Academic journal article Journal of Eating Disorders

Time to Restore Body Weight in Adults and Adolescents Receiving Cognitive Behaviour Therapy for Anorexia Nervosa

Academic journal article Journal of Eating Disorders

Time to Restore Body Weight in Adults and Adolescents Receiving Cognitive Behaviour Therapy for Anorexia Nervosa

Article excerpt

Authors: Simona Calugi (corresponding author) [1]; Riccardo Dalle Grave [1]; Massimiliano Sartirana [1]; Christopher G Fairburn [2]

Background

Anorexia nervosa is considered one of the most difficult psychiatric disorders to treat [1]. Patients are often reluctant to accept treatment and among those who start a large subgroup has a poor outcome. Anorexia nervosa is also difficult to study [2]-[6] because is relatively rare, associated with medical risks, and may require a lengthy duration of treatment. These difficulties have led to the recommendation that new treatments should be extensively tested prior to being evaluated in randomized controlled trials [2]-[6].

Enhanced cognitive behaviour therapy (CBT-E) is a treatment for eating disorder psychopathology, irrespective of the eating disorder diagnosis [7]-[9]. There are data from randomized control trials supporting its use in bulimia nervosa, and the other non-underweight eating disorder presentations [10]-[12], and from randomized and observational studies of adolescents and adults with anorexia nervosa [13]-[17]. When used to treat patients who are underweight CBT-E generally involves about 40 sessions over 40?weeks [8] (i.e., about twice the length of CBT-E for patients who do not need to regain weight). This length of treatment is mainly to accommodate the time needed for weight regain. The optimal duration of treatment has not been established, and it may be shorter for adolescents than adults as it has been suggested that they are easier to treat [5].

Purpose

The aim of the present study was to obtain benchmark data on the duration of treatment required to restore body weight in adolescents and adults with anorexia nervosa treated with outpatient CBT-E.

Methods

Design

A cohort of participants with anorexia nervosa was recruited from consecutive referrals to an eating disorder clinic. Eligible participants were offered 40 sessions of CBT-E over 40?weeks. This was the sole psychological intervention that they received. The study was approved by the local human subjects committee.

Setting and participants

The sample was recruited from consecutive referrals by family doctors and other clinicians to a well-established eating disorder clinic serving the Verona area of Italy. The patients were required to fulfill DSM-IV diagnostic criteria for anorexia nervosa [18] bar the amenorrhea criterion. In addition, for patients under 18?years, the patient?s parents or legal guardians had to provide written informed consent to their participation after having received a full description of the study.

One hundred and fifty-two patients were screened, of whom 32 did not meet the inclusion criteria. Fifteen met the following exclusion criteria: (i) extremely underweight (BMI?

The remaining 105 patients were offered CBT-E, of whom 95 accepted (90.5%). A detailed description of the participants has been provided elsewhere [13],[14].

The treatment

CBT-E is a treatment for people with eating disorder psychopathology, irrespective of their eating disorder diagnosis. A detailed description of the treatment has been published [8]. In brief, CBT-E for patients who are underweight has three main steps. The goal of the first step is to help patients see the need for weight regain and decide to embark upon it. The goal of the second step is to help patients regain weight to a low-healthy level, and at the same time address their eating disorder psychopathology. …

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