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Monteleone AM, Abbate-Daga G. Effectiveness and predictors of psychotherapy in eating disorders: state-of-the-art and future directions. Curr Opin Psychiatry 2024; 37:417-423. [PMID: 39146554 DOI: 10.1097/yco.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Psychotherapy is the cornerstone of the multidisciplinary treatment approach for eating disorders. This review examines recent evidence regarding effectiveness, predictors, and mechanisms of change of psychotherapy in eating disorders, providing a road map for clinicians and researchers. RECENT FINDINGS Family-based treatments (FBT) are effective in adolescents with anorexia nervosa and bulimia nervosa. Evidence-based psychotherapies for anorexia nervosa have no evidence of superiority compared with treatment as usual (TAU) in adults with anorexia nervosa. Cognitive-behavioural therapy (CBT) is the first-choice psychotherapy recommended for adults with bulimia nervosa and binge-eating disorder (BED). Self-help interventions have some evidence of effectiveness in nonunderweight individuals with eating disorders. Early symptom improvement and adolescent age predict more favourable outcomes. SUMMARY Evidence-based psychotherapies can be suggested for eating disorders, although follow-up data are needed. Beyond anorexia nervosa, bulimia nervosa, and BED, there is no evidence of psychotherapy effectiveness in other eating disorders. The effectiveness of novel (e.g. 'third-wave') psychotherapies, treatment delivery modality (e.g. internet-delivered), and adjunctive interventions (e.g. virtual reality) needs to be further explored. A broader definition of recovery is recommended, including behavioural, physical, and psychological criteria. Predictors and mechanisms of changes have not been studied enough: quantitative and qualitative studies are needed to promote more tailored and individualized psychotherapy interventions.
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Affiliation(s)
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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2
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Westermair AL, Reiter-Theil S, Wäscher S, Trachsel M. Ethical concerns in caring for persons with anorexia nervosa: content analysis of a series of documentations from ethics consultations. BMC Med Ethics 2024; 25:102. [PMID: 39354548 PMCID: PMC11443878 DOI: 10.1186/s12910-024-01101-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/12/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Caring for patients with anorexia nervosa (AN) is associated with high levels of moral distress among healthcare professionals. The main moral conflict has been posited to be between applying coercion to prevent serious complications such as premature death and accepting treatment refusals. However, empirical evidence on this topic is scarce. METHODS We identified all 19 documentations of ethics consultations (ECs) in the context of AN from one clinical ethics support service in Switzerland. These documentations were coded with a sequential deductive-inductive approach and the code system was interpreted in a case-based manner. Here, we present findings on patient characteristics and ethical concerns. FINDINGS The ECs typically concerned an intensely pretreated, extremely underweight AN patient endangering herself by refusing the proposed treatment. In addition to the justifiability of coercion, frequent ethical concerns were whether further coerced treatment aimed at weight gain would be ineffective or even harmful, evidencing uncertainty about beneficence and non-maleficence and a conflict between these principles. Discussed options included harm reduction (e.g. psychotherapy without weight gain requirements) and palliation (e.g. initiating end-of-life care), the appropriateness of which were ethical concerns in themselves. Overall, nine different types of conflicts between or uncertainties regarding ethical principles were identified with a median of eight per case. CONCLUSIONS Ethical concerns in caring for persons with AN are diverse and complex. To deal with uncertainty about and conflict between respect for autonomy, beneficence and non-maleficence, healthcare professionals consider non-curative approaches. However, currently, uncertainty around general justifiability, eligibility criteria, and concrete protocols hinders their adoption.
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Affiliation(s)
- Anna Lisa Westermair
- Clinical Ethics Unit, University Hospital Basel (USB), University Psychiatric Clinics (UPK) Basel, University Children's Hospital Basel (UKBB), Geriatric University Medicine Felix Platter (UAFP), Spitalstrasse 22, Basel, CH-4031, Switzerland.
- Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich (UZH), Zurich, Switzerland.
| | | | - Sebastian Wäscher
- Institute of Biomedical Ethics and History of Medicine (IBME), University of Zurich (UZH), Zurich, Switzerland
| | - Manuel Trachsel
- Clinical Ethics Unit, University Hospital Basel (USB), University Psychiatric Clinics (UPK) Basel, University Children's Hospital Basel (UKBB), Geriatric University Medicine Felix Platter (UAFP), Spitalstrasse 22, Basel, CH-4031, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
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3
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Petersen JM, Barney JL, Capel LK, Woolley MG, Lensegrav-Benson T, Quakenbush-Roberts B, Twohig MP. Self-compassion and body image inflexibility as mediators of outcomes in a residential eating disorder sample. Eat Disord 2024; 32:369-386. [PMID: 38389388 DOI: 10.1080/10640266.2024.2306440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Eating disorders are serious mental health conditions that are accompanied by negative health outcomes, high mortality rates, impaired functioning, and comorbid mental health conditions. Despite many empirically supported interventions for eating disorders, it remains one of the most challenging mental disorders to treat, as individuals often struggle to maintain treatment gains. One method of improving our understanding of effective eating disorder treatment is to identify important processes of change to target during therapy. The aim of the current study was to test two candidate mediators of disordered eating symptom change during residential treatment: self-compassion and body image inflexibility. In the present study, women and adolescent girls (N = 132) completed a battery of measures, including eating disorder severity, self-compassion, and body image inflexibility, at admission to and discharge from a residential eating disorder facility. Our results indicated that changes in body image inflexibility and self-compassion, specifically self-judgment, were both mediators between ED symptom severity from pre- to post-treatment. These results have potential treatment implications, pointing to the possible importance of targeting body image inflexibility, self-judgment, and self-compassion while treating eating disorders.
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Affiliation(s)
- Julie M Petersen
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Jennifer L Barney
- Department of Psychology, Utah State University, Logan, Utah, USA
- Parkview Behavioral Health Institute - Park Center, Fort Wayne, Indiana, USA
| | - Leila K Capel
- Department of Psychology, Utah State University, Logan, Utah, USA
| | | | | | | | - Michael P Twohig
- Department of Psychology, Utah State University, Logan, Utah, USA
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4
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Waller G, Beard J. Recent Advances in Cognitive-Behavioural Therapy for Eating Disorders (CBT-ED). Curr Psychiatry Rep 2024; 26:351-358. [PMID: 38717658 PMCID: PMC11211111 DOI: 10.1007/s11920-024-01509-0] [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] [Accepted: 04/25/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW Eating disorders require more effective therapies than are currently available. While cognitive behavioural therapy for eating disorders (CBT-ED) has the most evidence to support its effectiveness, it requires substantial improvement in order to enhance its reach and outcomes, and to reduce relapse rates. Recent years have seen a number of noteworthy developments in CBT-ED, which are summarised in this paper. RECENT FINDINGS The key advances identified here include: improvements in the efficiency and availability of CBT-ED; expansion of applicability to younger cases across durations of eating disorder; and new methodologies. There have been important recent advances in the field of CBT-ED. However, it is important to stress that there remain gaps in our evidence base and clinical skills, and suggestions are made for future research and clinical directions.
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Affiliation(s)
- Glenn Waller
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK.
| | - Jessica Beard
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
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5
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Romero-Márquez JM, Novo-Rodríguez M, Novo-Rodríguez C, Siles-Guerrero V, Herrera-Montes I, Navarro-Pelayo FG, López-de-la-Torre-Casares M, Muñoz-Garach A. Bioelectrical Impedance Vector Analysis, Nutritional Ultrasound ®, and Handgrip Strength as Innovative Methods for Monitoring Critical Anorexia Nervosa Physical Recovery: A Pilot Study. Nutrients 2024; 16:1539. [PMID: 38794777 PMCID: PMC11123858 DOI: 10.3390/nu16101539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Eating disorders (EDs) manifest as persistent disruptions in eating habits or related behaviors, significantly impacting physical health and psychosocial well-being. Nutritional assessment in ED patients is crucial for monitoring treatment efficacy. While dual-energy X-ray absorptiometry (DEXA) remains standard, interest in alternative methods such as bioelectrical impedance vector analysis (BIVA) and Nutritional Ultrasound® (NU) has risen due to their affordability and portability. Additionally, hand dynamometry offers a user-friendly approach to assessing grip strength (HGS), indicative of nutritional status. A prospective study was carried out to evaluate the utility of BIVA, NU®, and HGS in 43 female AN patients. Measurements were taken at baseline and hospital discharge. A total of 41 patients completed the study. After the intervention, numerous BIVA-related parameters such as fat (3.5 ± 2 kg vs. 5.3 ± 2.7 kg, p < 0.001) and free fat mass (33.9 ± 3.8 kg vs. 37.5 ± 4.1 kg, p < 0.001) were partially restored. Similarly, Nutritional Ultrasound® showed promising results in assessing body composition changes such as total abdominal fat tissue (0.5 ± 0.3 cm vs. 0.9 ± 0.3 cm, p < 0.05). In the same way, rectus femoris cross-sectional area values correlated with clinical outcomes such as free fat mass (0.883, p < 0.05) and appendicular muscle mass (0.965, p < 0.001). HGS reached the normality percentile after the intervention (21.6 ± 9.1 kg vs. 25.9 ± 12.3 kg, p < 0.05), demonstrating a significant association between grip strength and body composition parameters such as free fat mass (0.658, p < 0.001) and appendicular muscle mass (0.482, p < 0.001). Incorporating BIVA-, NU®-, and HGS-enhanced nutritional assessment into the treatment of AN patients offers cost-effective, portable, and non-invasive alternatives to DEXA. These techniques offer valuable insights into changes in body composition and nutritional status, which, in turn, facilitate treatment monitoring and contribute to improved patient outcomes.
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Affiliation(s)
- Jose M. Romero-Márquez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Foundation for Biosanitary Research of Eastern Andalusia—Alejandro Otero (FIBAO), 18012 Granada, Spain
| | - María Novo-Rodríguez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Foundation for Biosanitary Research of Eastern Andalusia—Alejandro Otero (FIBAO), 18012 Granada, Spain
| | - Cristina Novo-Rodríguez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
| | - Víctor Siles-Guerrero
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
| | - Isabel Herrera-Montes
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
| | | | - Martín López-de-la-Torre-Casares
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
| | - Araceli Muñoz-Garach
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
- Network Biomedical Research Center Physiopathology of Obesity and Nutrition (CiberOBN), Carlos III Health Institute, 28029 Madrid, Spain
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Rząd Z, Rog J, Kajka N, Szewczyk P, Krukow P, Karakuła-Juchnowicz H. The efficacy of transcranial direct current stimulation in the treatment of anorexia nervosa: a randomized double-blind clinical trial. Front Psychiatry 2024; 15:1284675. [PMID: 38757134 PMCID: PMC11096801 DOI: 10.3389/fpsyt.2024.1284675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Background Anorexia nervosa (AN) is a life-threatening disease with a low effectiveness of treatment. The high relapse and mortality rate indicate new treatment approaches are needed. Here, we represent the protocol for randomized clinical trial (RCT) of transcranial direct current stimulation (tDCS) efficiency in the AN treatment. The main purpose of the 3-week RCT is to determine the effect of tDCS on the mental state and advances in nutritional rehabilitation in patients with AN. Methods 50 female inpatients (13-25 years old, body mass index (BMI) 17.5 kg/m2 or less) will be randomly allocated into groups: active (n=25) and sham (n=25) tDCS. Thirty 25-minute tDCS sessions (applied current at 2mA) will be given to DLPFC (F3 anode/F4 cathode) twice a day for 3 weeks on working days parallel to treatment as usual. The primary outcome measures include changes in symptoms related to eating disorders, as assessed by the Eating Attitudes Test (EAT-26), following tDCS sessions over a 3-week trial period. The secondary outcome measures include changes in: brain bioelectric activity, anthropometric measurements, mood, nutritional status, neurocognition, psychological symptoms, selected biological markers related to stress, food intake, inflammation and neurotrophins. Discussion This paper describes the evaluation of a 3-week tDCS-based intervention for AN patients. The study design was developed by a multidisciplinary research team to assess the treatment effect, taking into account various types of variables. This approach could help in better understanding the potential therapeutic tDCS strategy in AN. Clinical trial registration www.ClinicalTrials.gov, identifier NCT05814458.
