Randomized controlled psychotherapy trials in eating disorders: Improving their conduct, interpretation and usefulness

Wade, Tracey D.; Johnson, Catherine; Byrne, Susan

doi:10.1002/eat.22872

Cited by 7 publications

(5 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current study has several strengths, some of which have been considered critical for improving the quality and clinical usefulness of randomised controlled trials in eating disorders (Lock et al ., 2018; Wade et al ., 2018). A protocol paper was published when the trial started (Cardi et al ., 2015) with a full description of rationale, methods and plans for analyses, ensuring that no changes to the original plan were made based on the trial findings.…”

Section: Discussionmentioning

confidence: 99%

A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa

et al. 2019

View full text Add to dashboard Cite

BackgroundOutpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa.MethodsParticipants with anorexia nervosa (n = 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n = 99; experimental group) or TAU only (n = 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months.ResultsAdherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p = 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p = 0.02) and alliance with the therapist at the outpatient service (p = 0.005) compared to the control group at 6 weeks.ConclusionsAugmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance.

show abstract

Section: Discussionmentioning

confidence: 99%

A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Although RCTs are crucial for determining the efficacy of CBT (Wade, Johnson, & Byrne, 2018), critics have raised concerns that the methods used to optimize experimental control in RCTs compromise the external validity and generalizability of study findings (Seligman, 1995). In particular, critics have questioned whether the patients, clinicians, and treatments used in highly controlled research trials are representative, applicable, or even relevant to what is experienced in routine clinical practice (Westen, Novotny, & Thompson-Brenner, 2004).…”

mentioning

confidence: 99%

Meta‐analysis of the effects of cognitive‐behavioral therapy for binge‐eating–type disorders on abstinence rates in nonrandomized effectiveness studies: Comparable outcomes to randomized, controlled trials?

Linardon

Messer

Fuller‐Tyszkiewicz

2018

Intl J Eating Disorders

View full text Add to dashboard Cite

Objective The efficacy of cognitive‐behavioral therapy (CBT) for eating disorders is well‐established. The extent to which CBT tested in controlled research settings generalizes to real‐world circumstances is unknown. We conducted a meta‐analysis of nonrandomized studies of CBT for eating disorders, with three aims: (a) to estimate the prevalence of patients who achieve binge‐purge abstinence after CBT in routine practice; (b) to compare these estimates with those derived from two recent meta‐analyses of randomized controlled trials (RCTs) of CBT for bulimia nervosa (BN) and binge‐eating disorder (BED); (c) to examine whether the degree of clinical representativeness of studies was associated with effect sizes. Method Twenty‐seven studies, mainly involving BN, were included. Pooled event rates were calculated using random effects models. Results The percentage of treatment completers who achieved abstinence at post‐treatment was 42.1% (95% CI = 34.7–50.0). The intention‐to‐treat (ITT) estimate was lower (34.6% [95% CI = 29.3–40.4]). However, abstinence rates varied across diagnoses, such that the completer and ITT analysis abstinence estimates were larger for BED samples (completer = 50.2%, 95% CI = 29.4–70.9; ITT = 47.2%, 95% CI = 29.8–65.2) than for BN (completer = 37.4%, 95% CI = 29.1–46.5; ITT = 29.8%, 95% CI = 24.9–35.3) and atypical eating disorder samples (completer = 37.8%, 95% CI = 20.2–59.3; ITT = 28.8%, 95% CI = 18.2–42.4). No relationship between the degree of clinical representativeness and the effect size was observed, and our estimates were highly comparable to those observed in recent meta‐analyses of RCTs. Discussion Findings suggest that CBT for eating disorder can be effectively delivered in real‐world settings. This study provides evidence for the generalizability of CBT from controlled research settings to routine clinical services.

show abstract

“…Additional research is also needed to understand the feasibility and outcomes of using FBT in higher level of care settings. Randomized controlled trials (RCTs) may be challenging to conduct with patients with eating disorders requiring higher levels of care as there can be difficulty in providing a no-treatment or treatment-as-usual option but can be impactful when properly executed (Wade et al, 2018). Additionally, the field is recognizing the value in adaptive trial designs (Nahum-Shani et al, 2012) and naturalistic studies which may provide a more accurate reflection of authentic treatment settings.…”

Section: Discussionmentioning

confidence: 99%

Adaptation of family‐based treatment within an inpatient medical stabilization program for children with eating disorders

Anderson

Han

Kavlich

et al. 2023

Intl J Eating Disorders

View full text Add to dashboard Cite

ObjectiveEating disorders are serious psychiatric conditions predominantly affecting children, adolescents, and young adults. While family‐based treatment (FBT) is the gold standard outpatient treatment approach for adolescents with restrictive eating disorders, there is not a universally recognized best practice within higher levels of care. There is a particular dearth of literature detailing recommended psychological and behavioral interventions in the inpatient medical setting.MethodThe present article provides an account of how FBT principles have been incorporated in Children's Hospital of Orange County at Mission's inpatient medical stabilization program for children and adolescents with restrictive eating disorders. Practical examples illustrate how key FBT tenets are successfully translated into the inpatient multidisciplinary setting.ResultsThe use of FBT can encourage a unified approach among medical and psychosocial providers and serves to destigmatize patients with eating disorders and associated behaviors. The successes and challenges of FBT implementation are discussed.DiscussionThough anecdotal evidence and preliminary findings support positive outcomes from the implementation of FBT within a pediatric medical stabilization program for patients, families, and staff, research is needed to understand best practices within higher levels of care. Additional research efforts will also help elucidate whether adapted FBT can become a standard of care for patients with restrictive eating disorders in inpatient settings.Public SignificanceThis article describes how a children's hospital has adopted family‐based treatment (FBT) for youth who are hospitalized due to an eating disorder. FBT is the most efficacious treatment for youth with eating disorders. This article describes specific examples of how FBT can be implemented within a medical setting. This article will support a greater understanding of FBT principles and guide providers to translate FBT into higher level of care settings.

show abstract

Randomized controlled psychotherapy trials in eating disorders: Improving their conduct, interpretation and usefulness

Abstract: We highlight a number of strategies for future research, including issues related to utilizing a variety of designs to examine treatment outcomes, integrity, openness and reproducibility.

Cited by 7 publications

References 40 publications

A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa

A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa

Meta‐analysis of the effects of cognitive‐behavioral therapy for binge‐eating–type disorders on abstinence rates in nonrandomized effectiveness studies: Comparable outcomes to randomized, controlled trials?

Adaptation of family‐based treatment within an inpatient medical stabilization program for children with eating disorders

Contact Info

Product

Resources

About