysregulation predicted increased scores on a diagnostic index comprised of questions relating to fear of weight gain, body image and eating habits.…”

Section: Discussionmentioning

confidence: 99%

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa (Thesis)

Jewell¹

2021

Preprint

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Family therapy for adolescent anorexia nervosa (FT-AN) is the first line treatment for the disorder, but little is known about who the treatment works for, or how it works. This thesis investigates the potential value of the constructs of attachment and mentalization as predictors of outcome in family therapy for adolescent AN. The thesis presents a systematic review of attachment and mentalization and their association with child and adolescent eating pathology in which 22 relevant studies were found. In keeping with the evidence base for adults with eating disorders, both attachment and mentalization were found to be correlates of eating pathology in childhood and adolescence. However, evidence for these constructs in the process of treatment in child and adolescent eating disorders is scarce. In a second systematic review, the psychometric properties of attachment measures in middle childhood and adolescence were investigated across 53 studies. The overall conclusion of the study is that there is a lack of evidence of adequate psychometric properties for attachment measures in this age group.In the main study, attachment and mentalization were investigated as predictors of outcome in a sample of adolescents and their parents (n = 192) receiving FT-AN across three specialist outpatient eating disorder services. Mentalization, but not attachment, was found to predict poor clinical outcome at nine months after starting of treatment, with the strongest predictive effect being excessive certainty about mental states as assessed in parents. Therapeutic alliance scores at one month were predictive of outcome but did not play a mediating role in relation to baseline attachment or mentalization. In a further empirical study, definitions of eating disorder recovery were investigated through a qualitative analysis of comments on recovery-focused social media forums. Two super-ordinate themes emerged: firstly, recovery was defined as encompassing broad psychosocial domains of wellbeing; secondly, recovery was understood to be an ongoing process. Social connectedness to others was regarded as important both to the process and definition of eating disorder recovery. The final chapter of the thesis integrates findings from across the studies with emerging theoretical developments in the fields of attachment and mentalization. It is argued that attachment and mentalization represent worthwhile constructs for further FT-AN research, with a particular emphasis on the need to better understand the mechanisms by which excessive mental state certainty might lead to poor clinical outcomes.

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Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial

Abstract: Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN.

Cited by 16 publications

References 37 publications

Is personality the key in cognitive‐behavioural therapy for eating disorders? A review

Is personality the key in cognitive‐behavioural therapy for eating disorders? A review

The effect of group cognitive behavior therapy on Chinese patients with anorexia nervosa: an open label trial

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa (Thesis)

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