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Affiliation(s)
- Zuzanna Rząd
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
| | - Joanna Rog
- Laboratory of Human Metabolism Research, Department of Dietetics, Institute of Human Nutrition Science, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Natalia Kajka
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
| | - Paweł Szewczyk
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
| | - Paweł Krukow
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland
| | - Hanna Karakuła-Juchnowicz
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
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Steinglass JE, Fei W, Foerde K, Touzeau C, Ruggiero J, Lloyd C, Attia E, Wang Y, Walsh BT. Change in food choice during acute treatment and the effect on longer-term outcome in patients with anorexia nervosa. Psychol Med 2024; 54:1133-1141. [PMID: 37781904 DOI: 10.1017/s0033291723002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Restriction of food intake is a central pathological feature of anorexia nervosa (AN). Maladaptive eating behavior and, specifically, limited intake of calorie-dense foods are resistant to change and contribute to poor long-term outcomes. This study is a preliminary examination of whether change in food choices during inpatient treatment is related to longer-term clinical course. METHODS Individuals with AN completed a computerized Food Choice Task at the beginning and end of inpatient treatment to determine changes in high-fat and self-controlled food choices. Linear regression and longitudinal analyses tested whether change in task behavior predicted short-term outcome (body mass index [BMI] at discharge) and longer-term outcome (BMI and eating disorder psychopathology). RESULTS Among 88 patients with AN, BMI improved significantly with hospital treatment (p < 0.001), but Food Choice Task outcomes did not change significantly. Change in high-fat and self-controlled choices was not associated with BMI at discharge (r = 0.13, p = 0.22 and r = 0.10, p = 0.39, respectively). An increase in the proportion of high-fat foods selected (β = 0.91, p = 0.02) and a decrease in the use of self-control (β = -1.50, p = 0.001) predicted less decline in BMI over 3 years after discharge. CONCLUSIONS Short-term treatment is associated with improvement in BMI but with no significant change, on average, in choices made in a task known to predict actual eating. However, the degree to which individuals increased high-fat choices during treatment and decreased the use of self-control over food choice were associated with reduced weight loss over the following 3 years, underscoring the need to focus on changing eating behavior in treatment of AN.
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Affiliation(s)
- Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Wenbo Fei
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Karin Foerde
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Caroline Touzeau
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Julia Ruggiero
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Caitlin Lloyd
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Yuanjia Wang
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
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López-Gil JF, Victoria-Montesinos D, Gutiérrez-Espinoza H, Jiménez-López E. Family Meals and Social Eating Behavior and Their Association with Disordered Eating among Spanish Adolescents: The EHDLA Study. Nutrients 2024; 16:951. [PMID: 38612985 PMCID: PMC11013300 DOI: 10.3390/nu16070951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE The aim of this study was to examine the association of family meals and social eating behavior with disordered eating behavior in Spanish adolescents. METHODS This was a cross-sectional study that included 706 adolescents (43.9% boys) from the Eating Habits and Daily Life Activities (EHDLA) study (aged 12 to 17) from Valle de Ricote, Region of Murcia, Spain. The frequency of family meals was assessed by asking participants to report how often their family, or most household members, had shared meals in the past week. Social eating behavior was evaluated using three statements: "I enjoy sitting down with family or friends for a meal", "Having at least one meal a day with others (family or friends) is important to me", and "I usually have dinner with others". To evaluate disordered eating, two psychologists administered the Sick, Control, One, Fat and Food (SCOFF) questionnaire. RESULTS After adjusting for several covariates, for each additional family meal, the likelihood of having disordered eating behavior was lower (odds ratio (OR) = 0.96; 95% confidence interval (CI) 0.93 to 0.9997, p = 0.049). On the other hand, a lower likelihood of having disordered eating behavior was observed for each additional point in the social eating behavior scale (OR = 0.85; 95% CI 0.77 to 0.93, p = 0.001). The likelihood of having disordered eating behavior was 0.7% lower for each additional family meal (95% CI 0.01% to 1.4%, p = 0.046). Furthermore, for each additional point in the social eating behavior scale, a lower probability of having disordered eating behavior was observed (3.2%; 95% CI 1.4% to 5.0%, p < 0.001). CONCLUSIONS While disordered eating behavior is complex and can be shaped by various factors, both family meals and social eating behavior emerge as significant factors inversely associated with this condition among adolescents. Promoting regular engagement in family meals and fostering positive social eating experiences could serve as effective strategies in public health initiatives aimed at mitigating the incidence of disordered eating behavior among the young population.
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Affiliation(s)
- José Francisco López-Gil
- Department of Communication and Education, Universidad Loyola Andalucía, 41704 Seville, Spain;
- One Health Research Group, Universidad de Las Américas, Quito 170124, Ecuador
| | | | | | - Estela Jiménez-López
- Health and Social Research Center, Universidad de Castilla-La Mancha, 16002 Cuenca, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Hebebrand J, Gradl-Dietsch G, Peters T, Correll CU, Haas V. The Diagnosis and Treatment of Anorexia Nervosa in Childhood and Adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:164-174. [PMID: 38170843 DOI: 10.3238/arztebl.m2023.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious disease with a lifetime prevalence of up to 3.6% in women and 0.3% in men. Abnormally low weight and the associated starvation partly account for its somatic and mental manifestations. METHODS This review is based on publications retrieved by a selective search concerning AN in childhood and adolescence. RESULTS The peak age of onset of AN is 15.5 years. The frequency of inpatient treatment for AN rose by 40% during the COVID pandemic, indicating the importance of environmental factors; the heritability of AN is estimated at 0.5. The ICD-11 sets the threshold for AN-associated underweight at the fifth percentile for age of the body mass index, as long as the remaining diagnostic criteria are met. The main goal of the multiprofessional treatment of AN is the return to normal body weight, which is a central prerequisite for regaining somatic and mental health. The mean duration of AN is 3.4 years, and approximately twothirds of patients recover from the disease over the long term. CONCLUSION Marked weight loss in childhood and adolescence can trigger AN in the presence of a predisposition to this disease. Patients and their families should receive psychoeducation regarding the symptoms of starvation and their overlap with those of AN. Important objectives are to shorten the duration of the illness, minimize mortality and the risk of chronic illness, and to identify pharmacological approaches to treatment.
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Affiliation(s)
- Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, LVR-Klinikum Essen, University of Duisburg-Essen; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin; The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; German Center for Mental Health (DZPG), Partner Site Berlin
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10
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Rennick A, Papastavrou Brooks C, Singh Basra R, Startup H, Lavender T, Oldershaw A. Acceptability of Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS): A novel intervention for anorexia nervosa. Int J Eat Disord 2024; 57:611-623. [PMID: 38258350 DOI: 10.1002/eat.24139] [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: 08/17/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Investigate the acceptability of Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS), a novel intervention for anorexia nervosa (AN), conducted as a feasibility trial to provide an initial test of the intervention. METHODS SPEAKS therapy lasting 9-12 months was provided to 34 people with AN or atypical AN by eight specialist eating disorder therapists trained in the model across two NHS Trusts in the UK (Kent and Sussex) during a feasibility trial. All participants were offered a post-therapy interview; sixteen patients and six therapists agreed. All patient participants were adult females. Interviews were semi-structured and asked questions around individuals' experience of SPEAKS, the acceptability of the intervention and of the research methods. Interviews were analyzed using thematic analysis. RESULTS Key areas explored in line with research questions led to 5 overarching themes and 14 subthemes: (1) shift in treatment focus and experience, (2) balancing resources and treatment outcomes, (3) navigating the online treatment environment, (4) therapist adaptation and professional development, and (5) research processes. DISCUSSION SPEAKS was found to be an acceptable intervention for treating AN from the perspective of patients and therapists. The findings provide strong support for delivery of a larger scale randomized control trial. Recommendations for future improvements, particularly pertaining to therapist understanding of the treatment model are detailed, alongside broader clinical implications. PUBLIC SIGNIFICANCE We aimed to evaluate the acceptability of a new anorexia nervosa treatment called SPEAKS. Interviews were conducted with patients and therapists involved in the pilot study and responses were analyzed. Results showed that both patients and therapists found SPEAKS to be an acceptable treatment for anorexia nervosa. The study suggests that SPEAKS meets the criteria for moving forward with a larger trial to assess its effectiveness.
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Affiliation(s)
- Abigail Rennick
- All Age Eating Disorder Service, North East London NHS Foundation Trust, Maidstone, UK
| | - Cat Papastavrou Brooks
- SPIRED Clinic, Sussex Partnership NHS Foundation Trust and Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Helen Startup
- Schema Therapy School, Brighton Psychology Service, Brighton, Sussex, UK
| | - Tony Lavender
- Canterbury Christ Church University, Salomons Institute for Applied Psychology, Tunbridge Wells, UK
| | - Anna Oldershaw
- Canterbury Christ Church University, Salomons Institute for Applied Psychology, Tunbridge Wells, UK
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Oldershaw A, Basra RS, Lavender T, Startup H. Specialist psychotherapy with emotion for anorexia in Kent and Sussex: An intervention development and non-randomised single arm feasibility trial. EUROPEAN EATING DISORDERS REVIEW 2024; 32:215-229. [PMID: 37815048 DOI: 10.1002/erv.3034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/29/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a serious eating disorder treated using psychological interventions, yet outcomes remain limited. Emotional difficulties are recognised as a treatment target. This research programme developed and evaluated feasibility of an emotion-focused therapy for adults with AN. METHODS Phase One intervention development utilised 'intervention mapping'. Qualitative research drew on lived experience highlighting objectives for change. Empirical evidence was synthesised into hypotheses of core emotional difficulties and an associated model of change. Relevant psychotherapeutic theory-based change methods were integrated to form the Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS) intervention, guidebook and clinician training package. Phase Two tested SPEAKS in a single-arm, multisite feasibility trial across two specialist services, utilising prespecified progression criteria, and embedded process evaluation. RESULTS SPEAKS was 9-12 months (40 sessions) of weekly individual psychotherapy, drawing on a range of psychotherapeutic modalities, predominantly Emotion Focused Therapy and Schema Therapy. Forty-six participants consented to feasibility trial participation; 42 entered the trial and 34 completed. Thirteen of 16 feasibility criteria were met at green level and three at amber, highlighting areas for improving model adherence. CONCLUSIONS A randomised controlled trial is indicated. Therapist training and guidebook adjustments to improve model adherence are suggested.
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Affiliation(s)
- Anna Oldershaw
- Salomons Institute for Applied Psychology, Tunbridge Wells, UK
- Kent and Medway All Age Eating Disorders Service, North East London NHS Foundation Trust (NELFT), Maidstone, UK
| | - Randeep Singh Basra
- Kent and Medway All Age Eating Disorders Service, North East London NHS Foundation Trust (NELFT), Maidstone, UK
| | - Tony Lavender
- Salomons Institute for Applied Psychology, Tunbridge Wells, UK
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Halbeisen G, Laskowski N, Brandt G, Waschescio U, Paslakis G. Eating Disorders in Men. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:86-91. [PMID: 38019152 PMCID: PMC11002438 DOI: 10.3238/arztebl.m2023.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Eating disorders are seen mainly as a problem affecting women, not just by the public at large, but also in specialized circles. Although it is true that more women than men suffer from all types of eating disorder, pertinent reviews have clearly shown that they do indeed occur in men, and that the available evidence on the matter is limited. The stigmatization of men with eating disorders makes it harder for these men, and for the relevant professionals, to recognize the symptoms and to seek or provide help. METHODS This review is based on publications retrieved by a selective search in PubMed on the epidemiological, diagnostic, clinical, and therapeutic aspects of eating disorders in men. RESULTS Current estimated lifetime prevalences in men are 0.2% for anorexia nervosa, 0.6% for bulimia nervosa, and 1% for bingeeating disorder; the corresponding figures for women are 1.4%, 1.9%, and 2.8%. Men and women may display different manifestations. Women are thought to be mainly seeking a slim figure and weight reduction; men, a muscular build. The established Germanlanguage screening and diagnostic tools, however, do not cover the types of symptoms that are more common in men. Little is known about whether treatment yields comparable results in men and women. CONCLUSION It is important to combat the stigmati - zation of men with eating disorders and to remove the obstacles to their appropriate diagnosis and treatment. The current methods of screening and diagnosis need to be adapted to take account of the special aspects of abnormal eating behavior in men. It remains unclear whether and how the disorderspecific treatment of these conditions in men should differ from their treatment in women.
