The impact of the COVID‐19 pandemic on intensive cognitive behavioral therapy outcomes in patients with anorexia nervosa—A cohort study

Abstract

Objective This study aimed to assess the impact of the COVID‐19 pandemic on the efficacy of an intensive treatment based on enhanced cognitive behavioral therapy (CBT‐E) in patients with anorexia nervosa. Methods This cohort study analyzed 57 patients with anorexia nervosa who experienced the COVID‐19 pandemic during intensive CBT‐E, comparing their outcomes (body mass index [BMI], eating‐disorder and general psychopathology, and clinical impairment) with those of patients with anorexia nervosa matched by gender, age, and BMI given the same treatment before the COVID‐19 outbreak as controls. Patients were assessed at baseline, at the end of treatment and after 20 weeks of follow‐up. Results More than 75% of patients during the pandemic versus 85% of controls completed the treatment, a difference that was not significant. BMI, eating disorder and general psychopathology and clinical impairment scores improved significantly from baseline to 20‐week follow‐up in both groups. However, the improvement was more marked in controls than in those treated during the COVID‐19 pandemic. Conclusion Patients with anorexia nervosa given intensive CBT‐E during the COVID‐19 pandemic had significantly improved psychopathology, albeit to a lesser extent than patients given the same treatment before the COVID‐19 pandemic. Public significance statement In this study, the outcome of 57 patients with anorexia treated with intensive enhanced cognitive behavior therapy during the COVID‐19 pandemic was compared with a matched group treated before the pandemic hit. The rate of remission from anorexia nervosa was similar between the two groups. However, patients exposed to the COVID‐19 pandemic showed lesser improvement than those not exposed.

Effects of the COVID-19 pandemic on youth mental health: a cross-sectional study on eating disorder patients and their unaffected siblings

“…This imperative is particularly pronounced when considering adolescents. Once again, our data accentuate the crucial importance of directing attention to the specific needs of youth in the ED field, encompassing their cognitive, emotional, and social requirements [ 72 , 73 ].…”

One year of COVID-19 pandemic on patients with eating disorders, healthy sisters, and community women: evidence of psychological vulnerabilities

“…Healthcare systems have been overwhelmed by the pandemic's effects on staff members and the increased support required by patients, showing the psychological burden of the exacerbation of ED symptomatology caused by the loss of in-person support, the feeling of being undeserving of help, and the limitations of online treatment options [12]. Moreover, evaluation of the changes in the effectiveness of treatment before and during the COVID-19 pandemic indicates a reduction in the improvement in patients, calling for evaluations on the possible necessity of specific strategies and procedures to help them [13]. Overall, this evidence showed the possible role of environmental adversity in developing psychological distress, understood as isolation, low mood, anxiety, lack of structure, disruption to routines, and media/social media messages around weight and exercise [14,15].…”

Intensive Cognitive Behavioral Therapy for Adolescents with Anorexia Nervosa Outcomes before, during and after the COVID-19 Crisis

“…Both groups exhibited significant improvements in BMI, eating disorder and general psychopathology, and clinical impairment scores from baseline to the 20-week follow-up. However, the improvement was more pronounced in the pre-pandemic control group than those treated during the COVID-19 pandemic [8].…”

“…These differences could be attributed to different treatment settings and different groups of patients (adults vs. adolescents). Some prior research, including on patients treated via intensive CBT-E, has suggested a more pronounced improvement among patients treated before the COVID-19 pandemic [8]. However, this disparity may be attributable to differences in the sample assessed before the pandemic.…”

“…In addition, even when in-person services have been feasible, their quality has been adversely affected by concerns about infection, the necessity for personal protective equipment, mandated social distancing measures and stringent disinfection protocols [7]. Additionally, inpatient eating disorder units previously organized as "open" units have had to be restructured into "closed" units [8].…”