The effectiveness of contingency management in the treatment of patients with anorexia nervosa: A systematic review

Abstract

Contingency management in stipulating weight gain is routinely used in the treatment of anorexia nervosa, however, empirical investigations concerning its effectiveness have been scarce. This systematic review was conducted according to the PRISMA statement. Of N = 973 hits, 42 full-texts were included in the qualitative synthesis (11 theoretical texts, 19 case reports, 12 descriptive, cohort, and controlled trials). A central topic in the included publications concerns the enhancement of patients' autonomy through participation in the contingency management process. This heightened autonomy is achieved by using contingency contracts. Positive short-term effects on weight gain were shown, whereas follow-up results were heterogeneous. Although contingency contracts are widely used in clinical practice, our systematic review shows that empirical evidence on underlying mechanisms and efficacy is still scarce. Using an explicit treatment contract can enhance patients' motivation, compliance, and autonomy. Clinical practice should see further development including innovative motivation enhancing and conflict dissolving techniques in addressing the pronounced ambivalence often shown by patients with anorexia nervosa.

Contingency Contracts for Weight Gain of Patients with Anorexia Nervosa in Inpatient Therapy: Practice Styles of Specialized Centers

“…Only a few experts reported also putting consequences on other eating disorder related behaviors such as excessive exercising or vomiting. Having weight gain or weight loss as a sole focus of contingency contracts for patients with AN presumably originates from early behavioristic approaches of contingency management [ 18 ]. In light of a holistic treatment approach however, it seems advisable to consider other eating disorder related behaviors such as excessive exercising or vomiting as part of the contingency contract as well.…”

“…A recent systematic review by our group showed that despite their routine usage in inpatient treatment, contingency contracts for weight gain are an understudied topic and the empirical evidence base is scarce [ 18 ]. The majority of publications included in our review were of rather historical nature with few current contributions.…”

Null hypothesis significance tests, a misleading approach to scientific knowledge: Some implications for eating disorders research

“…These primary research publications can later be included in epidemiological systematic reviews or meta‐analyses, which are based on structuring and synthesizing the available empirical evidence in order to answer a specific research question. For example, the publication that compiles previously published results for the association of disordered eating behaviours and autistic traits in nonclinical populations (Christensen, Bentz, Clemmensen, Strandberg‐Larsen, & Olsen, 2019), or the study measuring the effectiveness of contingency management in the treatment of Anorexia nervosa patients (Ziser et al, 2018).…”

Nutritional intervention in childhood overweight – Efficacy of the motivational multidisciplinary individualized treatment

“…These interventions highlight the behavioral contract between the patient and the health professional, which consists of a verbal or written agreement in which one or both parties agree with a change of behaviors related to the patient [6]. In the clinical context, behavioral contracts have been used for eating behaviors [6][7][8], but also smoking cessation, rheumatic diseases, tuberculosis [6] and for individuals with speci c psychiatric conditions [9].…”

“…A recent systematic review showed e cacy of behavioral contracts in short-term weight gain for the treatment of anorexia nervosa. The authors concluded that use of contracts increases patient participation, responsibility and motivation in their treatment process, emphasizing that there is little evidence on the e cacy of type of intervention in clinical practice [7]. Several authors have shown the effectiveness of contracts to change behaviors with monetary reward in reducing weight in overweight or obese adults [10][11][12].…”