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Affiliation(s)
- Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
| | - Nora Laskowski
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
| | - Gerrit Brandt
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
| | | | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum
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Haas V, Wechsung K, Kaiser V, Schmidt J, Raile K, Busjahn A, Le Grange D, Correll CU. Comparing family-based treatment with inpatient treatment in youth with anorexia nervosa eligible for hospitalization: A 12-month feasibility study. Int J Eat Disord 2024; 57:388-399. [PMID: 38082440 DOI: 10.1002/eat.24098] [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: 06/26/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Family-based treatment (FBT) for youth with anorexia nervosa (AN), has not been compared to inpatient, multimodal treatment (IMT). METHOD Prospective, non-randomized pilot feasibility study of adolescents with AN receiving FBT (n = 31), and as a reference point for exploratory outcome comparisons IMT (n = 31), matched for baseline age and percent median BMI (%mBMI). Feasibility of FBT in youth fulfilling criteria for IMT was assessed via study recruitment and retention rates; acceptability via drop-out and caregiver strain; safety via adverse events; preliminary treatment effectiveness between groups was assessed via a change in %mBMI, AN psychopathology (Eating Disorder Examination-Questionnaire, EDE-Q), and hospital days, over 12 months with intent-to-treat, mixed models repeated measures analyses covering post-intervention usual care until 12 months. RESULTS Taking into account that 8 FBT patients (25.8%) crossed over to IMT due to lack of weight gain or psychiatric concerns, FBT and IMT were similarly feasible, acceptable, and safe, apart from more physical antagonism toward others in FBT (p = .010). FBT lasted longer (median [interquartile range, IQR]; 33.6 [17.4, 49.9] vs. 17.3 [14.4, 24] weeks, p < .001), but required fewer hospital days than IMT (median, [IQR], FBT = 1 [0, 16] vs. IMT = 123 [101, 180], p < .001). Baseline comorbidity-adjusted changes over 12 months did not differ between groups in %mBMI (FBT = 12.6 ± 11.9 vs. IMT = 13.7 ± 9.1; p = .702) and EDE-Q global score (median, [IQR]; FBT = -1.2 [-2.3, 0.2] vs. IMT = -1.3 [-2.8, -0.4]; p = .733). DISCUSSION Implementing FBT in this pilot study was feasible, acceptable, and safe for youth eligible for IMT according to German S3 guidelines. Non-inferiority of FBT versus IMT requires confirmation in a sufficiently large multicenter RCT. PUBLIC SIGNIFICANCE This pilot study with 62 adolescent patients with anorexia nervosa demonstrated that for 2/3rd of patients eligible for a long hospitalization in the German health care system, outpatient, Family-based treatment (FBT) was a safe and feasible treatment alternative. Over 12 months, FBT lead to similar weight gain and reduction in eating disorder cognitions as inpatient treatment with fewer hospital days. This pilot study needs to be followed up by a larger, multicenter trial.
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Affiliation(s)
- Verena Haas
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Katja Wechsung
- Center for Social-Pediatric Care/Paediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Vivien Kaiser
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Janine Schmidt
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, USA
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago (Emeritus), Chicago, USA
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- German Center for Mental Health (DZPG), Berlin, Germany
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Solmi M, Monaco F, Højlund M, Monteleone AM, Trott M, Firth J, Carfagno M, Eaton M, De Toffol M, Vergine M, Meneguzzo P, Collantoni E, Gallicchio D, Stubbs B, Girardi A, Busetto P, Favaro A, Carvalho AF, Steinhausen HC, Correll CU. Outcomes in people with eating disorders: a transdiagnostic and disorder-specific systematic review, meta-analysis and multivariable meta-regression analysis. World Psychiatry 2024; 23:124-138. [PMID: 38214616 PMCID: PMC10785991 DOI: 10.1002/wps.21182] [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] [Indexed: 01/13/2024] Open
Abstract
Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta-analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD-defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all-cause and ED-related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow-up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44-49, n=283, mean follow-up: 44.9±62.8 months, no significant ED-group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23-29, n=170, mean follow-up: 59.3±71.2 months, no significant ED-group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2-0.7, n=214, mean follow-up: 72.2±117.7 months, no significant ED-group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person-years (95% CI: 4.4-6.1, n=167, mean follow-up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18-36, n=18, mean follow-up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self-injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio-demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family-based therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self-help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.
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Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Regional Centre for Treatment of Eating Disorders, and On Track: Champlain First Episode Psychosis Program, Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Francesco Monaco
- Department of Mental Health, Local Health Unit, Salerno, Italy
- European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark; Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Mike Trott
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
- Centre for Public Health, Queen's University, Belfast, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Melissa Eaton
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- School of Medical, Indigenous and Health Sciences Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Marco De Toffol
- Department of Mental Health, Local Health Unit, Lecce, Italy
| | | | - Paolo Meneguzzo
- Department of Neuroscience, University of Padua, Padua, Italy
| | | | | | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Anna Girardi
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Paolo Busetto
- Provincial Center for Eating Disorders, Local Health Unit, Treviso, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinic, Zurich, Switzerland
- Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Northwell Health, Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
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Heywood L, Conti J, Touyz S, Madden S, Hay P. Key-in-session identity negotiations in a first line treatment for adult anorexia nervosa. J Eat Disord 2024; 12:20. [PMID: 38297339 PMCID: PMC10832269 DOI: 10.1186/s40337-024-00979-0] [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: 09/02/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Exploration of client identity negotiations during treatment for Anorexia Nervosa (AN) is a relatively new area of research. Research suggests that difficulties with identity negotiations may present as a barrier to treatment. This study sought to explore individuals' identity negotiations during therapy sessions using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN). Analysis focused on moments in therapy where individuals' identities were dominated or defined by AN and where alternative identities could be generated. METHOD 40 in-session transcripts from sessions at early, mid and end points of the CBT-AN (with LEAP) treatment were qualitatively analysed for nine of the 78 participants in the original randomised control trial. Through a constructivist framework, thematic analysis was used to identify surface and latent meanings and discursive material participants used to negotiate their identities in the context of therapy sessions. RESULTS Analysis of in-therapy transcripts generated two themes pertaining to identity negotiations: (1) troubled identities and (2) rebuilding identities and lives outside of AN. Early therapy sessions explored fragmented and AN dominated identities, including how AN was troubling to participants' sense of self, contributed to conflicted identities, positioned them outside of normality, and was associated with isolated and othering identities. Within therapy sessions, participants engaged in a recursive process of shifting relationships with AN and themselves and building identities and lives outside of the AN identity. This included generating hopes for recovery and the future more frequently in mid- to late- therapy sessions. CONCLUSION Identity negotiations evident in the therapeutic conversations aligned with the key components of the CBT-AN intervention, including addressing (1) the characterisation of oneself as 'an anorexic' and (2) the diversification of roles and activities to broaden and enhance self-concepts. Future developments of therapeutic interventions for AN would benefit from greater consideration of ways to assist individuals to more comprehensively address problematic identities, including uncovering identities hidden by the AN identity and generating preferred identities. TRIAL REGISTRATION Ethics approval was obtained at the time of the initial study and for this embedded research by the HREC at the Western Sydney University (HR777332).
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Affiliation(s)
- Lauren Heywood
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Janet Conti
- School of Psychology, Western Sydney University, Sydney, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Stephen Touyz
- Inside Out Institute, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Sloan Madden
- School of Medicine and Heath, University of Sydney, Ramsay Clinic Northside, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
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Marchesi G, Cammisuli DM, Semonella M, Castelnuovo G, Pietrabissa G. The Efficacy of Cognitive Remediation Therapy for Anorexia Nervosa: A Systematic Review of Systematic Reviews. Brain Sci 2024; 14:118. [PMID: 38391693 PMCID: PMC10886621 DOI: 10.3390/brainsci14020118] [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: 12/15/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is an intervention specifically focused on addressing cognitive difficulties associated with the eating disorder. This systematic review of systematic reviews and meta-analysis aimed to provide a summary of the existing literature examining the efficacy of CRT in improving the neuropsychological, psychological, and clinical parameters of patients with AN. METHODS Systematic reviews and meta-analyses were sought in electronic databases, encompassing studies that explored the impact of CRT on AN. Three eligible reviews were identified based on the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was employed to evaluate the methodological quality of the reviews, and all included reviews demonstrated satisfactory methodological quality with an R-AMSTAR score of ≥22. Relevant information was extracted from each review and qualitatively compiled. RESULTS Findings suggest that CRT can help people increase their awareness of cognitive styles and information processing and have a positive effect on patients' responses to treatment. CONCLUSIONS Further research is required to better understand its impact on other relevant outcomes, including psychological variables, to optimize the treatment's benefits.
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Affiliation(s)
- Gloria Marchesi
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
| | | | | | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, 20149 Milan, Italy
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Zielinski-Gussen IM, Herpertz-Dahlmann B, Dahmen B. Involuntary Treatment for Child and Adolescent Anorexia Nervosa-A Narrative Review and Possible Advances to Move Away from Coercion. Healthcare (Basel) 2023; 11:3149. [PMID: 38132039 PMCID: PMC10742854 DOI: 10.3390/healthcare11243149] [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: 10/11/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Children and adolescents with psychiatric disorders frequently experience hospital treatment as coercive. In particular, for patients with severe anorexia nervosa (AN), clinical and ethical challenges often arise if they do not voluntarily agree to hospital admission, often due to the ego-syntonic nature of the disorder. In these cases, involuntary treatment (IVT) might be life-saving. However, coercion can cause patients to experience excruciating feelings of pressure and guilt and might have long-term consequences. METHODS This narrative review aimed to summarize the current empirical findings regarding IVT for child and adolescent AN. Furthermore, it aimed to present alternative treatment programs to find a collaborative method of treatment for young AN patients and their families. RESULTS Empirical data on IVT show that even though no inferiority of IVT has been reported regarding treatment outcomes, involuntary hospital treatment takes longer, and IVT patients seem to struggle significantly more with weight restoration. We argue that more patient- and family-oriented treatment options, such as home treatment, might offer a promising approach to shorten or even avoid involuntary hospital admissions and further IVT. Different home treatment approaches, either aiming at preventing hospitalization or at shortening hospital stays, and the results of pilot studies are summarized in this article.
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Affiliation(s)
- Ingar M. Zielinski-Gussen
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, 52074 Aachen, Germany
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Muroni O, Sudres JL. [Unconditional self-acceptance and self-compassion: another clinic for anorexia nervosa?]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2023; 68:41-44. [PMID: 38070982 DOI: 10.1016/j.soin.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
People suffering from anorexia have a particular emotional and cognitive profile (altered body and self-perception, emotional dysregulation, perfectionism, obsessive traits), which the disorder can compensate for through emotional distancing strategies. Self-compassion and unconditional self-acceptance have been shown to have therapeutic effects on the barriers to recovery associated with this profile.
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Affiliation(s)
- Océane Muroni
- Laboratoire CERPPS EA 7411 (Centre d'études et de recherches en psychopathologie et psychologie de la santé), Université Toulouse 2 Jean-Jaurès, 5 allée Antonio-Machado, 31058 Toulouse, France
| | - Jean-Luc Sudres
- Laboratoire CERPPS EA 7411 (Centre d'études et de recherches en psychopathologie et psychologie de la santé), Université Toulouse 2 Jean-Jaurès, 5 allée Antonio-Machado, 31058 Toulouse, France; Clinique Castelviel, Hôpital de jour L'Oasis, chemin des Affieux, 31180 Castelmaurou, France.
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Gumz A, Reuter L, Löwe B, Voderholzer U, Schwennen B, Fehrs H, Wünsch-Leiteritz W, Brunner R, Kästner D, Zapf A, Weigel A. Factors influencing the duration of untreated illness among patients with anorexia nervosa: A multicenter and multi-informant study. Int J Eat Disord 2023; 56:2315-2327. [PMID: 37814447 DOI: 10.1002/eat.24069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION The duration of untreated illness (DUI), that is, the interval between the onset of anorexia nervosa (AN) symptoms and start of specialized treatments, has a strong influence on the prognosis. OBJECTIVE To quantify modifiable predictors of the DUI and to derive recommendations for secondary prevention strategies. METHODS Within a multicenter, multi-informant study, DUI was assessed in interviews with patients undergoing first specialized AN treatment. Modifiable factors were assessed perspectives of AN-patients, their relatives, and primary care practitioners [PCPs]) with the FABIANA-checklist (Facilitators and barriers in anorexia nervosa treatment initiation). The effect of FABIANA-items on the DUI for each perspective was calculated using Cox Regression (control variables: age, eating disorder pathology, health care status, migration background, body mass index [BMI]). RESULTS We included data from N = 125 female patients with AN (72 adults, 53 adolescents, Mage = 19.2 years, SD = 4.2, MBMI = 15.7 kg/m2 , SD = 1.9), N = 89 relatives (81.8% female, 18.2% male, Mage = 46.0 years, SD = 11.0) and N = 40 PCPs (Mage = 49.7 years, SD = 9.0). Average DUI was 12.0 months. Watching or reading articles about the successful treatment of other individuals with AN (patients' perspective) and regular appointments with a PCP (PCPs' perspective) were related to a shorter DUI (HR = 0.145, p = .046/ HR = 0.395, p = .018). Patients whose relatives rated that PCPs trivialized patients' difficulties had a longer DUI (HR = -0.147, p = .037). PCPs and relatives rated PCPs' competence higher than patients did. DISCUSSION It is recommended (a) to incorporate treatment success stories in prevention strategies, (b) to inform PCPs about potential benefits of regular appointments during the transition to specialized care, and (c) to train PCPs in dealing with patients' complaints. PUBLIC SIGNIFICANCE Many individuals with AN seek treatment very late. Our study shows that a promising approach to facilitate earlier AN treatment is to inform patients about successful treatments of affected peers, to foster regular appointments with a PCP and, to motivate these PCPs to take individuals' with AN difficulties seriously. Thus, our study provides important suggestions for interventions that aim to improve early treatment in AN.
