Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt, Ulrike; Sharpe, Helen; Bartholdy, Savani; Bonin, Eva-Maria; Davies, Helen; Easter, Abigail; Goddard, Elizabeth; Hibbs, Rebecca; House, Jennifer; Keyes, Alexandra; Knightsmith, Pooky; Koskina, Antonia; Magill, Nicholas; McClelland, Jessica; Micali, Nadia; Raenker, Simone; Renwick, Bethany; Rhind, Charlotte; Simic, Mima; Sternheim, Lot; Woerwag‐Mehta, Sabine; Beecham, Jennifer; Campbell, Iain C.; Eisler, Ivan; Landau, Sabine; Ringwood, Susan; Startup, Helen; Tchanturia, Kate; Treasure, Janet

doi:10.3310/pgfar05160

Cited by 21 publications

(37 citation statements)

References 353 publications

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“…Based on this evidence, it seems plausible to state that technology-based guided self-help for anorexia nervosa is acceptable and is not associated with lower adherence than standard treatment. A recent study also found that an online, guided self-help intervention designed to prevent relapse from intensive treatment was beneficial in the aftercare of inpatients with anorexia nervosa (Schmidt et al, 2017). However, these findings cannot generalize to the use of standalone online interventions to replace standard treatment or as only form of support after care in anorexia nervosa.…”

Section: Clinical Implications and Limitationsmentioning

confidence: 97%

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

et al. 2020

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The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02336841.

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Section: Clinical Implications and Limitationsmentioning

confidence: 97%

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

et al. 2020

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“…Data were collected from clinical notes for adolescents aged 13-17 years with an eating disorder in all services beyond primary care across London. 32 Admission rates in the London study, which excluded admissions for medical stabilisation, were significantly different between groups, being 15% among those assessed and treated in a specialist service, 19% among those receiving a non-specialist assessment but treated in a specialist service and 40% among those assessed and treated in a non-specialist service. Those referred to non-specialist outpatient services were also found to have incurred approximately twice the costs of those referred to specialist services, with no statistically significant differences in outcome.…”

Section: Cost-effectiveness Of Specialist Versus Generic Servicesmentioning

confidence: 94%

“…31 Similarly, a more recent study found that service costs in a population of adolescents with eating disorders were driven by hospital admissions. 32 Thus, although our approach was narrower than that usually adopted for an economic evaluation (i.e. excluding broader health and social care services), it was considered appropriate to minimise respondent burden while still providing evidence of the key costs in this population.…”

Section: Health Service Usementioning

confidence: 99%

Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study

Byford

Petkova

Stuart

et al. 2019

Health Serv Deliv Res

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Background Evidence suggests that investing in specialist eating disorders services for young people with anorexia nervosa could have important implications for the NHS, with the potential to improve health outcomes and reduce costs through reductions in the number and length of hospital admissions. Objectives The primary objectives were to evaluate the costs and cost-effectiveness of alternative community-based models of service provision for young people with anorexia nervosa and to model the impact of potential changes to the provision of specialist services. Design Observational surveillance study using the Child and Adolescent Psychiatry Surveillance System. Setting Community-based secondary or tertiary child and adolescent mental health services (CAMHS) in the UK and the Republic of Ireland. Participants A total of 298 young people aged 8–17 years in contact with CAMHS for a first episode of anorexia nervosa in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria. Interventions Community-based specialist eating disorders services and generic CAMHS. Main outcome measures Children’s Global Assessment Scale (CGAS) score (primary outcome) and percentage of median expected body mass index (BMI) for age and sex (%mBMI) (secondary outcome) were assessed at baseline and at 6 and 12 months. Data sources Data were collected by clinicians from clinical records. Results Total costs incurred by young people initially assessed in specialist eating disorders services were not significantly different from those incurred by young people initially assessed in generic CAMHS. However, adjustment for baseline covariates resulted in observed differences favouring specialist services (costs were lower, on average) because of the significantly poorer clinical status of the specialist group at baseline. At the 6-month follow-up, mean %mBMI was significantly higher in the specialist group, but no other significant differences in outcomes were evident. Cost-effectiveness analyses suggest that initial assessment in a specialist service has a higher probability of being cost-effective than initial assessment in generic CAMHS, as determined by CGAS score and %mBMI. However, no firm conclusion can be drawn without knowledge of society’s willingness to pay for improvements in these outcomes. Decision modelling did not support the hypothesis that changes to the provision of specialist services would generate savings for the NHS, with results suggesting that cost per 10-point improvement in CGAS score (improvement from one CGAS category to the next) varies little as the percentage of participants taking the specialist or generic pathway is varied. Limitations Follow-up rates were lower than expected, but the sample was still larger than has been achieved to date in RCTs carried out in this population in the UK, and an exploration of the impact of missing cost and outcome data produced very similar results to those of the main analyses. Conclusions The results of this study suggest that initial assessment in a specialist eating disorders service for young people with anorexia nervosa may have a higher probability of being cost-effective than initial assessment in generic CAMHS, although the associated uncertainty makes it hard to draw firm conclusions. Although costs and outcomes were similar, young people in specialist services were more severely ill at baseline, suggesting that specialist services were achieving larger clinical effectiveness gains without the need for additional expenditure. The results did not suggest that providing more specialist services would save money for the NHS, given similar costs and outcomes, so decisions about which service type to fund could be made with reference to other factors, such as the preferences of patients and carers. Future work Data on measures of quality of life capable of generating quality-adjusted life-years are needed to confirm the cost-effectiveness of specialist services. Trial registration Current Controlled Trials ISRCTN12676087. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 37. See the NIHR Journals Library website for further project information.

