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

Abstract

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.

Group cognitive behavioral therapy as an effective approach for patients with alcohol dependence: A perspective study

“…GCBT showed significant improvement in eating pathology and associated psychopathology throughout treatment. [12] Moreover, Lin et al investigated the effectiveness of GCBT on depression and suicide reattempt and emotion regulation strategies among those with borderline personality disorder. They showed that GCBT effectively decreased depression and suicide reattempt in Borderline Personality Disorder college students, probably through increasing adaptive antecedent-focused or response-focused strategies of emotion regulation, respectively.…”

“…Some of these studies included crimination among HIV-positive Latino sexual minority men [7] ; individuals with anxiety, depression, and suicide reattempts [8,9] ; women diagnosed with bipolar disorder; major depressive disorder spectrum seeking help for menopausal symptoms [10] ; women with AD [11] ; and Chinese patients with anorexia nervosa. [12] The present study was designed to investigate the efficacy of GCBT in male Chinese patients with AD to provide an effective approach for patients with AD.…”

The effectiveness and cultural adaptations of psychological interventions for eating disorders in East Asia: A systematic scoping review

“…Incorporation of local diet and eating behaviors (Gu et al, 2021;Hamatani et al, 2022, b) Addition of Chinese traditional music for relaxation (Wang & Xiao, 2021) Value/importance of family/community Incorporation of the concept of extended family in the assessment and treatment (Ma & Lai, 2009) Language translation Addition of Korean subtitles (Kim et al, 2019), translation of manual to Japanese (Hamatani et al, 2022, b) Language tailoring Use of a less direct communication style when recommending behavioral changes in Japan (Hamatani et al, 2022, b) Provision of explanations of psychological terms such as rumination was changed to rumination (negatively, dwell on; Hamatani et al, 2022, b) Methodological components…”

“…This is due to the lack of specialist treatment centres and trained personnel, yet the demand was high (Okamoto et al, 2017); It was less costly to patients given the healthcare system was not free (Gu et al, 2021;Okamoto et al, 2017); Group treatments can help build confidence and for Japanese individuals to feel less guilty about having an ED (Okamoto et al, 2017) Use of lower intensity treatments (e.g., guided self-help) to increase access due to the lack of specialized services in the community (Setsu et al, 2018); Shortening of treatment to 10 sessions (e.g., Shiina et al, 2005) to make treatment more affordable and acceptable, as some people lived far away (Gu et al, 2021) Theoretical framework Use of the Formative Method for Adapting Psychotherapy (FMAP) when culturally adapting treatment (Hamatani et al, 2022, b) lack of specialist treatment centres, so that trained clinicians could see more patients (Okamoto et al, 2017). Another reason for shortening treatments, was to make them more affordable, as most healthcare systems described were not free and people lived far away from any specialist centres (Gu et al, 2021). Some treatments were conducted in general medicine (AN intervention, Amemiya et al, 2012) or pediatric settings (ARFID interventions, Tamura et al, 2021;Tomioka et al, 2022) rather than in specialist ED units.…”

“…For AN interventions, within-group, studies found significant improvements in ED psychopathology (Amemiya et al, 2012;Gu et al, 2021;Kim et al, 2019). However, in one of the RCTs which compared group CBT with treatment as usual (TAU), results in both groups were comparable (Gu et al, 2021) symptoms (Hamatani et al, 2019;Kwag et al, 2022;Okamoto et al, 2017;Setsu et al, 2018). However, despite the moderate to large effect sizes, the results were not significant in Hamatani et al (2019), likely due to low power.…”