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Affiliation(s)
- Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Laurence Reuter
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Voderholzer
- Schön Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| | | | - Helge Fehrs
- Department of Psychosomatic Medicine and Psychotherapy, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | | | - Romuald Brunner
- Department for Paediatric and Adolescent Medicine, Medical University Center Regensburg, Hamburg, Germany
| | - Denise Kästner
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Pelzer M, Werthmann J, Fleischhaker C, Svaldi J, Tuschen-Caffier B. Mirror Exposure Training for Adolescents With Anorexia Nervosa (MIRADAN): Cognitive Mechanisms of Body Disturbance - A Study Protocol. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e11277. [PMID: 38357429 PMCID: PMC10863679 DOI: 10.32872/cpe.11277] [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: 02/03/2023] [Accepted: 08/28/2023] [Indexed: 02/16/2024] Open
Abstract
Background Anorexia Nervosa (AN) is a severe mental illness, which typically develops in adolescence and, if left untreated, often becomes chronic. Body dissatisfaction is a core characteristic of AN. Mirror exposure (ME) is an effective therapeutic technique to tackle body dissatisfaction in adult patients with eating disorders, but there is limited evidence for the effects of ME in adolescence. One potential mechanism underlying effects of ME on body dissatisfaction is change in body-related attention bias. However, this mechanism remains to be empirically tested. Accordingly, the aim of the current study is twofold: primarily, we aim to test if ME can reduce body dissatisfaction and associated symptoms in adolescent patients with AN. Additionally, we aim to investigate whether change in biased body-related attention due to ME is a possible mechanism of action. Method Adolescent patients with AN are randomized to either 12 sessions of ME (3 ME-sessions/week) or wait-list within four weeks. Main outcomes include body dissatisfaction and associated symptoms of AN. Moreover, body-related attention bias is assessed at baseline and post-treatment by means of eye-tracking with two paradigms. Further, process variables are collected weekly. In addition, 12 weeks after end of the study, the acceptability of the ME is assessed. Discussion The main aim of the study is to evaluate high-frequency and high-intense ME for treating body dissatisfaction in adolescents with AN. In addition, we would like to clarify whether change in attentional bias for body stimuli is a mechanism underlying change in body dissatisfaction due to ME.
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Affiliation(s)
- Maarit Pelzer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Jessica Werthmann
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Freiburg University Hospital, Freiburg, Germany
| | - Jennifer Svaldi
- Faculty of Science, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Brunna Tuschen-Caffier
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
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21
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Lernia DDI, Serino S, Tuena C, Cacciatore C, Polli N, Riva G. Mental health meets computational neuroscience: A predictive Bayesian account of the relationship between interoception and multisensory bodily illusions in anorexia nervosa. Int J Clin Health Psychol 2023; 23:100383. [PMID: 36937547 PMCID: PMC10017360 DOI: 10.1016/j.ijchp.2023.100383] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023] Open
Abstract
Mental health disorders pose a significant challenge to society. The Bayesian perspective on the mind offers unique insights and tools that may help address a variety of mental health conditions. Psychopathological dysfunctions are often connected to altered predictive and active inference processes, in which cognitive and physiological pathogenic beliefs shape the clinical condition and its symptoms. However, there is a lack of general empirical models that integrate cognitive beliefs, physiological experience, and symptoms in healthy and clinical populations. In this study, we examined the relationship between altered predictive mechanisms, interoception, and pathological bodily distortions in healty individuals and in individuals suffering from anorexia nervosa (AN). AN patients (N=15) completed a Virtual Reality Full-Body Illusion along with interoceptive tasks twice: at hospital admission during an acute symptomatological phase (Time 1) and after a 12-week outpatient clinical weight-restoring rehabilitative program (Time 2). Results were compared to a healthy control group. Our findings indicated that higher levels of interoceptive metacognitive awareness were associated with a greater embodiment. However, unlike in healthy participants, AN patients' interoceptive metacognition was linked to embodiment even in multisensory mismatching (asynchronous) conditions. In addition, unlike in healthy participants, higher interoceptive metacognition in AN patients was related to prior abnormal bodily distortions during the acute symptomatology phase. Prediction errors in bodily estimates predicted posterior bodily estimate distortions after the illusion, but while this relationship was only significant in the synchronous condition in healthy participants, there was no significant difference between synchronous and asynchronous conditions in AN patients. Despite the success of the rehabilitation program in restoring some dysfunctional patterns in the AN group, prediction errors and posterior estimate distortions were present at hospital discharge. Our findings suggest that individuals with AN prioritize interoceptive metacognitive processes (i.e., confidence in their own perceived sensations rather than their actual perceptions), disregarding bottom-up bodily inputs in favour of their prior altered top-down beliefs. Moreover, even if the rehabilitative program partially mitigated these alterations, the pathological condition impaired the patients' ability to coherently update their prior erroneous expectations with real-time multisensory bottom-up bodily information, possibly locking the patients in the experience of a distorted prior top-down belief. These results suggest new therapeutic perspectives and introduce the framework of regenerative virtual therapy (RVT), which aims at utilizing technology-based somatic modification techniques to restructure the maladaptive priors underlying a pathological condition.
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Affiliation(s)
- Daniele DI Lernia
- Humane Technology Lab, Università Cattolica del Sacro Cuore di Milano, Italy
| | - Silvia Serino
- Humane Technology Lab, Università Cattolica del Sacro Cuore di Milano, Italy
| | - Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Chiara Cacciatore
- UO di Endocrinologia e Malattie Metaboliche, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicoletta Polli
- UO di Endocrinologia e Malattie Metaboliche, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore di Milano, Italy
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
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22
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Zhu J, Hay PJ, Yang Y, Le Grange D, Lacey JH, Lujic S, Smith C, Touyz S. Specific psychological therapies versus other therapies or no treatment for severe and enduring anorexia nervosa. Cochrane Database Syst Rev 2023; 8:CD011570. [PMID: 37610143 PMCID: PMC10445422 DOI: 10.1002/14651858.cd011570.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Anorexia nervosa is a psychological condition characterised by self-starvation and fear or wait gain or other body image disturbance. The first line of treatment is specific psychological therapy; however, there is no consensus on best practice for treating people who develop severe and enduring anorexia nervosa (SEAN). Notably, there is no universal definition of SEAN. OBJECTIVES To evaluate the benefits and harms of specific psychological therapies for severe and enduring anorexia nervosa compared with other specific therapies, non-specific therapies, no treatment/waiting list, antidepressant medication, dietary counselling alone, or treatment as usual. SEARCH METHODS We used standard, extensive Cochrane search methods. The last search date was 22 July 2022. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs) of people (any age) with anorexia nervosa of at least three years' duration. Eligible experimental interventions were any specific psychological therapy for improved physical and psychological health in anorexia nervosa, conducted in any treatment setting with no restrictions in terms of number of sessions, modality, or duration of therapy. Eligible comparator interventions included any other specific psychological therapy for anorexia nervosa, non-specific psychological therapy for mental health disorders, no treatment or waiting list, antipsychotic treatment (with or without psychological therapy), antidepressant treatment (with or without psychological therapy), dietary counselling, and treatment as usual as defined by the individual trials. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were clinical improvement (weight restoration to within the normal weight range for participant sample) and treatment non-completion. Results were presented using the GRADE appraisal tool. MAIN RESULTS We found two eligible studies, but only one study provided usable data. This was a parallel-group RCT of 63 adults with SEAN who had an illness duration of at least seven years. The trial compared outpatient cognitive behaviour therapy for SEAN (CBT-SEAN) with specialist supportive clinical management for SEAN (SSCM-SE) over eight months. It is unclear if there is any difference between the effect of CBT-SEAN versus SSCM-SE on clinical improvement at 12 months (risk ratio (RR) 1.42, 95% confidence interval (CI) 0.66 to 3.05) or treatment non-completion (RR 1.72, 95% CI 0.45 to 6.59). There were no reported data on adverse effects. The trial was at high risk of performance and detection bias. We rated the GRADE level of evidence as very low-certainty for both primary outcomes, downgrading for imprecision and risk of bias concerns. AUTHORS' CONCLUSIONS This review reports evidence from one trial that evaluated CBT-SEAN versus SSCM-SE. There was very low-certainty evidence of little or no difference in clinical improvement and treatment non-completion between the two therapies. There is a need for larger high-quality trials to determine the benefits of specific psychological therapies for people with SEAN. These should take into account the duration of illness as well as participants' previous experience with evidence-based psychological therapy for anorexia nervosa.
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Affiliation(s)
- James Zhu
- Sydney Local Health District, Sydney, NSW, Australia
| | - Phillipa J Hay
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
- Mental Health Services, WSLHD, Campbelltown, Australia
| | - Yive Yang
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | | | | | - Sanja Lujic
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - Caroline Smith
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Stephen Touyz
- School of Psychology and InsideOut Institute, University of Sydney, Sydney, Australia
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23
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Besse-Flütsch N, Bühlmann C, Fabijani N, Ruschetti GG, Smigielski L, Pauli D. Home treatment as an add-on to family-based treatment for adolescents with anorexia nervosa compared with standard family-based treatment and home-based stress reduction training: study protocol for a randomized clinical trial. J Eat Disord 2023; 11:135. [PMID: 37580810 PMCID: PMC10424408 DOI: 10.1186/s40337-023-00861-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Family-based treatment (FBT) is currently the most effective evidence-based treatment approach for adolescents with anorexia nervosa (AN). Home treatment (HT) as an add-on to FBT (FBT-HT) has been shown to be acceptable, feasible and effective. The described three-arm randomized clinical trial (RCT) is intended to investigate whether FBT-HT demonstrates higher efficacy compared to standard outpatient FBT with supplemental mindfulness-based stress reduction training (FBT-MBSR). METHODS This RCT compares FBT-HT to standard outpatient FBT and FBT-MBSR as a credible home-based control group in terms of efficacy and delivery. Adolescents with AN or atypical AN disorder (n = 90) and their parent(s)/caregiver(s) are to be randomly assigned to either FBT, FBT-HT or FBT-MBSR groups. Eating disorder diagnosis and symptomatology are to be assessed by eating disorder professionals using standardized questionnaires and diagnostic instruments (Eating Disorder Examination, Eating Disorder Inventory, Body Mass Index). In addition, parents and caregivers independently provide information on eating behavior, intrafamily communication, stress experience and weight. The therapeutic process of the three treatments is to be measured and assessed among both participants and care providers. The feasibility, acceptability and appropriateness can thus also be evaluated. DISCUSSION We hypothesize that FBT-HT will be an acceptable, appropriate and feasible intervention and, importantly, will outperform both established FBT and FBT-MBSR in improving adolescent weight and negative eating habits. Secondary outcome measures include the reduction in the stress experienced by caregivers, as well as the regulation of perceived expressed emotions within the family, while the intrafamily relationships are hypothesized to mediate/moderate the effectiveness of FBT. The proposed study has the potential to enhance the scientific and clinical understanding of the efficacy of FBT for AN, including whether the addition of HT to FBT versus another home-based adjunct intervention improves treatment outcomes. Furthermore, the study aligns with public health priorities to optimize the outcomes of evidence-based treatments and integrate the community setting. Trial registration This study is registered at ClinicalTrials.gov (NCT05418075).
