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Dalle Grave R, Calugi S. Enhanced cognitive behaviour therapy for adolescents with eating disorders: development, effectiveness, and future challenges. Biopsychosoc Med 2024; 18:18. [PMID: 39232751 PMCID: PMC11373333 DOI: 10.1186/s13030-024-00315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024] Open
Abstract
Eating disorders can significantly impact the psychosocial functioning and physical health of adolescents. Early and effective treatment is crucial to prevent long-lasting and potentially devastating adverse effects. The National Institute for Health and Care Excellence has recommended cognitive behaviour therapy (CBT) for eating disorders in adolescents when family therapy is unacceptable, contraindicated, or ineffective. This recommendation was primarily based on the review of promising results from the enhanced version of CBT (CBT-E) adapted for adolescents with eating disorders aged between 12 and 19 years. A non-randomized effectiveness trial has also shown that CBT-E achieved a similar outcome to family-based treatment (FBT) at 6- and 12-months. CBT-E has several advantages. It is acceptable to young people, and its collaborative nature suits ambivalent young patients who may be particularly concerned about control issues. The transdiagnostic scope of the treatment is an advantage as it can treat the full range of disorders that occur in adolescent patients. It is an individual one-on-one treatment that does not necessitate the full involvement of the family. This approach is particularly beneficial for families that can only provide limited support. Future challenges include clarifying the relative efficacy of CBT-E and family therapy for the treatment of adolescent patients with eating disorders in a randomized control trial and increasing its effectiveness, identifying the reasons for the lack of response, and modifying the treatment accordingly.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89 37016, Garda, VR, Italy.
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89 37016, Garda, VR, Italy
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Gkintoni E, Kourkoutas E, Vassilopoulos SP, Mousi M. Clinical Intervention Strategies and Family Dynamics in Adolescent Eating Disorders: A Scoping Review for Enhancing Early Detection and Outcomes. J Clin Med 2024; 13:4084. [PMID: 39064125 PMCID: PMC11277612 DOI: 10.3390/jcm13144084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: This systematic review investigated the impact of familial factors on individuals aged 10-17 who have clinical signs or symptoms of eating disorders. Simultaneously, it scrutinized the involvement of the family in therapy, as well as other forms of intervention. Methods: The PsycINFO, PubMed, and Scopus databases were used to search for research material comprehensively. After applying specific criteria, 46 articles were deemed suitable and included in the systematic review. The study comprised a cohort of 4794 adolescents who received a diagnosis of either Anorexia Nervosa (AN), Bulimia Nervosa (BN), or Binge-Eating Disorder (BED). In addition, controls were utilized for 1187 adolescents, 1563 parents, 1809 siblings, and 11 other relatives. Results: The connection between family factors and eating disorders is primarily determined by the families' level of functioning, satisfaction with the family dynamic, parents' attitudes toward their children, and the role of food within the family system. Family Therapy was the most used psychotherapeutic approach in the treatment of AN. The incidence of reports in BN closely paralleled that of Cognitive-Behavioral Therapy (CBT) models. Articles about (Enhanced) CBT were exclusively associated with BED. Conclusions: Family-based approaches are crucial in comprehending, preventing, and addressing eating disorders in adolescents. Incorporating the study of family dynamics and actively engaging families in the treatment process can significantly enhance recovery rates and decrease the occurrence of relapses.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Education and Social Work, University of Patras, 26504 Patras, Greece;
| | - Elias Kourkoutas
- Department of Primary Education, Research Center for the Humanities, Social and Education Sciences, University of Crete, 74150 Rethymno, Greece;
| | | | - Maria Mousi
- Department of Psychology, University of Crete, 74150 Rethymno, Greece;
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Calugi S, Dalle Grave A, Chimini M, Lorusso A, Dalle Grave R. Illness duration and treatment outcome of intensive cognitive-behavioral therapy in adolescents with anorexia nervosa. Int J Eat Disord 2024; 57:1566-1575. [PMID: 38482877 DOI: 10.1002/eat.24196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive-behavioral therapy (CBT-E) in patients aged between 12 and 18 years with anorexia nervosa with a duration of illness <3 versus ≥3 years. METHODS One hundred and fifty-nine consecutively treated patients (n = 122 with illness duration <3 years and n = 37 ≥ 3 years) were enrolled in a 20-week intensive CBT-E program. All patients underwent assessment at admission, end of treatment (EOT), and 20-week follow-up. The following measures were used: body mass index (BMI)-for-age percentile and percentage of expected body weight (EBW), Eating Disorder Examination Questionnaire, Brief Symptom Inventory, and Clinical Impairment Assessment. RESULTS