Sudden gains in the outpatient treatment of anorexia nervosa: A process‐outcome study

Cartwright, Anna V; Cheng, Yat Ping; Schmidt, Ulrike; Landau, Sabine

doi:10.1002/eat.22773

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…For example, although many studies focused on age as a potential predictor, we could find only one that reported significant findings (e.g., Jun, Zoellner, & Feeny, 2013, vs. Collins & Coles, 2017. The same seems to be true for education, where out of the many studies that tested it as a potential predictor, we could find only two that revealed significant findings (e.g., Cartwright et al, 2017, vs. Jun et al, 2013. And the same is true also for depressive symptoms, where we found only two studies that showed significant findings out of the many that tested it (e.g., Drymalski & Washburn, 2011, vs. Masterson et al, 2014.…”

mentioning

confidence: 54%

Are there any robust predictors of “sudden gainers,” and how is sustained improvement in treatment outcome achieved following a gain?

Zilcha‐Mano¹,

Errázuriz

Yaffe-Herbst³

et al. 2019

Journal of Consulting and Clinical Psychology

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Objective: It has been widely demonstrated that the process of change many patients undergo in therapy is not linear. Some patients benefit greatly from large sudden improvements, commonly referred to as "sudden gains." It is less clear whether certain baseline characteristics make patients more prone to displaying sudden gains, as well as what mechanisms are responsible for the lasting effects of sudden gains. Method: In a sample of 547 patients receiving treatment in an outpatient mental health clinic, a machine learning approach was used to search for potential predictors of sudden gains. A within-patient mediation model was used to investigate whether alliance serves as a mechanism underlying the sustained effect of sudden gains. Results: Twelve percent of patients showed sudden gains. Consistent with previous studies, no robust predictors of sudden gains were found, even when using an approach capable of evaluating the contributions of multiple predictors and their interactions. A significant within-patient mediation model was found, according to which sudden gains predict subsequent strengthening in alliance, which in turn predict subsequent improvement in life satisfaction and psychological dysfunction. These findings support the proposed theoretical framework whereby alliance is an important ingredient of an upward spiral that may results in sustained sudden gains. Conclusions: The findings provide first evidence of the presence of an ingredient responsible for the sustained effect of sudden gains, using a within-patient mediation model. The findings support the important role alliance may play in the consolidation and subsequent expansion of the effect of sudden gains. What is the public health significance of this article?Findings suggest that the alliance may act as an important ingredient in sustaining large sudden improvements (commonly referred to as "sudden gains") over time. The analyses support the conceptual model according to which sudden gains drive subsequent strengthening in alliance, which in turn serves to improve life satisfaction and psychological dysfunction.

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mentioning

confidence: 54%

Are there any robust predictors of “sudden gainers,” and how is sustained improvement in treatment outcome achieved following a gain?

Zilcha‐Mano¹,

Errázuriz

Yaffe-Herbst³

et al. 2019

Journal of Consulting and Clinical Psychology

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“…None of the sub‐group associations between duration and outcome were significant, and heterogeneity remained medium to high. In the third subgroup analysis, we examined 12 of the 13 binary outcomes related to indicators of recovery (except for Cartwright et al (2017), who examined sudden weight gain between two treatment sessions) to two of the largest sub‐groups across the continuous outcomes as categorized in Table 2: eating disorder psychopathology ( N = 7), weight gain ( N = 3). No significant moderation was present, and none of the sub‐group associations between duration and outcome were significant.…”

Section: Resultsmentioning

confidence: 99%

Relationship between eating disorder duration and treatment outcome: Systematic review and meta‐analysis