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Affiliation(s)
- Nicole Besse-Flütsch
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland.
| | - Claudia Bühlmann
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Natalie Fabijani
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Gian Giacomo Ruschetti
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Lukasz Smigielski
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Dagmar Pauli
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
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Hay P, Mohsin M, Liu L, Touyz S, Meyer C, Arcelus J, Madden S, Attia E, Pike KM, Conti J. Impact of LEAP and CBT-AN Therapy on Improving Outcomes in Women with Anorexia Nervosa. Behav Sci (Basel) 2023; 13:651. [PMID: 37622791 PMCID: PMC10451721 DOI: 10.3390/bs13080651] [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: 05/25/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Anorexia nervosa (AN) is a mental health disorder that has serious physical, emotional and social consequences. Whilst cognitive behavioural therapy for AN (CBT-AN) has demonstrated efficacy, there remains a global need to improve AN treatment. Compulsive exercise activity therapy (LEAP) is an active therapy consisting of the addition to CBT-AN of eight specific sessions that focus on exercise and motivation for behavioural change. This paper presents a secondary analysis of 74 female participants in a randomised control trial of LEAP plus CBT-AN versus CBT-AN alone. The main aim of this study was to explore putative predictors and to estimate the magnitude of changes due to LEAP for specific outcome measures. Participants (LEAP: n = 36; CBT-AN: n = 38) were assessed at three successive surveys: baseline, end of therapy, and 6 months post-therapy. The overall effect sizes for changes between baseline to end of therapy and baseline to 6-month follow-up assessment showed large effect sizes (Cohen's d > = 0.80) for mental-health-related quality of life (MHRQoL), weight concern, dietary restraint, eating concern, AN stage change, and psychological distress (all p < 0.05). The results also indicated that several pre-treatment characteristics, including body mass index (BMI), level of eating disorder (ED) symptoms, and MHRQoL are important for identifying whether a treatment is likely to be effective. Future treatment programs should aim to optimise early improvements in BMI, ED symptoms, and MHRQoL.
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Affiliation(s)
- Phillipa Hay
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Mohammed Mohsin
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Faculty of Medicine & Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Liquan Liu
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW 2560, Australia
| | - Stephen Touyz
- Inside Out Institute, University of Sydney, Sydney, NSW 2006, Australia
| | - Caroline Meyer
- International Digital Laboratory, The University of Warwick, Coventry CV4 7AL, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
- Psychoneurobiology of Eating and Addictive Behaviors Group, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, University of Barcelona, 08908 Barcelona, Spain
| | - Sloane Madden
- The Sydney Children’s Hospitals Network, Westmead, Sydney, NSW 2145, Australia
| | - Evelyn Attia
- The New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA
| | - Kathleen M. Pike
- World Health Organization Collaborating Centre for Capacity Building and Training in Global Mental Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
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25
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Ursumando L, Ponzo V, Monteleone AM, Menghini D, Fucà E, Lazzaro G, Esposito R, Picazio S, Koch G, Zanna V, Vicari S, Costanzo F. The efficacy of non-invasive brain stimulation in the treatment of children and adolescents with Anorexia Nervosa: study protocol of a randomized, double blind, placebo-controlled trial. J Eat Disord 2023; 11:127. [PMID: 37533058 PMCID: PMC10394844 DOI: 10.1186/s40337-023-00852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Current psychological and pharmacological treatments for Anorexia Nervosa (AN) provide only moderate effective support, and there is an urgent need for research to improve therapies, especially in developing age. Non-invasive brain stimulation has suggested to have the potential to reducing AN symptomatology, via targeting brain alterations, such as hyperactivity of right prefrontal cortex (PFC). We suppose that transcranial direct current stimulation (tDCS) to the PFC may be effective in children and adolescents with AN. METHODS We will conduct a randomized, double blind, add-on, placebo-controlled trial to investigate the efficacy of tDCS treatment on clinical improvement. We will also investigate brain mechanisms and biomarkers changes acting in AN after tDCS treatment. Eighty children or adolescent with AN (age range 10-18 years) will undergo treatment-as-usual including psychiatric, nutritional and psychological support, plus tDCS treatment (active or sham) to PFC (F3 anode/F4 cathode), for six weeks, delivered three times a week. Psychological, neurophysiological and physiological measures will be collected at baseline and at the end of treatment. Participants will be followed-up one, three, six months and one year after the end of treatment. Psychological measures will include parent- and self-report questionnaires on AN symptomatology and other psychopathological symptoms. Neurophysiological measures will include transcranial magnetic stimulation (TMS) with electroencephalography and paired pulse TMS and repetitive TMS to investigate changes in PFC connectivity, reactivity and plasticity after treatment. Physiological measures will include changes in the functioning of the endogenous stress response system, body mass index (BMI) and nutritional state. DISCUSSION We expect that tDCS treatment to improve clinical outcome by reducing the symptoms of AN assessed as changes in Eating Disorder Risk composite score of the Eating Disorder Inventory-3. We also expect that at baseline there will be differences between the right and left hemisphere in some electrophysiological measures and that such differences will be reduced after tDCS treatment. Finally, we expect a reduction of endogenous stress response and an improvement in BMI and nutritional status after tDCS treatment. This project would provide scientific foundation for new treatment perspectives in AN in developmental age, as well as insight into brain mechanisms acting in AN and its recovery. Trial registration The study was registered at ClinicalTrials.gov (ID: NCT05674266) and ethical approval for the study was granted by the local research ethics committee (process number 763_OPBG_2014).
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Affiliation(s)
- Luciana Ursumando
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Viviana Ponzo
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Giulia Lazzaro
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Romina Esposito
- Experimental Neuropsychophysiology Lab, IRCCS S. Lucia Foundation, Rome, Italy
| | - Silvia Picazio
- Experimental Neuropsychophysiology Lab, IRCCS S. Lucia Foundation, Rome, Italy
- Department of Psychology, University "Sapienza" of Rome, Rome, Italy
| | - Giacomo Koch
- Experimental Neuropsychophysiology Lab, IRCCS S. Lucia Foundation, Rome, Italy
- Section of Human Phisiology, University of Ferrara, Ferrara, Italy
| | - Valeria Zanna
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
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26
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Goshen D, Stein D, Kurman J, Farbstein D, Enoch-Levy A, Aival-Naveh E, Gur E, Yoeli N, Bretler T, Koren D, Rothschild-Yakar L. The association between deficiencies in paternal and maternal reflective functioning and anorexia nervosa symptomatology. J Eat Disord 2023; 11:116. [PMID: 37434261 DOI: 10.1186/s40337-023-00836-6] [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: 03/04/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND A large theoretical body of knowledge exists emphasizing the importance of parental mentalizing in the context of anorexia-nervosa (AN). However, the empirical support to these assumptions is still scarce. The aim of the present study was to examine whether parents of patients with AN are characterized by a lower mentalizing ability, and whether it is associated with impaired mentalizing, AN symptomatology and eating disorder (ED) related psychological traits in the daughters. METHODS Thirty-two family triads (fathers, mothers, and daughters) of female adolescent and young adult inpatients with AN were compared with thirty-three non-clinical family triads (N = 195). The mentalizing ability of all the participants was assessed using semi-structured interviews and coded using the Reflective Functioning Scale (RFS). Self-report questionnaires were administered to the daughters to evaluate ED symptomatology and ED related psychological traits (e.g., low self-esteem, interpersonal insecurity, emotional dysregulation). RESULTS Decreased reflective functioning (RF) levels were found among mothers and fathers of patients with AN compared to their control peers. Examining the entire sample, clinical and non-clinical groups together, showed that both paternal and maternal RF were associated with the daughters' RF and each were found to have a significant and distinct contribution to the daughters' RF. Significant associations were found between lower levels of maternal and paternal RF and increased ED symptoms and ED related psychological traits. The use of a mediation model suggested a serial relationship in which low maternal and paternal RF contributes to the daughters' low RF, which in turn is associated with higher levels of psychological maladjustment, and ultimately contributes to the increased severity of ED symptoms. CONCLUSIONS The present results provide strong empirical support for theoretical models that suggest that deficits in parental mentalizing may represent important correlates of the presence and severity of ED symptoms in AN. Furthermore, the results highlight the relevance of fathers' mentalizing ability in the context of AN. Finally, clinical and research implications are discussed.
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Affiliation(s)
- Dor Goshen
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel.
| | - Daniel Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Jenny Kurman
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Dan Farbstein
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Erez Aival-Naveh
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Eitan Gur
- Center for the Treatment of Eating Disorders and Obesity, Sheba Medical Center, Tel Hashomer, Israel
| | - Neta Yoeli
- Ziv Medical Center, Zfat, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Poriya, Israel
| | - Tali Bretler
- Ziv Medical Center, Zfat, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Poriya, Israel
| | - Danny Koren
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
- Psychiatry Division, Rambam Medical Center, Haifa, Israel
| | - Lily Rothschild-Yakar
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
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Chovel Sella A, Hadaway N, Stern C, Becker KR, Holsen LM, Eddy KT, Micali N, Misra M, Thomas JJ, Lawson EA. Lower Ghrelin Levels Are Associated With Higher Anxiety Symptoms in Adolescents and Young Adults With Avoidant/Restrictive Food Intake Disorder. J Clin Psychiatry 2023; 84:22m14482. [PMID: 37134126 PMCID: PMC10336648 DOI: 10.4088/jcp.22m14482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Objective: Avoidant/restrictive food intake disorder (ARFID) is associated with increased risk for anxiety, which may adversely affect prognosis. The appetite-stimulating hormone, ghrelin, increases in response to stress, and exogenous ghrelin decreases anxiety-like behaviors in animal models. The aim of this study was to evaluate the relationship between ghrelin levels and measures of anxiety in youth with ARFID. We hypothesized that lower ghrelin levels would be associated with increased anxiety symptoms. Methods: We studied a cross-sectional sample of 80 subjects with full and subthreshold ARFID diagnosed by DSM-5 criteria, aged 10-23 years (female, n = 39; male, n = 41). Subjects were enrolled in a study of the neurobiology of avoidant/restrictive eating conducted from August 2016 to January 2021. We assessed fasting ghrelin levels and anxiety symptoms (State-Trait Anxiety Inventory [STAI] and STAI for Children [STAI-C] measuring general trait anxiety; Beck Anxiety Inventory [BAI] and BAI for youth [BAI-Y] assessing cognitive, emotional, and somatic symptoms of anxiety; and Liebowitz Social Anxiety Scale [LSAS] assessing symptoms of social anxiety). Results: Consistent with our hypothesis, ghrelin levels were inversely associated with anxiety symptoms as assessed by STAI/STAI-C T scores (r = -0.28, P = .012), BAI/BAI-Y T scores (r = -0.28, P = .010), and LSAS scores (r = -0.3, P = .027), all with medium effect sizes. Findings held in the full threshold ARFID group when adjusting for body mass index z scores (STAI/STAI-C T scores, β = -0.27, P = .024; BAI/BAI-Y T scores, β = -0.26, P = .034; LSAS, β = -0.34, P = .024). Conclusions: These findings demonstrate that lower levels of ghrelin are associated with more severe anxiety symptoms in youth with ARFID and raise the question of whether ghrelin pathways could be targeted in the treatment of ARFID.
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Affiliation(s)
- Aluma Chovel Sella
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Division of Pediatric Endocrinology, Mass General for Children, Massachusetts General Hospital, Boston, Massachusetts
| | - Natalia Hadaway
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Casey Stern
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Laura M Holsen
- Division of Women's Health, Department of Medicine and Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Nadia Micali
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Department of Pediatrics Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Division of Pediatric Endocrinology, Mass General for Children, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Indicates shared senior authorship
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Indicates shared senior authorship
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Corresponding author: Elizabeth A. Lawson, MD, MMSc, Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
- Indicates shared senior authorship
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Brockmeyer T, Titzmann M, Zipfel S, Wild B, Resmark G, Teufel M, Giel K, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, Rothermund E, Zeeck A, Herzog W, Friederich HC. The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa. Behav Res Ther 2023; 163:104285. [PMID: 36913844 DOI: 10.1016/j.brat.2023.104285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms 'clarification' (insight), 'mastery' (coping), and 'therapeutic relationship' were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.
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Affiliation(s)
- Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany; Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Marieke Titzmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Beate Wild
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital, Essen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department for Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital and University Hospital Muenster, Muenster, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- Faculty of Social Sciences, TH Köln-University of Applied Sciences, Köln, Germany
| | - Eva Rothermund
- Ulm University Medical Center, Department of Psychosomatic Medicine and Psychotherapy, Ulm, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Herzog
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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29
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Stalujanis E, Zeeck A, Euler S. Mentalisieren und Mentalisierungsbasierte Therapie (MBT) bei Essstörungen. PDP - PSYCHODYNAMISCHE PSYCHOTHERAPIE 2023. [DOI: 10.21706/pdp-22-1-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Downs J, Ayton A, Collins L, Baker S, Missen H, Ibrahim A. Untreatable or unable to treat? Creating more effective and accessible treatment for long-standing and severe eating disorders. Lancet Psychiatry 2023; 10:146-154. [PMID: 36697122 DOI: 10.1016/s2215-0366(22)00400-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 01/25/2023]
Abstract
The evidence base for the treatment of severe eating disorders is limited. In addition to improving access to early intervention, there is a need to develop more effective treatments for complex presentations of eating disorders. For patients with long-standing and severe illnesses, particular difficulties might exist with their engagement with treatment and achieving treatment outcomes. Alarmingly, there is an emerging international discourse about a concept labelled as terminal anorexia and about the withdrawal of treatment for people with severe eating disorders, resulting in the death of patients, as a legitimate option. This concept has arisen in the context of vastly overstretched specialist services and insufficient research and funding for new treatments. This Personal View combines multiple perspectives from carers, patients, and mental health professionals based in the UK, highlighting how the risks of current service provision are best alleviated by increasing resources, capacity, and training, and not by a narrowing of the criteria according to which patients with eating disorders are offered the care and support they need.