Approximately 81% of eligible patients began the program, with over 80% successfully completing it. Patients with a longer or shorter duration of illness did not show significantly different treatment outcomes. In detail, BMI-for-age percentile and percentage of EBW outcomes were significantly improved from baseline to EOT, remaining stable until 20-week follow-up in both groups. Similarly, in both groups, scores for eating disorder psychopathology, general psychopathology, and clinical impairment decreased significantly at EOT and remained stable from EOT to follow-up. Furthermore, a substantial percentage of adolescents in both groups achieved a good BMI outcome at EOT and 20-week follow-up, with approximately 60% maintaining a full response at the latter time point. DISCUSSION These findings suggest that intensive CBT-E appears to be an effective treatment for severely ill adolescent patients with anorexia nervosa, regardless of whether the duration of illness is shorter or longer than 3 years. PUBLIC SIGNIFICANCE Existing treatment outcome studies in adolescents, whether randomized controlled trials or longitudinal investigations, typically involve patients with less than 3 years of illness, while data on the treatment outcomes for adolescents with anorexia nervosa with an illness duration of 3 years or over is very limited. Our findings suggest that adolescents with anorexia nervosa, irrespective of the duration of their illness, can derive similar benefits from intensively CBT-E.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Mirko Chimini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Anna Lorusso
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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Gioia AN, Ali S, Reilly EE. Clinical Experiences Using Cognitive-Behavioral Therapy for Eating Disorders. Behav Ther 2024; 55:872-884. [PMID: 38937056 PMCID: PMC11219095 DOI: 10.1016/j.beth.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 06/29/2024]
Abstract
Data suggests that despite the availability of evidence-based psychological treatments for eating disorders (EDs), techniques from these therapies may be less frequently used within real-life clinical practice. The aim of this study was to provide the opportunity for clinicians to give feedback on their experiences treating EDs using cognitive-behavioral therapy (CBT) through reporting on use of CBT techniques and barriers to treatment implementation in naturalistic settings. Clinicians (N = 126) who self-identified as using CBT for EDs reported demographic information, frequency/usefulness of empirically supported treatment techniques, problems/limitations of CBT, and barriers faced while implementing CBT. The most frequently used technique reported by clinicians was psychoeducation, and the least frequently used technique was use of surveys to address mind reading. Patients' unwillingness to follow a meal plan/nutritional guide was rated as the most impactful barrier, alongside ED severity. Of the problems/limitations of CBT, too little guidance on treating co-occurring symptoms was rated as the most impactful. This study provided a mechanism for clinicians to share their experiences using CBT for EDs in real-world settings. Overall, results regarding frequency of use and usefulness of techniques indicate a high level of endorsement. Moreover, the most frequently endorsed barriers to/limitations of CBT related to lack of guidance on treating complex ED presentations. Future research should explore ways to treat cases that go beyond the prototypical ED case and explore ways to adapt CBT to meet the needs of naturalistic treatment settings.
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Fuller SJ, Tan J, Nicholls D. The importance of individualised care, good communication and trust for reducing nasogastric tube feeding under physical restraint: qualitative multi-informant study. BJPsych Open 2024; 10:e86. [PMID: 38629302 PMCID: PMC11060075 DOI: 10.1192/bjo.2024.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/18/2023] [Accepted: 02/06/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Nasogastric tube (NGT) feeding against a patient's consent is an intervention that clinicians working in specialist mental health in-patient units may need to implement from time to time. Little research has explored clinician, patient and carer perspectives on good practice. AIMS To use qualitative data from people with lived experience (PWLE), parents/carers and clinicians, to identify components of best practice when this intervention is required. METHOD PWLE and parents/carers were recruited via BEAT UK's eating disorder charity. Clinicians were recruited via a post on The British Eating Disorders Society's research page. Semi-structured interviews were administered, transcribed and thematically analysed. RESULTS Thirty-six interviews took place and overlapping themes were identified. Participants spoke in relation to three themes: first, the significance of individualised care; second, the importance of communication; third, the impact of staff relationships. Sub-themes were identified and explored. CONCLUSIONS Good care evolved around positive staff relationships and individualised care planning rather than standard processes. The centrality of trust as an important mediator of outcome was identified, and this should be acknowledged in any service that delivers this intervention.
