Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-06-30T18:19:03.013Z Has data issue: false hasContentIssue false
  • English
  • Français

Outpatient CBT for Underweight Patients with Eating Disorders: Effectiveness Within a National Health Service (NHS) Eating Disorders Service

Published online by Cambridge University Press:  02 August 2018

Paul E. Jenkins ,
Ceri Morgan  and
Catherine Houlihan
Paul E. Jenkins*
Affiliation:
Oxford Health NHS Foundation Trust, Cotswold House, Warneford Hospital, Oxford OX3 7JX, UK School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK
Ceri Morgan
Affiliation:
Oxford Health NHS Foundation Trust, Cotswold House, Warneford Hospital, Oxford OX3 7JX, UK
Catherine Houlihan
Affiliation:
Oxford Health NHS Foundation Trust, Cotswold House, Warneford Hospital, Oxford OX3 7JX University of Oxford, The Isis Education Centre, Roosevelt Drive, Warneford Hospital, Headington, Oxford OX3 7JX, UK
*
Correspondence to Dr Paul E. Jenkins, School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Underweight eating disorders (EDs) are notoriously difficult to treat, although a growing evidence base suggests that outpatient cognitive behaviour therapy for EDs (CBT-ED) can be effective for a large proportion of individuals. Aims: To investigate the effectiveness of CBT-ED for underweight EDs in a ‘real-world’ settings. Method: Sixty-three adults with underweight EDs (anorexia nervosa or atypical anorexia nervosa) began outpatient CBT-ED in a National Health Service setting. Results: Fifty-four per cent completed treatment, for whom significant changes were observed on measures of ED symptoms, psychological distress and psychosocial impairment. There was also a large effect on body weight at end-of-treatment. Conclusions: The results suggest that good outcomes can be achieved by the majority of those who complete treatment, although treatment non-completion remains a significant barrier to recovery. Future studies should focus on improving treatment retention, as evidence suggests that CBT-ED in ‘real-world’ settings is effective.