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Affiliation(s)
- James Downs
- Royal College of Psychiatrists, London, UK; Faculty of Wellbeing, Education, and Language Studies, Open University, Milton Keynes, UK.
| | - Agnes Ayton
- Department of Psychiatry, Oxford University, Oxford, UK
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31
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Schaper R, Nowotny C, Michalek S, Schmidt U, Brockmeyer T. Language style matching and treatment outcome in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023; 31:110-120. [PMID: 35962959 DOI: 10.1002/erv.2943] [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: 08/03/2021] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Psychotherapy is the treatment of choice for anorexia nervosa (AN) but mechanisms of action are still largely unknown. Growing research suggests that synchrony between patient and therapist contributes to treatment success. Adding to this literature, this study examined the association between language style matching (LSM) among patient and therapist as an indicator of interpersonal (verbal) synchrony and treatment outcome in AN. METHOD Audio recordings of mid-treatment therapy sessions (n = 25) in a multi-centre randomized controlled trial on the Maudsley Model of Anorexia Nervosa Treatment for Adults were transcribed and used to calculate LSM for each patient-therapist dyad. These scores were used to predict treatment outcome at 12-month follow-up. RESULTS LSM did not predict body mass index (primary outcome) at follow-up. However, higher LSM (M = 0.87, SD = 0.04) was associated with lower eating disorder psychopathology (accounting for 11% of the variance) and higher recovery rates (accounting for 28% of variance) at follow-up. CONCLUSIONS These preliminary findings suggest that verbal synchrony between patients with AN and their therapists contributes to favourable treatment outcomes. High levels of LSM may reflect therapeutic empathy, cooperation, or mutual positive perception. Further research should explore the mechanisms of linguistic synchrony with larger samples to allow for stronger conclusions.
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Affiliation(s)
- Rachel Schaper
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Christina Nowotny
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Silke Michalek
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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32
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Abstract
Anorexia nervosa is a disorder associated with serious adverse health outcomes, for which there is currently considerable treatment ineffectiveness. Characterised by restrictive eating behaviours, distorted body image perceptions and excessive physical activity, there is growing recognition anorexia nervosa is associated with underlying dysfunction in excitatory and inhibitory neurometabolite metabolism and signalling. This narrative review critically explores the role of N-methyl-D-aspartate receptor-mediated excitatory and inhibitory neurometabolite dysfunction in anorexia nervosa and its associated biomarkers. The existing magnetic resonance spectroscopy literature in anorexia nervosa is reviewed and we outline the brain region-specific neurometabolite changes that have been reported and their connection to anorexia nervosa psychopathology. Considering the proposed role of dysfunctional neurotransmission in anorexia nervosa, the potential utility of zinc supplementation and sub-anaesthetic doses of ketamine in normalising this is discussed with reference to previous research in anorexia nervosa and other neuropsychiatric conditions. The rationale for future research to investigate the combined use of low-dose ketamine and zinc supplementation to potentially extend the therapeutic benefits in anorexia nervosa is subsequently explored and promising biological markers for assessing and potentially predicting treatment response are outlined.
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33
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Meier AF, Zeeck A, Taubner S, Gablonski T, Lau I, Preiter R, Gläser H, Zipfel S, Herzog W, Wild B, Friederich HC, Resmark G, Giel K, Teufel M, Burgmer M, Dinkel A, Herpertz S, Löwe B, Tagay S, von Wietersheim J, De Zwaan M, Hartmann A. Mentalization-enhancing therapeutic interventions in the psychotherapy of anorexia nervosa: An analysis of use and influence on patients’ mentalizing capacity. Psychother Res 2022; 33:595-607. [DOI: 10.1080/10503307.2022.2146542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alexander Ferdinand Meier
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Svenja Taubner
- Institute for Psychosocial Prevention, Center for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Thorsten Gablonski
- Department for Psychology, Psychotherapy and Psychoanalysis, Institute for Psychology, University of Klagenfurth, Klagenfurth, Austria
| | - Inga Lau
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Romi Preiter
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Hannes Gläser
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR Universityhospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, LWL-Hospital Muenster and University Hospital Muenster, Muenster, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr-University Bochum, Bochum, Germany
| | - Bernd Löwe
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- TH Köln, University of Applied Sciences, Köln, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Martina De Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Armin Hartmann
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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34
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Kaa BS, Bünemann JMN, Clausen L. A benchmark study of a combined individual and group anorexia nervosa therapy program. Nord J Psychiatry 2022:1-8. [PMID: 36398931 DOI: 10.1080/08039488.2022.2143558] [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] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a treatment-resistant illness. Up to half of the patients show limited or no significant treatment response. First, we aimed to describe a new stepped-care outpatient treatment combining group and individual therapy (CIGAN) with a strong focus on normalizing eating and weight and in vivo meal support for adults with moderate to severe AN. Second, we aimed to compare CIGAN with specialized treatments of Specialized Supportive Clinical Management (SSCM) and the Maudsley model of AN (MANTRA). METHOD The study includes 137 adults with moderate to severe AN and the primary outcome (BMI) at six and twelve months was compared with the outcomes published for SSCM and MANTRA using the Chi-squared test and Student's t-test. The paired t-test and Cohen's d were used to compare the within-group follow-up data with the baseline data. RESULTS CIGAN patients changed significantly on all outcome measures at 6 and 12 months, with effect sizes on BMI of 1.37 and 1.51 and on the weight of 1.36 and 1.60, respectively. Except for the 12-month comparison with MANTRA, patients had a higher BMI and larger BMI increase at both 6 and 12 months than SSCM (BMI p = 0.002 and 0.023, BMI increase p < 0.001 and 0.003) and MANTRA (BMI p = 0.031 and 0.168, BMI increase p < 0.001 and 0.037). DISCUSSION CIGAN, including a stepped care approach, is a promising treatment, and further research on the effective elements is warranted.
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Affiliation(s)
- Bo Skytte Kaa
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Loa Clausen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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35
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Monteleone AM, Pellegrino F, Croatto G, Carfagno M, Hilbert A, Treasure J, Wade T, Bulik CM, Zipfel S, Hay P, Schmidt U, Castellini G, Favaro A, Fernandez-Aranda F, Il Shin J, Voderholzer U, Ricca V, Moretti D, Busatta D, Abbate-Daga G, Ciullini F, Cascino G, Monaco F, Correll CU, Solmi M. Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses. Neurosci Biobehav Rev 2022; 142:104857. [PMID: 36084848 PMCID: PMC9813802 DOI: 10.1016/j.neubiorev.2022.104857] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/27/2022] [Accepted: 09/02/2022] [Indexed: 02/07/2023]
Abstract
MONTELEONE, A.M., F. Pellegrino, G. Croatto, M. Carfagno, A. Hilbert, J. Treasure, T. Wade, C. Bulik, S. Zipfel, P. Hay, U. Schmidt, G. Castellini, A. Favaro, F. Fernandez-Aranda, J. Il Shin, U. Voderholzer, V. Ricca, D. Moretti, D. Busatta, G. Abbate-Daga, F. Ciullini, G. Cascino, F. Monaco, C.U. Correll and M. Solmi. Treatment of Eating Disorders: a systematic meta-review of meta-analyses and network meta-analyses. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2022.- Treatment efficacy for eating disorders (EDs) is modest and guidelines differ. We summarized findings/quality of (network) meta-analyses (N)MA of randomized controlled trials (RCTs) in EDs. Systematic meta-review ((N)MA of RCTs, ED, active/inactive control), using (anorexia or bulimia or eating disorder) AND (meta-analy*) in PubMed/PsycINFO/Cochrane database up to December 15th, 2020. Standardized mean difference, odds/risk ratio vs control were summarized at end of treatment and follow-up. Interventions involving family (family-based therapy, FBT) outperformed active control in adults/adolescents with anorexia nervosa (AN), and in adolescents with bulimia nervosa (BN). In adults with BN, individual cognitive behavioural therapy (CBT)-ED had the broadest efficacy versus active control; also, antidepressants outperformed active. In mixed age groups with binge-eating disorder (BED), psychotherapy, and lisdexamfetamine outperformed active control. Antidepressants, stimulants outperformed placebo, despite lower acceptability, as did CBT-ED versus waitlist/no treatment. Family-based therapy is effective in AN and BN (adolescents). CBT-ED has the largest efficacy in BN (adults), followed by antidepressants, as well as psychotherapy in BED (mixed). Medications have short-term efficacy in BED (adults).
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Affiliation(s)
| | | | | | - Marco Carfagno
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Tracey Wade
- Flinders Institute for Mental Health and Well-Being, the Blackbird Initiative, Flinders University, South Australia, Australia
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tuebingen, Germany; Centre of Excellence for Eating Disorders Tuebingen (KOMET), Germany
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Australia
| | - Ulrike Schmidt
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Angela Favaro
- Neurosciences Department, University of Padua, Padua, Italy
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL and CIBERobn, ISCIII, Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Clinic for Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany; Clinic for Psychiatry and Psychotherapy, University Hospital of Munich, Munich, Germany
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Davide Moretti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Daniele Busatta
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Filippo Ciullini
- Department of General Psychology, University of Padova, Padova, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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36
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Haas V, Nadler J, Crosby RD, Madden S, Kohn M, Le Grange D, Gonçalves ASO, Hebebrand J, Correll CU. Comparing randomized controlled trials of outpatient family-based or inpatient multimodal treatment followed by outpatient care in youth with anorexia nervosa: Differences in populations, metrics, and outcomes. EUROPEAN EATING DISORDERS REVIEW 2022; 30:693-705. [PMID: 35474627 DOI: 10.1002/erv.2907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Various approaches exist to treat youth with anorexia nervosa (AN). Family-based treatment (FBT) has never been compared to long inpatient, multimodal treatment (IMT) in a randomized controlled trial (RCT). The aim of this study was to compare data on body weight trajectories, change in eating disorder psychopathology, hospital days and treatment costs in RCTs delivering FBT or IMT. METHOD Review of RCTs published between 2010 and 2020 in youth with AN, delivering FBT or IMT. RESULTS Four RCTs delivering FBT (United States, n = 2; Australia, n = 2), one RCT delivering Family Therapy for AN (United Kingdom) and two RCTs delivering IMT (France, n = 1; Germany, n = 1) were identified from previous meta-analyses. The comparison of studies was limited by (1) significant differences in patient baseline characteristics including pretreated versus non-pretreated patients, (2) use of different psychometric and weight measures and (3) different initial velocity of weight recovery. Minimal baseline and outcome reporting standards for body weight metrics and nature/dose of interventions allowing international comparison are needed and suggestions to developing these standards are presented. DISCUSSION An RCT should investigate, whether FBT is a viable alternative to IMT, leading to comparable weight and psychopathology improvement with less inpatient time and costs.
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Affiliation(s)
- Verena Haas
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Janine Nadler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | | | - Michael Kohn
- Department of Adolescent and Young Adult Medicine, Centre for Research into Adolescent'S Health, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Ana Sofia Oliveira Gonçalves
- Institute of Public Health, Charité - Universitätsmedizin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph U Correll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA
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37
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Radden J. Capturing the anorexia nervosa phenotype: Conceptual and normative issues in ICD-11. J Eval Clin Pract 2022; 28:807-813. [PMID: 34121277 DOI: 10.1111/jep.13586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION ICD-11's diagnostic definition possesses conceptual lacunae and normative implications calling for further attention. METHOD Assumptions underlying it and their ethical implications, are examined employing philosophical analysis; particularly, these are (1) changes to eliminate implications of voluntary agency to caloric restriction; (2) definitions of "dangerously low weight;" and (3) disorder boundaries as stated in qualifications and exclusions. RESULTS (1) The extent to which AN behaviour can be acknowledged to be driven by forces out of, or limiting, voluntary control is unresolved; this is illustrated using the contested part played by excessive exercise, clarification of which requires understanding of AN motivation. (2) AN's uncertain aetiology leaves doubt over the sub-threshold state. This affects not only when treatment is appropriate, but how definitions of morbidly low body weight are determined, putting individuals with prodromal symptoms at the social risks associated with "medicalizing" normal variation. Concluded here is not that ICD-11's conservative definition is mistaken but that since false positives are common, they must be factored into the complex cost-risk assessments involved. (3) ICD-11 efforts to minimize reliance on subjective motivation reveal limitations in exclusion criteria. Were AN motivation itself better understood, it would be possible to deal with non-anorexic motivation by exclusion. But the history of "fat fears" illustrates that uncertainty attaches to interpretations of AN motivation. Neither AN motivation nor cultural norms around other forms of self-starvation admit of clear characterization, leaving an impasse. DISCUSSION At least with present day medical and scientific knowledge, a complete characterization of the AN phenotype cannot be achieved without reference to psychological states of motivation. And more research, not only clinical, genetic and neurobiological but also conceptual and ethical, will be required to resolve the challenges presented by AN.