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Affiliation(s)
- Sarah J. Fuller
- Division of Psychiatry, Imperial College London, UK
- Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Jacinta Tan
- Retired Consultant Child and Adolescent Psychiatrist, Swansea, UK
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Johnson-Munguia S, Bottera AR, Vanzhula I, Forbush KT, Gould SR, Negi S, Thomeczek ML, L’Insalata AM, Like EE, Sharma AR, Morgan RW, Rasheed S. Understanding community provider practices in diagnosing and treating atypical anorexia nervosa: A mixed methods study. Int J Eat Disord 2024; 57:892-902. [PMID: 38239071 PMCID: PMC11018496 DOI: 10.1002/eat.24125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE There is a lack of consensus in defining "significant weight loss" when diagnosing atypical anorexia nervosa (atypical AN) and no guidelines exist for setting target weight (TW). The current study aimed to identify community providers' practices related to the diagnosis of atypical AN and the determination of TW. A secondary aim was to evaluate whether professional discipline impacted "significant weight loss" definitions. METHOD A variety of providers (N = 141; 96.4% female) completed an online survey pertaining to diagnostic and treatment practices with atypical AN. Descriptive statistics were computed to characterize provider-based practices and Fisher's exact tests were used to test for differences in diagnostic practices by professional discipline. Thematic analysis was used to examine open-ended questions. RESULTS Most (63.97%) providers diagnosed atypical AN in the absence of any weight loss if other AN criteria were met, but doctoral-level psychologists and medical professionals were less likely to do so compared to nutritional or other mental health professionals. Most providers found weight gain was only sometimes necessary for atypical AN recovery. Qualitative responses revealed providers found atypical AN to be a stigmatizing label that was not taken seriously. Providers preferred to use an individualized approach focused on behaviors, rather than weight when diagnosing and treating atypical AN. DISCUSSION Lack of diagnostic clarity and concrete treatment guidelines for atypical AN may result in substantial deviations from the DSM-5-TR criteria in real-world practice. Clinically useful diagnostic definitions for restrictive eating disorders and evidence-based treatment guidelines for TW and/or other relevant recovery metrics are needed. PUBLIC SIGNIFICANCE The current study found variability in how community providers diagnose and determine target recovery weight for atypical anorexia nervosa (atypical AN). Many providers viewed the diagnosis of atypical AN as stigmatizing and preferred to focus on behaviors, rather than weight. This study underscores the importance of creating a clinically useful diagnostic definition and guidelines for recovery for atypical AN backed by empirical evidence that providers may implement in practice.
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Mares SHW, Roelofs J, Zinzen J, Béatse M, Elgersma HJ, Drost RMWA, Evers SMAA, Elburg AAV. Clinical effectiveness, cost-effectiveness and process evaluation of group schema therapy for eating disorders: study protocol for a multicenter randomized controlled trial. BMC Psychol 2024; 12:123. [PMID: 38439092 PMCID: PMC10913254 DOI: 10.1186/s40359-024-01624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Eating disorders (EDs), such as (atypical) Anorexia (AN) and Bulimia Nervosa (BN), are difficult to treat, causing socioeconomic impediments. Although enhanced cognitive behavioral therapy (CBT-E) is widely considered clinically effective, it may not be the most beneficial treatment for (atypical) AN and BN patients who do not show a rapid response after the first 4 weeks (8 sessions) of a CBT-E treatment. Alternatively, group schema therapy (GST) may be a valuable treatment for this ED population. Even though GST for EDs has yielded promising preliminary findings, the current body of evidence requires expansion. On top of that, data on cost-effectiveness is lacking. In light of these gaps, we aim to describe a protocol to examine whether GST is more (1) clinically effective and (2) cost-effective than CBT-E for (atypical) AN and BN patients, who do not show a rapid response after the first 4 weeks of treatment. Additionally, we will conduct (3) process evaluations for both treatments. METHODS Using a multicenter RCT design, 232 Dutch (atypical) AN and BN patients with a CBT-E referral will be recruited from five treatment centers. Clinical effectiveness and cost-effectiveness will be measured before treatment, directly after treatment, at 6 and at 12 months follow-up. In order to rate process evaluation, patient experiences and the degree to which treatments are implemented according to protocol will be measured. In order to assess the quality of life and the achievement of personalized goals, interviews will be conducted at the end of treatment. Data will be analyzed, using a regression-based approach to mixed modelling, multivariate sensitivity analyses and coding trees for qualitative data. We hypothesize GST to be superior to CBT-E in terms of clinical effectiveness and cost-effectiveness for patients who do not show a rapid response to the first 4 weeks of a CBT-E treatment. DISCUSSION To our knowledge, this is the first study protocol describing a multicenter RCT to explore the three aforementioned objectives. Related risks in performing the study protocol have been outlined. The expected findings may serve as a guide for healthcare stakeholders to optimize ED care trajectories. TRIAL REGISTRATION clinicaltrials.gov (NCT05812950).
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Affiliation(s)
- Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, St. Annastraat 312c, Nijmegen, 6525 HG, The Netherlands.