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“…A feasibility trial 13 in the UK found tentative evidence for the efficacy of a manual-based emailguided self-care programme in preventing relapse following inpatient treatment compared to TAU. An RCT by Jacobi et al 32 examined an internet-based relapse prevention (IN@) for women with BN following inpatient treatment, again compared to TAU.…”

Section: Relapse Preventionmentioning

confidence: 99%

“…Some researchers have argued that self-help interventions are contraindicated in anorexia nervosa (AN) due to the ego-syntonic nature of the disorder and high medical risk 8,9 . However, a small body of evidence suggests that people with AN can benefit from self-help programmes enhancing treatment motivation as an adjunct to face-to-face treatment 10,11 or for relapse prevention 12,13 By comparison, self-help is a widely used treatment option for BN and BED where it has a sizeable evidence-base. In the UK, guidelines of the National Institute of Care and Excellence (NICE) recommend self-help interventions as the first step for treatments for 'bulimic-type' disorders, including bulimia nervosa (BN), binge eating disorder (BED), and milder forms of binge eating 14 .…”

Section: Introductionmentioning

confidence: 99%

Self-Help Treatment of Eating Disorders

Yim

Schmidt

2019

Psychiatric Clinics of North America

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DISCLOSURE STATEMENTDisclosure of any relationship with a commercial company that has a direct financial interest in subject matter or materials discussed in article or with a company making a competing product None. KEYWORDS 4-8 keywords to enhance online search results Self-help, eating disorders, review, bulimia nervosa, binge eating disorder, intervention KEY POINTS 3 to 5 bullet points of approximately 25 words each that summarize the main ideas of your article. Key points appear at the very beginning of your article in print and online. -Studies of self-help interventions have mainly focused on the treatment of bulimia nervosa (BN), and binge eating disorder (BED), with very few addressing treatment of anorexia nervosa (AN). -Guided self-help interventions for BN and BED are superior to waiting list or delayed treatment in terms of improving ED psychopathology and abstinence rates. -Systematic reviews comparing guided self-help (GSH) and other therapies have combined other treatments that are less intensive (pure self-help), more intensive or equally intensive as GSH. It is hard to draw firm conclusions on the relative efficacy of GSH from these. -Findings on the impact of guidance on outcome are mixed, however there is some evidence on the impact of guidance on treatment adherence. -Future studies are needed to separate out the effects of different modes of self-help (guided/unguided; bibliotherapy/digital), comparison groups (waitlist/type of comparison therapy), as well as the point in the care pathway (prevention, relapse prevention) at which the intervention is delivered. SYNOPSISBrief summary of your article (100 words or fewer; no references or figures/tables). The synopsis appears only in the table of contents, and is often used by indexing services such as PubMed.The authors provide an overview of the current state of research on self-help interventions for eating disorders. The efficacy of different forms of self-help interventions for bulimia nervosa, binge eating disorder and other eating disorders at various stages of the care pathway (from prevention to relapse prevention) is described. Cost-effectiveness studies are also presented. Moderators of outcome, such as guidance and adherence, are discussed. Overall, the findings are promising and support the use of self-help interventions in the treatment of bulimic disorders, across the stages of the care pathway. Less is known about the use of self-help in anorexia nervosa.

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Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Cited by 21 publications

References 353 publications

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study

Self-Help Treatment of Eating Disorders

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