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Affiliation(s)
- Jennifer Radden
- Philosophy Department, University of Massachusetts Boston, Boston, Massachusetts, USA
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Heywood L, Conti J, Hay P. Paper 1: a systematic synthesis of narrative therapy treatment components for the treatment of eating disorders. J Eat Disord 2022; 10:137. [PMID: 36076272 PMCID: PMC9461296 DOI: 10.1186/s40337-022-00635-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are presently a number of eating disorder treatment interventions that have a research-evidence base to support their effectiveness. However, rates of attrition and treatment outcomes demonstrate that there is no one-size fits all for the treatment of eating disorders. Narrative therapy is a promising, but under-researched, intervention for the treatment of eating disorders (EDs). The aim of this study was to conduct a narrative synthesis of the literature to explore the content and use of narrative therapy in the treatment of EDs. METHOD Data were extracted from 33 eligible included studies following systematic search of five data bases. Data included aims and objectives, sample characteristics, treatment details and components of narrative therapy, which informed the narrative synthesis. The study is reported according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Narrative therapy interventions for EDs consisted of several components including the narrative worldview; unpacking the problem story; finding, thickening the meaning and performance of stories hidden by the problem story; and safety considerations. A notable proportion of the extracted articles discussed components of unpacking problem stories, and finding and re-authoring openings (or unique outcomes) that were hidden by problematic stories. Relatively fewer papers discussed the processes by identity shifts were performed or lived out, including in the eating practices of those with a lived ED experience. Furthermore, few papers addressed how therapists established client safety within the narrative framework when working with EDs. CONCLUSION This narrative synthesis found that narrative practitioners utilise a variety of narrative therapy techniques in working with individuals with a lived ED experience. The current literature has emphasis on specific narrative therapy techniques used in ED treatments, with some aspects of the narrative worldview and safety considerations left undiscussed. Additional research is needed to explore how identity shifts in narrative therapy are performed and lead to measurable behavioural changes, and to consider how safety considerations can be established within the narrative worldview. There are a number of psychological therapies for eating disorders that have research evidence-base. These treatments, however, do not work for everyone as indicated by drop-out rates and eating disorders running a severe and enduring course for some people. Narrative therapy is a therapeutic intervention that has been reported as a promising intervention for people with an eating disorder. The focus of narrative therapy is to engage the person in finding identities hidden by problem-saturated identities and in the performance of these hidden identities. In this review, we have explored the use of narrative therapy for eating disorders to identify what aspects of this therapy are currently being used and which components are less referenced in the literature. Findings from this study support the need for further research into narrative therapy components in the treatment of eating disorders, particularly how hidden identities are performed and safety considerations are integrated into this therapeutic intervention.
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Affiliation(s)
- Lauren Heywood
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Janet Conti
- School of Psychology, Western Sydney University, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
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Clark Bryan D, Macdonald P, Cardi V, Rowlands K, Ambwani S, Arcelus J, Bonin EM, Landau S, Schmidt U, Treasure J. Transitions from intensive eating disorder treatment settings: qualitative investigation of the experiences and needs of adults with anorexia nervosa and their carers. BJPsych Open 2022; 8:e137. [PMID: 35856250 PMCID: PMC9347315 DOI: 10.1192/bjo.2022.535] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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
BACKGROUND Relapse rates for individuals with anorexia nervosa after intensive hospital treatment (in-patient or full-time day care) are high. Better knowledge about the difficulties and opportunities that arise during this transition is needed to identify factors that support or hinder continued recovery upon discharge. AIMS The aim of this study was to explore the experiences of adult patients and their chosen carers on the process of transitioning from intensive eating disorder treatment settings to the community. METHOD Semi-structured interviews were conducted with patients with anorexia nervosa (n = 11) discharged from day or in-patient care from specialised eating disorder units across the UK, and their chosen carers (n = 20). Data were analysed with inductive thematic analysis. RESULTS Four interrelated themes were identified for both groups. For patients, themes were continuity of care, ambivalence about continued recovery, the value of social support and a call for enhanced transition support. For carers, themes were the impact of the eating disorder on themselves and the family, perceptions of recovery and support post-discharge, the impact of previous treatment and care experiences, and desire to create a supportive transition process. CONCLUSIONS The study provides an insight into the unique challenges that individuals with anorexia nervosa face upon leaving intensive treatment. A lack of post-discharge planning, support system and identity formation outside of anorexia nervosa were perceived as barriers to continued recovery. Patients and carers advocated for transition support that incorporates a phased, inclusive approach with accessible professional and social support in the community.
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Affiliation(s)
- Danielle Clark Bryan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Pamela Macdonald
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of General Psychology, University of Padova, Italy
| | - Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Pennsylvania, USA
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, UK
| | - Eva-Maria Bonin
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, King's College London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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40
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Harris LM, Huang X, Funsch KM, Fox KR, Ribeiro JD. Efficacy of interventions for suicide and self-injury in children and adolescents: a meta-analysis. Sci Rep 2022; 12:12313. [PMID: 35853962 PMCID: PMC9296501 DOI: 10.1038/s41598-022-16567-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Abstract
Despite increased numbers of children and adolescents seeking and receiving mental health treatment, rates of self-injurious thoughts and behaviors (SITBs) in youth are rising. In the hopes of aiding ongoing efforts to alleviate the burden of SITBs in this vulnerable population, the present study summarizes current knowledge on the efficacy of SITB interventions in children and adolescents. We conducted a meta-analysis of randomized controlled trials (RCTs) assessing treatment effects on SITBs in child and adolescent populations. A total of 112 articles comprising 558 effect sizes were included in analyses. Nearly all interventions produced nonsignificant reductions in SITBs. For binary SITB outcomes, a nonsignificant treatment effect was detected, with an RR of 1.06 (95% CIs [0.99, 1.14]). For continuous SITB outcomes, analyses also yielded a nonsignificant treatment effect (g = - 0.04 [- 0.12, 0.05]). These patterns were largely consistent across SITB outcomes, regardless of intervention type, treatment components, sample and study characteristics, and publication year. Our findings highlight opportunities for improving SITB intervention development and implementation in child and adolescent populations. The most efficacious interventions are likely to directly target the causes of SITBs; therefore, future research is needed to identify the causal processes underlying the onset and maintenance of SITBs in youth.
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Affiliation(s)
- Lauren M Harris
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA.
| | - Xieyining Huang
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA
| | - Kensie M Funsch
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA
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Lawson R, Carter JD, Britt E, Knowles K, Then R, Vallance J, Jenkins L, Tauamiti R. Modified metacognitive therapy for anorexia nervosa: An open trial in an outpatient setting. Int J Eat Disord 2022; 55:983-989. [PMID: 35635052 DOI: 10.1002/eat.23749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Current evidence indicates treatment for adults with anorexia nervosa (AN) requires improvement given recovery rates are low to moderate, and relapse rates are high. Metacognitive therapy (MCT) is an effective treatment for anxiety and depressive disorders. This study evaluates if MCT can be successfully modified to treat AN in a naturalistic clinical setting. METHOD Twenty-four patients with AN participated in an open trial of modified metacognitive therapy (MCT-AN). Twelve of the 24 patients (50%) completed treatment. MCT was modified to include components specific to eating disorders. The MCT-AN was delivered by clinical psychologists who had undertaken training in MCT in a specialist outpatient service. Group and single participant data analyses were undertaken on those who completed treatment. RESULTS As well as statistically significant differences from pre- to posttreatment in the group data there were also clinically significant improvements at the individual patient level for eating disorder and depressive symptoms, as well as weight. The mean number of therapy sessions was 18. DISCUSSION These findings indicate that MCT-AN may be a promising intervention in the treatment of AN, warranting further investigation. PUBLIC SIGNIFICANCE Treatment for anorexia nervosa in adults requires improvement. Research indicates that Metacognitive therapy (MCT) is an effective treatment for anxiety and depression and may be applicable to the eating disorders. This small open trial suggests that MCT can be modified successfully to treat patients with anorexia nervosa (AN). The results are preliminary and require further research to provide more evidence on the effectiveness of this treatment for AN.
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Affiliation(s)
- Rachel Lawson
- South Island Eating Disorders Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Janet D Carter
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Eileen Britt
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Karen Knowles
- South Island Eating Disorders Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Rebecca Then
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Joanna Vallance
- South Island Eating Disorders Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Louise Jenkins
- South Island Eating Disorders Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Rachel Tauamiti
- South Island Eating Disorders Service, Canterbury District Health Board, Christchurch, New Zealand
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Tanck JA, Hartmann AS, Svaldi J, Hagena S, Osen B, Stierle C, Vocks S. What happens in the course of positive mirror exposure? Effects on eating pathology, body satisfaction, affect, and subjective physiological arousal in patients with anorexia and bulimia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:797-814. [PMID: 35731138 DOI: 10.1002/erv.2929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Mirror exposure (ME) is a therapeutic technique to improve body image disturbance. However, evidence on the effectiveness of different forms of ME in clinical populations is lacking. The present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN). METHOD The present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN). In total, 47 inpatients underwent 3 ME sessions guided by a therapist, with instructions to exclusively verbalise positively about their whole body. Participants completed questionnaires on trait-like eating pathology and body image at the start and end of the study, and instruments on state affect and body satisfaction were administered directly before and after each ME session. Subjective physiological arousal and emotional valence relating to each body part were assessed within each session. RESULTS The results indicate significant improvements in eating pathology and body image regarding trait-like measures in patients with AN and BN. Concerning state measures, negative affect significantly decreased and body satisfaction increased during ME. Physiological arousal decreased and positively valenced emotions relating to the various body parts increased. CONCLUSIONS These findings suggest that positively verbalising about one's body during ME improves eating pathology, body image, affect, and subjective physiological arousal, and thus seems to be an effective form of ME.
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Affiliation(s)
- Julia A Tanck
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Andrea S Hartmann
- Department of Psychology, Unit of Experimental Clinical Psychology, University of Konstanz, Konstanz, Germany
| | - Jennifer Svaldi
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Silka Hagena
- Asklepios Klinik Nord Ochsenzoll, Hamburg, Germany
| | | | | | - Silja Vocks
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
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Radden J. Starving to death and the anorexic frame of mind. Transcult Psychiatry 2022; 59:302-311. [PMID: 34986696 DOI: 10.1177/13634615211066697] [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] [Indexed: 11/15/2022]
Abstract
Because some forms of self-starvation such as hunger striking are exempt from attributions of pathology, and due to incomplete understanding of its etiology, anorexia nervosa (AN) is and must presently be defined by psychological criteria as well as behavioral and bodily measures. Although opaque, typical motivational frames of mind in AN lack the apparent cognitive and volitional dysfunction usually indicating disorder. In contrast to other conditions that exhibit more evident dysfunction, this distinguishes AN from the perspective of medical epistemology: the opacity of AN motivation jeopardizing the epistemic warrant for assigning it to the category of a mental disorder (and so influencing decisions over diagnosis and recovery). This seems to invite non-medical approaches to its prevention and care.
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Baranauskas M, Kupčiūnaitė I, Stukas R. Potential Triggers for Risking the Development of Eating Disorders in Non-Clinical Higher-Education Students in Emerging Adulthood. Nutrients 2022; 14:2293. [PMID: 35684093 PMCID: PMC9182964 DOI: 10.3390/nu14112293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Nowadays, eating disorders (ED) among individuals during emerging adulthood have become a crucial challenge to public health, taking into account the fact that the global prevalence of the ED risk in student-aged populations already stands at 10.4% and has been sharply increasing during the COVID-19 pandemic. In all, from 50% to 80% of all the ED cases go undetected or are not correctly diagnosed; moreover, these individuals do not receive specialized treatment. Therefore, early diagnosis detected via screening questionnaires for ED is highly recommended. This study aimed to identify the triggers for ED risk development in emerging-adulthood individuals and to reveal the factors significant not only for ED prevention but also for assessing individuals with subthreshold symptoms. This cross-sectional study provides the results for the ED symptom screening in 1716 Lithuanian higher-education students aged 21.2 ± 3.9, during emerging adulthood. According to the results of this study, 19.2% of students were at risk for ED. Potential risk factors such as sex (odds ratio (OR): 3.1, 95% CI: 1.9-4.9), body weight (self-reported body mass index) (adjusted (A) OR: 1.4; 95% CI: 1.2-1.7) and comorbidities such as smoking (AOR: 2.1; 95% CI: 1.6-2.8), and perceived stress during the pandemic (AOR: 1.4; 95% CI: 1.1-1.8) are involved in anticipating the symptomatology of ED during emerging adulthood. Regular initial screenings with universally adopted questionnaires and further referral to a psychiatrist must be applied to promote both the diagnosis of early-onset symptomatology and the treatment of these ED in student-aged populations. Preventive programs for reducing the prevalence of overweight or obesity among students during emerging adulthood should focus on integration directions for the development of a positive body image.