| | - Jeffrey Roelofs
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Experimental Psychopathology, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - Janôt Zinzen
- Clinical Psychological Science, Faculty of Psychology and Neuroscience, Experimental Psychopathology, Maastricht University, Maastricht, 6200 MD, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Manouk Béatse
- Department of Eating Disorders (Amarum), GGNet Mental Health, St. Annastraat 312c, Nijmegen, 6525 HG, The Netherlands
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hermien J Elgersma
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Trimbos Institute, Centre for Economic evaluation and Machine Learning, National Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Annemarie A van Elburg
- Department of Eating Disorders (Amarum), GGNet Mental Health, St. Annastraat 312c, Nijmegen, 6525 HG, The Netherlands
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
- Co-eur, Utrecht, The Netherlands
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Calugi S, Dalle Grave A, Conti M, Dametti L, Chimini M, Dalle Grave R. The Role of Weight Suppression in Intensive Enhanced Cognitive Behavioral Therapy for Adolescents with Anorexia Nervosa: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3221. [PMID: 36833916 PMCID: PMC9967636 DOI: 10.3390/ijerph20043221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The study aimed to establish the role of weight suppression in a cohort of adolescents with anorexia nervosa treated with intensive enhanced cognitive behavioral therapy (CBT-E). One hundred and twenty-eight adolescent patients with anorexia nervosa (128 females and 2 males), aged between 14 and 19 years, were recruited from consecutive referrals to a community-based eating disorder clinic offering intensive CBT-E. Weight, height, Eating Disorder Examination Questionnaire, and Brief Symptom Inventory scores were recorded at admission, end-of-treatment, and at a 20-week follow-up. In addition, the developmental weight suppression (DWS, difference between one's highest premorbid and current z-BMI, i.e., BMI z-scores) was calculated. The mean baseline z-BMI was -4.01 (SD = 2.27), and the mean DWS was 4.2 (SD = 2.3). One hundred and seven patients (83.4%) completed the treatment and showed both considerable weight gain and reduced scores for eating-disorder and general psychopathology. Among completers, 72.9% completed the 20-week follow-up and maintained the improvement reached at the end-of-treatment. DWS was negatively correlated with end-of-treatment and follow-up z-BMI. This indicates that weight suppression is a predictor of the BMI outcome of intensive CBT-E and confirms that this treatment is promising for adolescents with anorexia nervosa.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo 89, 37016 Garda, VR, Italy
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Dalle Grave R, Calugi S, Ruocco C, Chimini M, Segala A, Ragni M, Carruba M, Valerio A, Nisoli E. Efficacy and tolerability of a specific blend of amino acids in patients with anorexia nervosa treated in a hospital setting: study protocol for a randomized controlled trial. Trials 2023; 24:104. [PMID: 36759873 PMCID: PMC9912576 DOI: 10.1186/s13063-023-07120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Specific blends of essential amino acids (EAA) containing a high percentage of branched-chain amino acids preserves mitochondrial metabolism and higher physical resistance in elderly mice, increasing their survival and improving physical performance and cognitive functions in malnourished elderly patients. However, no study has been yet done on patients with anorexia nervosa (AN) who regain weight with specialized intensive treatment. The present study aims to evaluate the efficacy of supplementation with EAA on the change in lean body mass (LBM) and other physical and psychological outcomes in patients with AN who are undergoing specialist treatment for eating disorders. METHODS This is a 13-week randomized, double-blind, placebo-controlled study. Patients will be randomized to either a mixture of a complex blend of EAA and intermediates of the tricarboxylic acid (TCA) cycle (citrate, malate, succinate) supplementation (or placebo) upon admission at the intensive residential and day-hospital treatment for eating disorders. Ninety-two participants with AN aged 16-50 years will be recruited from a specialized intensive treatment of eating disorders. Double-blind assessment will be conducted at baseline (T0) and the end of the 13 weeks of treatment (T1). The study's primary aim is to evaluate the efficacy of supplementation with EAA and TCA intermediates on the change in lean body mass (LBM) with weight restoration in patients with AN who are undergoing specialist treatment for eating disorders. The secondary aims of the study are to assess the effect of dietary supplementation on physical fitness, weight restoration, modification of AN and general psychopathology, and psychosocial impairment. DISCUSSION The study's results will inform researchers and clinicians on whether supplementing a mixture of EAA and TCA cycle intermediates will improve the increase of LBM and other important physical and psychological outcomes in patients with AN who regain weight with specialized intensive treatment. TRIAL REGISTRATION NCT, NCT05290285. Registered on 22 March 2022.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, Garda, 37016, Verona, Italy.
| | - Simona Calugi
- grid.416990.30000 0004 1787 1136Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, Garda, 37016 Verona, Italy
| | - Chiara Ruocco
- grid.4708.b0000 0004 1757 2822Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129 Milan, Italy
| | - Mirko Chimini
- grid.416990.30000 0004 1787 1136Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, 89, Garda, 37016 Verona, Italy
| | - Agnese Segala
- grid.7637.50000000417571846Department of Molecular and Translational Medicine, Brescia University, Viale Europa 11, 25123 Brescia, Italy
| | - Maurizio Ragni
- grid.4708.b0000 0004 1757 2822Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129 Milan, Italy
| | - Michele Carruba
- grid.4708.b0000 0004 1757 2822Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129 Milan, Italy
| | - Alessandra Valerio
- grid.7637.50000000417571846Department of Molecular and Translational Medicine, Brescia University, Viale Europa 11, 25123 Brescia, Italy
| | - Enzo Nisoli
- grid.4708.b0000 0004 1757 2822Center for Study and Research on Obesity, Department of Biomedical Technology and Translational Medicine, University of Milan, Via Vanvitelli, 32, 20129 Milan, Italy
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Cognitive behaviour therapy (CBT) as a psychological intervention in the treatment of ARFID for children and young people. COGNITIVE BEHAVIOUR THERAPIST 2023. [DOI: 10.1017/s1754470x22000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Abstract
Avoidant Restrictive Food Intake Disorder (ARFID) is a condition characterised by a disturbance in eating behaviour that leads to a significant negative impact on physical, social and nutritional health. The diagnosis of ARFID relies on a comprehensive, multi-disciplinary assessment to understand the individual’s history, physical, social and mental health risk, and any co-occurring mental health difficulties. Consensus guidance suggests that psychological treatment, alongside medical and dietetic input is delivered with consideration of any appropriate adaptions to accommodate developmental stage and/or common co-occurring presentations. This paper has been authored by clinicians working in an out-patient setting for children and adolescents with ARFID, and focuses on the presentation and assessment of ARFID and cognitive behavioural therapy (CBT) approaches that can help children, young people and their families. After an introductory section, the paper is split into four sections: assessment of ARFID; drivers of avoidant restrictive eating behaviour; multi-disciplinary formulation and intervention planning; and treatment. The treatment section provides an overview of the available research on CBT for ARFID, and a brief summary of the broader evidence base for CBT in children and young people with anxiety. Following a review of the evidence base, three case descriptions are provided to illustrate the clinical application of CBT where fear-based avoidance is the main driver. The paper concludes with practice points for clinicians to take forward when working with children and young people with ARFID.