Keywords

eating disordersanorexia nervosacognitive behaviour therapyeffectiveness
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 2 , March 2019 , pp. 217 - 229
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agras, W. S., Brandt, H. A., Bulik, C. M., Dolan-Sewell, R., Fairburn, C. G., Halmi, K. A. et al. (2004). Report of the National Institutes of Health workshop on overcoming barriers to treatment research in anorexia nervosa. International Journal of Eating Disorders, 35, 509–521. doi: 10.1002/eat.10261Google Scholar
Barkham, M., Margison, F., Leach, C., Lucock, M., Mellor-Clark, J., Evans, C. et al. (2001). Service profiling and outcomes benchmarking using the CORE-OM: toward practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology, 69, 184–196. doi: 10.1037/0022-006X.69.2.184Google Scholar
Bell, C., Waller, , G., Shafran, R. and Delgadillo, J. (2017). Is there an optimal length of psychological treatment for eating disorder pathology? International Journal of Eating Disorders, 50, 687–692. doi: 10.1002/eat.22660Google Scholar
Bohn, K. and Fairburn, G, C.. (2008). Clinical Impairment Assessment Questionnaire (CIA 3.0). In Fairburn, C. G. (ed), Cognitive Behaviour Therapy and Eating Disorders (pp. 315–317). New York: Guilford Press.Google Scholar
Brown, A., Mountford, V. and Waller, G. (2013). Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa. Behaviour Research and Therapy, 51, 216–220. doi: 10.1016/j.brat.2013.01.008Google Scholar
Byrne, S. M., Fursland, A., Allen, K. L. and Watson, H. (2011). The effectiveness of enhanced cognitive behavioural therapy for eating disorders: an open trial. Behaviour Research and Therapy, 49, 219–226. doi: 10.1016/j.brat.2011.01.006Google Scholar
Byrne, S., Wade, T., Hay, P., Touyz, S., Fairburn, C. G., Treasure, J. et al. (2017). A randomised controlled trial of three psychological treatments for anorexia nervosa. Psychological Medicine, 47, 2823–2833. doi: https://doi.org/10.1017/S0033291717001349Google Scholar
Fairburn, C. G. (2008). Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press.Google Scholar
Fairburn, C. G. and Beglin, S. J. (2008). Eating Disorder Examination Questionnaire (EDE-Q 6.0). In Fairburn, C. G. (ed), Cognitive Behaviour Therapy and Eating Disorders (pp. 309–313). New York: Guilford Press.Google Scholar
Fairburn, C. G., Cooper, Z., Doll, H. A., O'Connor, M. E., Bohn, K., Hawker, D. M. et al. (2009). Transdiagnostic Cognitive-Behavioral Therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry, 166, 311–319. doi: 10.1176/appi.ajp.2008.08040608Google Scholar
Fairburn, C. G., Cooper, Z., Doll, H. A., O'Connor, M. E., Palmer, R. L. and Dalle Grave, R. (2013). Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK–Italy study. Behaviour Research and Therapy, 51, R2–R8. doi: 10.1016/j.brat.2012.09.010Google Scholar
Fairburn, C. G., Bailey-Straebler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R. et al. (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour Research and Therapy, 70, 64–71. doi: 10.1016/j.brat.2015.04.010Google Scholar
Fairburn, C. G. and Walsh, B. T. (2002). Atypical eating disorders (Eating Disorder Not Otherwise Specified). In Fairburn, C. G. and Brownell, K. D. (eds), Eating Disorders and Obesity: A Comprehensive Handbook (2nd edn, pp. 171–177). New York: Guilford Press.Google Scholar
Graham, J. W. (2009). Missing data analysis: making it work in the real world. Annual Review of Psychology, 60, 549–576. doi: 10.1146/annurev.psych.58.110405.085530Google Scholar
Halmi, K. A., Agras, W. S., Crow, S., Mitchell, J., Wilson, G. T., Bryson, S. and Kraemer, H. C. (2005). Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Archives of General Psychiatry, 62, 776–781. doi: 10.1001/archpsyc.62.7.776Google Scholar
Hughes, E. K., Le Grange, D., Court, , A. and Sawyer, S. M. (2017). A case series of family-based treatment for adolescents with atypical anorexia nervosa. International Journal of Eating Disorders, 50, 424–432. doi: 10.1002/eat.22662Google Scholar
Kazdin, A. E., Fitzsimmons-Craft, E. E. and Wilfley, D. E. (2017). Addressing critical gaps in the treatment of eating disorders. International Journal of Eating Disorders, 50, 170–189. doi: 10.1002/eat.22670Google Scholar
Knott, S., Woodward, D., Hoefkens, A. and Limbert, C. (2015). Cognitive behaviour therapy for bulimia nervosa and eating disorders not otherwise specified: translation from randomized controlled trial to a clinical setting. Behavioural and Cognitive Psychotherapy, 43, 641–654. doi: 10.1017/S1352465814000393Google Scholar
Kraemer, H. C. and Blasey, C. M. (2004). Centring in regression analyses: a strategy to prevent errors in statistical inference. International Journal of Methods in Psychiatric Research, 13, 141–151. doi: 10.1002/mpr.170Google Scholar
Linardon, J. and Brennan, L. (2017). The effects of cognitive-behavioral therapy for eating disorders on quality of life: a meta-analysis. International Journal of Eating Disorders, 50, 715–730. doi: 10.1002/eat.22719Google Scholar
Linardon, J., Wade, T. D., De La Piedad Garcia, X. and Brennan, L. (2017). The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85, 1080–1094. doi: 10.1037/ccp0000245Google Scholar
National Institute for Health and Care Excellence (NICE) (2017). Eating disorders: recognition and treatment. NICE guideline (NG69). London, UK: NICE.Google Scholar
Peterson, C. B., Crosby, R. D., Wonderlich, S. A., Joiner, T., Crow, S. J., Mitchell, J. E. et al. (2007). Psychometric properties of the Eating Disorder Examination-Questionnaire: factor structure and internal consistency. International Journal of Eating Disorders, 40, 386–389. doi: 10.1002/eat.20373Google Scholar
Rose, C. and Waller, G. (2017). Cognitive-behavioral therapy for eating disorders in primary care settings: does it work, and does a greater dose make it more effective? International Journal of Eating Disorders, 50, 1350–1355. doi: 10.1002/eat.22778Google Scholar
Santonastaso, P., Bosello, R., Schiavone, P., Tenconi, E., Degortes, D. and Favaro, A. (2009). Typical and atypical restrictive anorexia nervosa: weight history, body image, psychiatric symptoms, and response to outpatient treatment. International Journal of Eating Disorders, 42, 464–470. doi: 10.1002/eat.20706Google Scholar
Serpell, L., Stobie, B., Fairburn, C. G. and van Schaick, R. (2013). Empirically-supported and non-empirically supported therapies for bulimia nervosa: retrospective patient ratings. Journal of Eating Disorders, 1, 41. doi: 10.1186/2050-2974-1-41Google Scholar
Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A. et al. (2009). Mind the gap: improving the dissemination of CBT. Behaviour Research and Therapy, 47, 902–909. doi: 10.1016/j.brat.2009.07.003Google Scholar
Signorini, R., Sheffield, J., Rhodes, N., Fleming, C. and Ward, W. (2017). The effectiveness of Enhanced Cognitive Behavioural Therapy (CBT-E): a naturalistic study within an out-patient eating disorder service. Behavioural and Cognitive Psychotherapy, 46, 21–34. doi: 10.1017/S1352465817000352Google Scholar
Steiger, H. (2017). Evidence-informed practices in the real-world treatment of people with eating disorders. Eating Disorders, 25, 173–181. doi: 10.1080/10640266.2016.1269558Google Scholar
Turner, H., Marshall, E., Stopa, L. and Waller, G. (2015). Cognitive-behavioural therapy for outpatients with eating disorders: effectiveness for a transdiagnostic group in a routine clinical setting. Behaviour Research and Therapy, 68, 70–75. doi: 10.1016/j.brat.2015.03.001Google Scholar
Vall, E. and Wade, T. D. (2015). Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. International Journal of Eating Disorders, 48, 946–971. doi: 10.1002/eat.22411Google Scholar
Vitousek, K., Watson, S. and Wilson, G. T. (1998). Enhancing motivation for change in treatment-resistant eating disorders. Clinical Psychology Review, 18, 391–420. doi: 10.1016/S0272-7358(98)00012-9Google Scholar
Wallace, L. M. and von Ranson, K. M. (2012). Perceptions and use of empirically-supported psychotherapies among eating disorder professionals. Behaviour Research and Therapy, 50, 215–222. doi: 10.1016/j.brat.2011.12.006Google Scholar
Waller, G., Gray, E., Hinrichsen, H., Mountford, V., Lawson, R., and Patient, E. (2014). Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: effectiveness in clinical settings. International Journal of Eating Disorders, 47, 13–17. doi: 10.1002/eat.22181Google Scholar
Waller, G., Tatham, M., Turner, H., Mountford, V. A., Bennetts, A., Bramwell, K. et al. (2018). A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: outcomes from a case series of non-underweight adult patients. International Journal of Eating Disorders, 51, 262–269. doi: 10.1002/eat.22837Google Scholar
World Health Organization (WHO) (2016). ICD-10 version: 2016. Available at: http://apps.who.int/classifications/icd10/browse/2016/en#Google Scholar
Submit a response

Comments

No Comments have been published for this article.