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Affiliation(s)
- Marius Baranauskas
- Faculty of Biomedical Sciences, Panevėžys University of Applied Sciences, 35200 Panevėžys, Lithuania;
| | - Ingrida Kupčiūnaitė
- Faculty of Biomedical Sciences, Panevėžys University of Applied Sciences, 35200 Panevėžys, Lithuania;
| | - Rimantas Stukas
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
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Herzog W, Wild B, Giel KE, Junne F, Friederich HC, Resmark G, Teufel M, Schellberg D, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Zeeck A, von Wietersheim J, Tagay S, Schade-Brittinger C, Schauenburg H, Schmidt U, Zipfel S. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in female outpatients with anorexia nervosa (ANTOP study): 5-year follow-up of a randomised controlled trial in Germany. Lancet Psychiatry 2022; 9:280-290. [PMID: 35294860 DOI: 10.1016/s2215-0366(22)00028-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anorexia nervosa is a serious illness leading to substantial morbidity and mortality. The Anorexia Nervosa Treatment of Outpatients (ANTOP) study is the largest randomised controlled trial (RCT) globally that uses psychotherapy in outpatients with anorexia nervosa. In this Article, we report the results of the 5-year follow-up. METHODS The ANTOP study is an open-label, multicentre RCT involving 242 adult female outpatients with anorexia nervosa. Participants were recruited from ten university hospitals in Germany, had to be aged at least 18 years and female, and have a diagnosis of anorexia nervosa with a body-mass index (BMI) of 15·0-18·5 kg/m2. Participants were randomly allocated (1:1:1) to 10 months of treatment with focal psychodynamic therapy, enhanced cognitive behaviour therapy, or optimised treatment as usual; complete masking of the participants was not possible. The mean duration of the follow-up was 5·96 years (SD 0·2) after randomisation. The primary outcome was change in BMI from baseline at the end of treatment; here, we present the change in BMI from baseline to the 5-year follow-up, using an intention-to-treat approach with a mixed model for repeated measurements. Groups were also compared according to global outcome (based on the combination of BMI and measures of anorexia severity), eating pathology (based on the Eating Disorder Inventory 2), and other secondary mental health outcomes. We did a linear regression analysis to identify the predictors of BMI at follow-up. FINDINGS Between May, 2007, and June, 2009, we screened 727 patients for eligibility; at baseline, 242 patients with a mean BMI of 16·7 kg/m2 (SD 1·0) were included and randomly allocated to 10 months of treatment with focal psychodynamic therapy, enhanced cognitive behaviour therapy, or optimised treatment as usual. 154 (64%) of 242 patients completed the 5-year follow-up assessment (53 [66%] of 80 in the focal psychodynamic therapy group, 55 [69%] of 80 in the enhanced cognitive behaviour therapy group, and 46 [56%] of 82 in the optimised treatment-as-usual group), with a mean age of 32·4 years; all reported their ethnicity as White. At the 5-year follow-up, there was an improvement in mean BMI, eating pathology, and global outcome in all treatment groups with no significant differences between treatment groups. Estimated mean BMI was: 18·64 kg/m2 (95% CI 18·07-19·21) in the focal psychodynamic therapy group (with an estimated mean BMI gain from baseline to 5-year follow-up of 1·91 kg/m2 [1·34-2·48]); 18·70 kg/m2 (18·15-19·25) in the enhanced cognitive behaviour therapy group (with an estimated mean BMI gain of 1·98 kg/m2 [1·43-2·53]); and 18·99 kg/m2 (18·39-19·59) in the optimised treatment-as-usual group (with an estimated mean BMI gain of 2·26 kg/m2 [1·67-2·86]). There were no significant differences between treatment groups regarding BMI at the 5-year follow-up; the estimated difference was -0·06 (-0·85 to 0·73) between the focal psychodynamic therapy and enhanced cognitive behaviour therapy groups; -0·35 (-1·18 to 0·47) between the focal psychodynamic therapy and optimised treatment-as-usual groups; and -0·29 (-1·10 to 0·52) between the enhanced cognitive behaviour therapy and optimised treatment-as-usual groups. On the basis of observed data, global outcome at the 5-year follow-up showed 41% (33-49) full recoveries, 41% (33-49) partial recoveries, and 18% (12-24) with full-syndrome anorexia nervosa. One patient initially treated in the enhanced cognitive behaviour therapy group died by suicide between the 1-year and 5-year follow-up. BMI at the 5-year follow-up was predicted by BMI at baseline (p=0·0021), illness duration (p=0·0004), and depression at baseline (p=0·012). INTERPRETATION The long-term results of the ANTOP trial confirm the improvement in BMI of patients with anorexia nervosa in all groups; however, a substantial proportion of patients had a poor global outcome. The predictors for the long-term course of anorexia nervosa in our ANTOP study show that we need to treat patients with anorexia nervosa at an earlier stage of the disease, with a clear focus on weight gain and considering other comorbidities (especially depression). FUNDING German Federal Ministry of Education and Research.
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Affiliation(s)
- Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, University of Bochum, Bochum, Germany
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital Münster and University of Münster, Münster, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Sefik Tagay
- Köln-University of Applied Sciences, Köln, Germany
| | | | - Henning Schauenburg
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Ulrike Schmidt
- Department of Psychological Medicine, King's College London, London, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
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Nadler J, Correll CU, Le Grange D, Accurso EC, Haas V. The Impact of Inpatient Multimodal Treatment or Family-Based Treatment on Six-Month Weight Outcomes in Youth with Anorexia Nervosa: A Naturalistic, Cross-Continental Comparison. Nutrients 2022; 14:1396. [PMID: 35406009 PMCID: PMC9003203 DOI: 10.3390/nu14071396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 02/06/2023] Open
Abstract
In the USA, family-based treatment (FBT) with inpatient medical stabilization as needed is the leading evidence-based treatment for youth with anorexia nervosa (AN). In continental Europe, typically inpatient multimodal treatment targeting weight recovery followed by outpatient care (IMT) is standard care, if prior outpatient treatment was not sufficient. Our aim was to compare weekly weight gain and hospital days over six months for adolescents receiving FBT (USA) versus IMT (Germany) using naturalistic treatment data. To yield similar subgroups of youth aged 12−18 years, inclusion criteria were a percent median BMI (%mBMI) between 70−85 and the restrictive AN subtype. Weight gain and hospital days were compared, adjusted further in a multiple linear regression analysis (MLRA) for baseline group differences. Samples differed on baseline %mBMI (FBT [n = 71], 90.5 ± 12.8; IMT [n = 29], 78.3 ± 9.1, p < 0.05). In subgroups with comparable baseline %mBMI, the weekly weight gain over 6 months was similar (FBT [n = 21]: 0.35 ± 0.18 kg/week; IMT [n = 20]: 0.30 ± 0.18, p = 0.390, p = 0.166 after MLRA), but achieved fewer hospital days in FBT (FBT [n = 7]: 4 ± 6 days, IMT [n = 20]: 121 ± 42 days, p < 0.0001 before and after MLRA). FBT may be effective for a subgroup of adolescents with AN currently receiving IMT, but head-to-head studies in the same healthcare system are needed.
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Affiliation(s)
- Janine Nadler
- Department of Child and Adolescent Psychiatry, Charité University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.U.C.); (V.H.)
| | - Christoph U. Correll
- Department of Child and Adolescent Psychiatry, Charité University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.U.C.); (V.H.)
- Department of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA
- Department of Psychiatry and Molecular Medicine, The Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Ave., San Francisco, CA 94143, USA; (D.L.G.); (E.C.A.)
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago as Emeritus, Chicago, IL 60637, USA
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Ave., San Francisco, CA 94143, USA; (D.L.G.); (E.C.A.)
| | - Verena Haas
- Department of Child and Adolescent Psychiatry, Charité University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.U.C.); (V.H.)
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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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Kiely L, Touyz S, Conti J, Hay P. Conceptualising specialist supportive clinical management (SSCM): current evidence and future directions. J Eat Disord 2022; 10:32. [PMID: 35255984 PMCID: PMC8900319 DOI: 10.1186/s40337-022-00557-2] [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: 10/27/2021] [Accepted: 02/23/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Current evidence-based treatments for adult anorexia nervosa (AN) have limitations, with high attrition, very poor outcomes for 20% of people, and no clearly superior manualised therapy for adults with AN. Specialist Supportive Clinical Management (SSCM) was designed as a control treatment but has evolved as a valid first line treatment. The present paper aims to provide an overview of the evidence base for SSCM and a pedagogical reconceptualization with expansion by theoretical integration (TI). BODY: A secondary meta-analysis endorses SSCM as a promising treatment. This paper positions SSCM as a manualised therapy for adult AN with six unique features, namely (1) a philosophy which is person-centred, non-prescriptive, and informed by the person's strengths and values, (2) a focus on the person through inclusion of supportive psychotherapy and problem (clinical management), within target symptoms as defined in relation to AN, (3) a flexible and responsive therapy that could be delivered by a variety of clinicians with experience treating AN (4) a commitment to reversing starvation though a directional approach and a defined yet flexible stance on dietetic intervention (5) a commitment to the therapeutic relationship within all three phases of treatment, and (6) a therapy 'uncluttered' by specific mandates. In addition, this paper positions SSCM as a treatment that may be strengthened by other modalities and may also be adapted to the treatment of other eating disorders (ED), not just AN. The level of therapist sophistication to deliver upon the supportive psychotherapy component is explored and future directions are offered. CONCLUSION SSCM is a unique and valid first line treatment for AN and would benefit from further expansion in line with emerging understandings of AN to strengthen it as a treatment. Speculation on aspects of potency would benefit from further testing. The proposed re-conceptualisation of SSCM in the context of its evidence may strengthen it as a treatment overall, position it as adaptable for treatment of other eating disorders and make it more accessible to clinicians.
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Affiliation(s)
- Laura Kiely
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Stephen Touyz
- University of Sydney InsideOut Institute, Camperdown, NSW Australia
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
- School of Psychology, Western Sydney University, Penrith, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
- Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, NSW 2560 Australia
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Rhoades KA, Slep AMS, Lorber MF, Heyman RE, Eddy JM, Linkh DJ. Prevention System Implementation and Reach: Attitudes and Environmental Predictors in a Randomized Controlled Trial of the NORTH STAR Prevention System. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1426-1437. [DOI: 10.1007/s11121-022-01352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
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Experiences when implementing enhanced cognitive behavioral therapy as a standard treatment for anorexia nervosa in outpatients at a public specialized eating-disorder treatment unit. J Eat Disord 2022; 10:15. [PMID: 35123583 PMCID: PMC8817598 DOI: 10.1186/s40337-022-00536-7] [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: 10/07/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enhanced cognitive behavioral therapy (CBT-E) is a promising treatment option for outpatients with anorexia nervosa (AN). We aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area. METHODS This study had an open, longitudinal design. Thirty three (of planned 100) outpatients aged > 16 years suffering from AN were included to receive 40 sessions of CBT-E. Eating-disorder psychopathology and body mass index (BMI) were assessed before and after treatment, while comorbid psychiatric symptoms and trauma experiences were evaluated at the baseline, and therapeutic alliance was assessed after 4 weeks of treatment. RESULTS A high proportion (69%) of patients dropped out of the treatment. Patient recovery was considered when they reached BMI > 18.5 and Eating Disorder Examination Questionnaire (EDE-Q) score < 2.5, and 27% of all patients recovered. CONCLUSIONS Patients who completed the treatment had mostly satisfactory outcomes. Considering the high dropout rate, it is necessary to improve the strategies for engaging patients in therapy. Several aspects of CBT-E as a standard treatment are discussed regarding the high dropout rate. Trial registration ClinicalTrials.gov. Identifier: NCT02745067. Registered: April 20, 2016. https://clinicaltrials.gov/ct2/showNCT02745067.
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