Key learning aims
(1)
To be aware of the international consensus for the use of psychological interventions as a component of ARFID treatment alongside medical and dietetic input.
(2)
To understand that ARFID is characterised as a disturbance of eating behaviour, and as such, psychological intervention should target the drivers of this disturbance to promote behavioural change.
(3)
To gain an overview of the multi-disciplinary team assessment as an important tool to understand the contribution of each of the three drivers proposed to underpin an ARFID presentation.
(4)
To recognise when a CBT approach might be indicated, the current best evidence base for CBT for ARFID and how to adapt CBT to accommodate developmental stage and/or common co-occurring presentations.
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Calugi S, Dametti L, Dalle Grave A, Dalle Grave R. Changes in specific and nonspecific psychopathology network structure after intensive cognitive behavior therapy in patients with anorexia nervosa. Int J Eat Disord 2022; 55:1090-1099. [PMID: 35689570 DOI: 10.1002/eat.23755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to compare eating disorder-specific and nonspecific clinical features in patients with anorexia nervosa before and after intensive enhanced cognitive behavior therapy (CBT-E) via network analysis. METHODS All consecutive patients admitted to intensive CBT-E were eligible, and the sample comprised patients aged ≥16 years who completed a 20-week intensive CBT-E program. Body mass index (BMI), Eating Disorder Examination Questionnaire and Brief Symptoms Inventory responses were gathered at baseline and end of treatment, and used to generate statistical networks of the connections between symptoms (nodes) and the strength and centrality thereof. RESULTS A total of 214 patients were included. Most nodes had relatively similar centrality compared to other nodes in the networks. "Eating concern" and "phobic anxiety" showed the greatest bridge centrality at both time points. No differences were found between baseline and the end of treatment in either global network or individual connection strengths. CONCLUSION These findings suggest that some clinical expressions not specific to eating-disorder psychopathology remain strongly connected in the generalized network of patients with anorexia nervosa after CBT-E. Future research should examine whether additional procedures specifically designed to target these symptoms should be integrated into this and other treatments.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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Changes in obsessive-compulsive symptoms during inpatient treatment of anorexia nervosa. J Eat Disord 2022; 10:106. [PMID: 35851073 PMCID: PMC9295505 DOI: 10.1186/s40337-022-00629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is one of the most prevalent comorbidities in anorexia nervosa (AN). As AN is a severe, life-threatening condition, reducing obsessive-compulsive symptomatology is not the primary objective during treatment of AN and, thus, these symptoms may remain unchanged or may even increase in terms of a "symptom shift". METHODS In this retrospective analysis, we examined clinical records of 149 adolescents (n = 96, 64%) and adults (n = 53, 36%) with AN (6 males, 4%) who received inpatient treatment and completed the Obsessive-Compulsive Inventory-Revised at admission and discharge. RESULTS Obsessive-compulsive symptoms decreased from admission to discharge, irrespective of whether patients had comorbid OCD or not. Within-person decreases in obsessive-compulsive symptoms weakly correlated with increases in body weight. CONCLUSIONS These results indicate that obsessive-compulsive symptoms decrease during inpatient treatment of AN although they are not primarily targeted during treatment. Furthermore, these improvements seem to be associated with general improvements in AN symptomatology, suggesting the absence of a "symptom shift". Yet, effect sizes were small and obsessive-compulsive symptoms were still clinically elevated in patients with comorbid OCD at discharge, suggesting that these patients need OCD-specific, psychotherapeutic aftercare.
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13
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Dalle Grave R, Dalle Grave A, Bani E, Oliosi A, Conti M, Dametti L, Calugi S. The impact of the COVID-19 pandemic on intensive cognitive behavioral therapy outcomes in patients with anorexia nervosa-A cohort study. Int J Eat Disord 2022; 56:216-224. [PMID: 35751430 PMCID: PMC9349485 DOI: 10.1002/eat.23765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 01/21/2023]
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.