Radunz

Keegan

Osenk

et al. 2020

Intl J Eating Disorders

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Objective: This systematic review and meta-analysis examine the contribution of duration to treatment outcome for eating disorders. Method: Studies (n = 31) were identified that examined associations (r) between duration and 45 different outcomes. We were unable to extract r for seven studies (9 outcomes) and extracted r for 36 outcomes across 24 studies (2,349 participants). Indicators of treatment outcome were heterogeneous and thus a series of different meta-analyses, aimed at increasing homogeneity, were conducted. Results: First, we examined the average effect size for one primary eating disorder related outcome from each of the 24 studies. There was no association between duration and treatment outcome (r = .05, 95% CI: −.03:.13), with high heterogeneity. Second, we conducted three subgroup analyses to explore possible sources of heterogeneity (diagnosis: anorexia nervosa versus bulimia nervosa; nature of the outcome: binary versus continuous; or type of outcome: binary indicator of recovery, eating disorder psychopathology, weight gain). There was no significant moderation or associations between duration and outcome (ranging from .02-.08), with low to medium heterogeneity. Third, two stand-alone analyses examined outcomes related to weight gain (n = 8) and eating disorder psychopathology (n = 5), with nonsignificant rs of .23/−.06, respectively. High levels of heterogeneity were present. Discussion: Duration did not influence treatment outcome across any of our metaanalyses. Increasing homogeneity and power will allow more stable estimates of the impact of duration on outcome to be calculated; to this end, future treatment studies should include outcome related to weight gain (anorexia nervosa) and improvements in eating disorder psychopathology. Resumen Antecedentes: Esta revisión sistemática y metaanálisis examinan la contribución de la duración al resultado del tratamiento para los trastornos de la conducta alimentaria. Métodos: Se identificaron estudios (n = 31) que examinaron las asociaciones (r) entre la duración y 45 diferentes resultados. No fue posible extraer r para siete estudios (nueve resultados) y se extrajo r para 36 resultados en 24 estudios (2349 participantes). Los indicadores del resultado del tratamiento fueron heterogéneos y, por lo

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“…The third class was described as higher/increasing as there was an increase in BMI over at the 6‐week assessment of 1.34 points. It can be noted that the latter two classes showed evidence of weekly sudden weight gains (Cartwright et al, 2017), which would equate to 6 × 0.183 BMI points, or a total of 1.10 points.…”

Section: Resultsmentioning

confidence: 99%

“…An increase in BMI early in treatment predicts better outcome in outpatients with AN after treatment (Cartwright et al, 2017) but relatively little attention has been paid to those patients who do not exhibit early response, that is, a later‐response group. The main aim of the current study was to examine this group in a small sample of outpatients who all received recommended outpatient care including psychoeducation, symptom monitoring, psychotherapy (Cardi et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Adult inpatients were 18 times more likely to have a positive outcome if they met weight increases of at least 0.5–1 kg/week during the first 6 weeks of treatment (Wales et al, 2016). Sudden gains (average between‐session increase of ≥0.183 kg/m 2 per week) in body mass index (BMI) during outpatient treatment predicts longer‐term weight outcomes (Cartwright, Cheng, Schmidt, & Landau, 2017).…”

mentioning

confidence: 99%

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Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment

Wade

Ambwani

Cardi

et al. 2021

Intl J Eating Disorders

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Objective To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome. Method From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses (N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty‐six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12‐month follow‐up data. Predictors included global EDE‐Q, negative affect (Depression, Anxiety, and Stress Scales) and functional impairment (Work and Social Adjustment Scale). Results Good outcome was achieved by 23% of patients and remission by 15%. Good outcome was predicted by less functional impairment at baseline. Discussion Further work that can identify sub‐groups of patients with anorexia nervosa who do not achieve good outcome after treatment will inform the development of targeted engagement approaches.

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Sudden gains in the outpatient treatment of anorexia nervosa: A process‐outcome study

Abstract: SGs in BMI during the outpatient treatment of anorexia nervosa are clinically useful predictors of longer-term weight outcomes.

Cited by 8 publications

References 32 publications

Are there any robust predictors of “sudden gainers,” and how is sustained improvement in treatment outcome achieved following a gain?

Are there any robust predictors of “sudden gainers,” and how is sustained improvement in treatment outcome achieved following a gain?

Relationship between eating disorder duration and treatment outcome: Systematic review and meta‐analysis

Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment

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