Academic journal article Journal of Eating Disorders

A 10-Year Follow-Up Study of Completers versus Dropouts Following Treatment with an Integrated Cognitive-Behavioral Group Therapy for Eating Disorders

Academic journal article Journal of Eating Disorders

A 10-Year Follow-Up Study of Completers versus Dropouts Following Treatment with an Integrated Cognitive-Behavioral Group Therapy for Eating Disorders

Article excerpt

Author(s): Yuri Okamoto[sup.1], Yoshie Miyake[sup.1], Ichie Nagasawa[sup.1] and Kazuhiro Shishida[sup.2]

Plain English summary

We compared the 10-year prognosis of patients who completed integrated group CBT with those who dropped out and examined the effect of completing group CBT on prognosis. After group CBT, eating attitudes and depressive symptoms decreased, and self-esteem increased significantly. We also compared the clinical features and 10-year prognosis of patients who completed the study and those who dropped out. The completer group had a significantly higher number of patients who had a good outcome, and the dropout group had a significantly higher number of patients who had a poor outcome. The integrated group CBT experience might have positive long-term effects.

Background

Eating disorders are serious illnesses that can be difficult to treat [1]. Many serious problems are associated with eating disorders [2, 3], such as 1) significant mortality rates [4], 2) suicidal behavior [5, 6], 3) high medical costs [7], 4) high rates of comorbidity [8], and 5) high association with childhood trauma, such as abuse. Nonetheless, the existing evidence-based treatments are still limited in their effectiveness.

In the National Institute for Health and Clinical Excellence guidelines [9], cognitive behavioral therapy (CBT) is recommended for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Fairburn [10] reported that most eating disorders have a mixed clinical presentation, in which the features of AN, BN, BED, and those of incomplete types overlap in various ways. Fairburn adapted CBT to make it transdiagnostic, i.e., appropriate all eating disorder psychopathologies, and reported that this Enhanced CBT (CBT-E) outcome did not depend on the type of eating disorder involved [11]. Accordingly, we conducted CBT in a transdiagnostic sample.

We conducted CBT in a group setting for the following two reasons. First, group therapy is time-efficient. In Japan, outpatient clinics treat many patients and it is not possible to commit large amounts of time to individual treatment. With group therapy, time problems can be solved to an extent. In addition, group therapy reduces patient payment to 54-70% of that of individual psychotherapy; therefore, group therapy is cost-effective. Many reports have indicated that group therapy for eating disorders is cost-effective and cost-beneficial [12-14]. Moreover, both CBT and interpersonal therapy have demonstrated good outcomes [15]. The second reason is that group psychodynamics work therapeutically. Group therapy gives patients the opportunity to be supported by others and to support others. Yalom et al. [16, 17] reported that interpersonal learning is an important and dynamic factor in group-based psychotherapy that allows group members to share aspects of their emotions, thoughts, and perceptions while receiving feedback from fellow group members in a safe and collaborative setting. Because recovery from eating disorders takes considerable time, many patients lose motivation during treatment. We believe that group therapy can contribute to enhancing and continuing motivation for treatment as the patients support each other.

In this study, it was difficult to apply Fairburn's CBT-E in its entirety because in group therapy, it is difficult to carefully intervene in patient's cognitions as is done on a one-to-one basis in individual therapy. Therefore, we partially adopted CBT-E and added a variety of approaches for conducting group therapy that motivate recovery efforts. In the group CBT, a self-assertion session seemed necessary. This is because Japanese individuals, and especially those with eating disorders, are not typically self-assertive, and it is important for patients to address this in order to have acceptable experiences within the group. A Japanese study reported that a combination program of CBT with assertive training and self-esteem enhancement was effective [18]. …

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