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Affiliation(s)
| | - Anna Dalle Grave
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Elena Bani
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Alessandra Oliosi
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Maddalena Conti
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Laura Dametti
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Simona Calugi
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
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14
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Frostad S, Bentz M. Anorexia nervosa: Outpatient treatment and medical management. World J Psychiatry 2022; 12:558-579. [PMID: 35582333 PMCID: PMC9048449 DOI: 10.5498/wjp.v12.i4.558] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/20/2021] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
Anorexia nervosa (AN) is a disabling, costly and potentially deadly illness. Treatment failure and relapse are common after completing treatment, and a substantial proportion of patients develop severe and enduring AN. The time from AN debut to the treatment initiation is normally unreasonably long. Over the past 20 years there has been empirical support for the efficacy of several treatments for AN. Moreover, outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients. Early intervention improves outcomes and should be a priority for all patients. Outpatient treatment is usually the best format for early intervention, and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable. Inpatient care is more disruptive, more costly, and usually has a longer waiting list than does outpatient care. The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult. The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN. The scientific essentials for outpatient treatment are described, including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated. The following aspects are discussed: early intervention, outpatient treatment of AN, including outpatient psychotherapy for severe and extreme AN, how to determine when outpatient treatment is safe, and when transfer to inpatient healthcare is indicated. Emerging treatments, ethical issues and outstanding research questions are also addressed.
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Affiliation(s)
- Stein Frostad
- Department of Mental Health Research, Division of Psychiatry, Haukeland University Hospital, Bergen 5021, Norway
| | - Mette Bentz
- Child and Adolescent Mental Health Centre, Capital Region of Denmark, University of Copenhagen, Copenhagen 2400, Denmark
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15
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Ayton A, Viljoen D, Ryan S, Ibrahim A, Ford D. Risk, demand, capacity and outcomes in adult specialist eating disorder services in South-East of England before and since COVID-19. BJPsych Bull 2022; 46:89-95. [PMID: 34486966 PMCID: PMC9074142 DOI: 10.1192/bjb.2021.73] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD This is a longitudinal cohort study describing the demand, capacity and outcomes of adult specialist eating disorder in-patient services covering a population of 3.5 million in a South-East England provider collaborative before and since the COVID-19 pandemic, between July 2018 and March 2021. RESULTS There were 351 referrals for admission; 97% were female, 95% had a diagnosis of anorexia nervosa and 19% had a body mass index (BMI) <13. Referrals have increased by 21% since the start of pandemic, coinciding with reduced capacity. Waiting times have increased from 33 to 46 days. There were significant differences in outcomes between providers. A novel, integrated enhanced cognitive behaviour theapy treatment model showed a 25% reduction in length of stay and improved BMI on discharge (50% v. 16% BMI >19), compared with traditional eclectic in-patient treatment. CLINICAL IMPLICATIONS Integrated enhanced cognitive behaviour theapy reduced length of stay and improved outcomes, and can offer more effective use of healthcare resources.
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Affiliation(s)
| | | | | | - Ali Ibrahim
- Berkshire Eating Disorder Service, Berkshire NHS Foundation Trust, UK
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16
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Kolar DR, Meule A, Naab S, Voderholzer U. Early within-person weight gain and variability during inpatient treatment for anorexia nervosa: Age-dependent effects on treatment outcome. EUROPEAN EATING DISORDERS REVIEW 2022; 30:328-340. [PMID: 35297141 DOI: 10.1002/erv.2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Early weight gain during inpatient treatment for anorexia nervosa (AN) is a dynamic process characterised by within-person variability that may be age-dependent. We examined whether age moderates the effect of within-person weight gain and variability on treatment outcome. METHOD Within-person level estimates of N = 2881 underweight adolescents and adults with AN for daily average weight gain (linear slope) and variability (root mean squared errors) were obtained using random-effects modelling. Between-person level regression analyses were calculated to assess effects on weight, eating disorder psychopathology and attaining normal body weight (body mass index [BMI]: 18.5-25 kg/m2 ). RESULTS Higher weight gain during first 2 weeks of inpatient treatment predicted higher weight, lower drive for thinness and lower body dissatisfaction at discharge, but not lower bulimic symptoms. Moreover, it predicted a higher probability of discharge weight within normal range. Younger age was associated with stronger effects of early weight gain on weight, drive for thinness and body dissatisfaction at discharge. Weight variability was not associated with any outcome. CONCLUSIONS Age moderated effects of early weight gain on treatment outcomes, with larger effects for younger patients. Weight variability alone did not influence treatment across age and should be of lesser clinical concern during early inpatient treatment.
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Affiliation(s)
- David R Kolar
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Silke Naab
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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17
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van den Berg E, Schlochtermeier D, Koenders J, de Mooij L, de Jonge M, Goudriaan AE, Blankers M, Peen J, Dekker J. Effectiveness and cost-effectiveness of cognitive behavior therapy-enhanced compared with treatment-as-usual for anorexia nervosa in an inpatient and outpatient routine setting: a consecutive cohort study. J Eat Disord 2022; 10:2. [PMID: 34991730 PMCID: PMC8734258 DOI: 10.1186/s40337-021-00526-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND For anorexia nervosa, firm evidence of the superiority of specialized psychological treatments is limited and economic evaluations of such treatments in real world settings are scarce. This consecutive cohort study examined differential (cost-)effectiveness for adult inpatients and outpatients with anorexia nervosa, after implementing cognitive behavioral therapy-enhanced (CBT-E) throughout a routine setting. METHODS Differences in remission, weight regain and direct eating disorder treatment costs were examined between one cohort (N = 75) receiving treatment-as-usual (TAU) between 2012-2014, and the other (N = 88) CBT-E between 2015-2017. The economic evaluation was performed from a health care perspective with a one-year time horizon, using EDE global score < 2.77, the absence of eating disorder behaviors combined with a BMI ≥ 18.5, as effect measure. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that CBT-E is cost effective compared to TAU. RESULTS Using direct eating disorder treatment costs in the cost-effectiveness analysis, the cost-effectiveness plane of the base case scenario for all patients indicated a 84% likelihood of CBT-E generating better health gain at additional costs. The median ICER is €51,081, indicating a probable preference for CBT-E (> 50% probability of cost-effectiveness) assuming a WTP of €51,081 or more for each additional remission, On remission, no difference was found with 9.3% remission during TAU and 14.6% during CBT-E (p = .304). Weight regain was higher during CBT-E (EMD = 1.33 kg/m2, SE = .29, 95% CI [0.76-1.9], p < .001). CONCLUSIONS In this mixed inpatient and outpatient cohort study, findings indicate a probability of CBT-Ebeing more effective at higher costs. These findings may contribute to the knowledge of effectiveness and cost-effectiveness of specialized psychological treatments. In this study, the effectiveness and treatment costs of a specialized psychological treatment for adult clients with anorexia nervosa were compared with a regular, non-specialist treatment. One group of inpatients and outpatients did receive non-specialist treatment, the next group of inpatients and outpatients received CBT-E, a specialized treatment, later on. CBT-E is recommended for clients with bulimia and with binge eating disorder, for clients with anorexia nervosa it is less clear which specialized psychological treatment should be recommended. Results indicate that at end-of-treatment, CBT-E was not superior on remission. When looking at weight regain, CBT-E seemed superior than the treatment offered earlier. Economic evaluation suggests that CBT-E generates better health gain, but at additional costs. This study contributes to the knowledge on the effectiveness and treatment costs of psychological treatments, as they are offered in routine practice, to adults with anorexia nervosa.
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Affiliation(s)
- Elske van den Berg
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands.
| | - Daniela Schlochtermeier
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands
| | - Jitske Koenders
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands
| | - Liselotte de Mooij
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands.,Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Margo de Jonge
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands.,Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands.,Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Jaap Peen
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.,Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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18
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Dalle Grave R, Dametti L, Conti M, Bersan C, Dalle Grave A, Calugi S. Day-hospital enhanced cognitive behavior therapy for adults with eating disorders: Immediate and follow-up effects. Int J Eat Disord 2022; 55:125-130. [PMID: 34687248 DOI: 10.1002/eat.23632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess outcomes in adult patients with eating disorders administered enhanced cognitive behavioral therapy (CBT-E) in a day-hospital setting. METHOD Forty-three consecutive patients with eating disorders (86% females; mean age 28.8 [SD = 11.8]) were admitted to a 13-week day-hospital CBT-E program. Twenty-five (58.1%) patients were underweight (i.e., body mass index [BMI] <18.5 kg/m2 ; BMI 15.4 [SD = 2.2]) and 18 not (mean BMI 23.1 [SD = 6.3]) at baseline. All patients responded poorly to prior outpatient treatment. Body mass index and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at baseline, end of treatment, and 20-week follow-up. RESULTS In 37 patients (86.0%) who completed the treatment, there were substantial improvements in eating-disorder features, general psychopathology, clinical impairment, and body weight (only in underweight patients), which were well maintained at follow-up. DISCUSSION Day-hospital CBT-E is a promising treatment for adults with eating disorders.
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Affiliation(s)
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Chiara Bersan
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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19
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Peters K, Meule A, Voderholzer U, Rauh E. Effects of interval-based inpatient treatment for anorexia nervosa: An observational study. Brain Behav 2021; 11:e2362. [PMID: 34543514 PMCID: PMC8613410 DOI: 10.1002/brb3.2362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/24/2021] [Accepted: 09/02/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE After inpatient treatment for anorexia nervosa (AN), many patients relapse and need to be readmitted. To obtain a sustained improvement, a pre-planned multistep inpatient procedure might help to improve the patient's skills in dealing with symptoms and transdiagnostic problems, thus decreasing symptoms of AN. However, no data have been reported for such interval treatment yet. Therefore, this study examined effects of interval treatment in inpatients with AN. METHOD Data of adult women with AN (N = 304) who received inpatient treatment and either received interval treatment (n = 179) or not (n = 125) were analyzed. Of these, 225 patients completed a follow up measurement after an average of 25 months. Treatment outcome variables were body mass index and subscales of the Eating Disorder Inventory-2 at admission, discharge, and follow up. RESULTS Across measurements, the interval treatment group had larger increases in body mass index and larger decreases in drive for thinness and binge/purge symptoms than the no interval treatment group. These differences did not seem to be driven by longer treatment duration. DISCUSSION Our data suggest that interval treatment for AN is effective and may even be superior to conventional single inpatient treatment. Given the observational nature of this study, however, controlled studies are necessary to corroborate these findings.
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Affiliation(s)
- Kathrin Peters
- Schoen Clinic Bad Staffelstein, Bad Staffelstein, Germany.,Department of Pathopsychology, University of Bamberg, Bamberg, Germany
| | - Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| | - Elisabeth Rauh
- Schoen Clinic Bad Staffelstein, Bad Staffelstein, Germany
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20
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Calugi S, Dametti L, Chimini M, Dalle Grave A, Dalle Grave R. Change in eating-disorder psychopathology network structure in patients with anorexia nervosa treated with intensive cognitive behavior therapy. Int J Eat Disord 2021; 54:1800-1809. [PMID: 34331465 DOI: 10.1002/eat.23590] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study was designed to compare the change in eating-disorder feature networks in patients with anorexia nervosa after treatment with intensive enhanced cognitive behavior therapy (CBT-E). METHODS Patients seeking treatment for anorexia nervosa were consecutively recruited from January 2016 to September 2020. All patients aged ≥16 years who completed a 20-week intensive CBT-E program (13 weeks of inpatient followed by 7 weeks of day-hospital treatment) were included in the study. Body mass index (BMI) was measured, and the Eating Disorder Examination Questionnaire completed for each patient, both at baseline and the end of treatment. RESULTS The sample comprised 214 patients with anorexia nervosa. Treated patients showed significant improvements in BMI and eating-disorder psychopathology. Network analysis revealed a significant reduction in the network global and connection strengths at the end of treatment. The most central and highly interconnected nodes in the network at baseline were related to the drive for thinness, but at the end of treatment to body image concerns. Some edge connections were significantly stronger at baseline than at the end of treatment, while others were significantly stronger at the end of treatment than at baseline. DISCUSSION CBT-E reduces the psychopathology network connectivity over time in patients with anorexia nervosa. The differences in central nodes and edge connections between baseline and end of treatment, not detected by classical inferential analysis, may be informative for understanding the centrality of symptoms in the psychopathology network, and how a specific treatment may act to reduce symptoms and change their connections over time.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Laura Dametti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Mirko Chimini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Anna Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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21
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Herpertz-Dahlmann B. Intensive Treatments in Adolescent Anorexia Nervosa. Nutrients 2021; 13:1265. [PMID: 33924294 PMCID: PMC8068891 DOI: 10.3390/nu13041265] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 12/26/2022] Open
Abstract
Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
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22
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Baudinet J, Simic M. Adolescent Eating Disorder Day Programme Treatment Models and Outcomes: A Systematic Scoping Review. Front Psychiatry 2021; 12:652604. [PMID: 33995149 PMCID: PMC8116630 DOI: 10.3389/fpsyt.2021.652604] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Adolescent eating disorder day programmes (DP), or partial hospitalization programs, are becoming increasingly widespread worldwide. They typically function as an alternative to inpatient care and/or a step up or down in treatment intensity. There has been an increase in the number of publications within the last 5 years investigating DP outcomes. While there are now numerous programmes operating internationally, there is large variability in the content, structure and theoretical underpinnings of each programme. This makes it difficult to compare programme outcomes, and the impact the therapeutic model may have. Aims: To review existing literature on adolescent eating disorder DP treatment models and outcomes. Methods: A systematic scoping review was conducted. Four databases (PsychInfo, EMBASE, Medline, CENTRAL) were searched for relevant peer-reviewed journal articles and book chapters investigating adolescent eating disorder DPs that function as alternatives to inpatient treatment. No restrictions on study methodology were imposed. Studies were first mapped by location, study characteristics and day programme treatment characteristics, then narratively synthesized. Results: Forty nine studies were included in this review. All used a quantitative methodology. One study also included qualitative methods. The majority of studies included describe DPs in the USA (69%). Seventy-six percent of the studies described DPs that operate 5-days per week and most (57%) either only admit or only report on outcomes for restrictive eating disorders. Two-thirds (69%) reported on DPs that had a family focused treatment model, the remainder had a more integrated treatment model informed mostly by individual psychotherapeutic models. Generally, DP treatment is associated with weight gain and improvements in eating disorder and comorbid psychopathology. The studies that include follow-up data (27%) reveal improvements are usually maintained from 3 months to 2 years post-treatment. Early weight gain, early psychological change and early therapeutic alliance are associated with improved end of treatment outcomes. Findings regarding other potential predictors of outcome are mixed. Conclusions: Current evidence suggests day programmes are an effective alternative to inpatient treatment that lead to sustained improvements. DPs tend to either be young-person-only with a family-focused treatment model or all age with a more integrative model. Controlled, empirical investigations into the impact of the therapeutic model on outcomes are needed, as are investigations into treatment mechanisms and the individual and parent experience of day programme treatment.
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Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, London, United Kingdom.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, United Kingdom
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, London, United Kingdom
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