The effectiveness of enhanced cognitive behavioural therapy for eating disorders: An open trial

University of Western Australia School of Psychology, 35 Stirling Highway Crawley, 6009 Perth, Western Australia, Australia.
Behaviour Research and Therapy (Impact Factor: 3.85). 04/2011; 49(4):219-26. DOI: 10.1016/j.brat.2011.01.006
Source: PubMed


The aim of this study was to examine the effectiveness of Enhanced Cognitive Behaviour Therapy (CBT-E) for eating disorders in an open trial for adults with the full range of eating disorders found in the community. The only previously published trial of CBT-E for eating disorders was a randomised controlled trial (RCT) conducted in the U.K. for patients with a BMI ≥ 17.5. The current study represents the first published trial of CBT-E to include patients with a BMI<17.5. The study involved 125 patients referred to a public outpatient clinic in Perth, Western Australia. Patients attended, on average, 20-40 individual sessions with a clinical psychologist. Of those who entered the trial, 53% completed treatment. Longer waiting time for treatment was significantly associated with drop out. By the end of treatment full remission (cessation of all key eating disorder behaviours, BMI ≥ 18.5 kg/m(2), not meeting DSM-IV criteria for an eating disorder) or partial remission (meeting at least 2 these criteria) was achieved by two thirds of the patients who completed treatment and 40% of the total sample. The results compared favourably to those reported in the previous RCT of CBT-E, with one exception being the higher drop-out rate in the current study. Overall, the findings indicated that CBT-E results in significant improvements, in both eating and more general psychopathology, in patients with all eating disorders attending an outpatient clinic.

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Available from: Hunna J Watson, Mar 18, 2015
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    • "A potential threat to the generalisability of the findings is the fact that the therapists were well trained. This problem may be more apparent than real since data from three " real world " clinics indicate that the outcome of patients who complete CBT-E, or a CBT-E-like treatment, is similar to that obtained in the main randomised controlled trials although the completion rates are lower (Byrne et al., 2011; Knott, Woodward, Hoefkens, & Limbert, 2014; Turner, Marshall, Stopa, & Waller, 2015). Nevertheless the scaling up of therapist training is a challenge. "
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    ABSTRACT: Little is known about the treatment of adolescents with an eating disorder who are not underweight. Enhanced cognitive behaviour therapy (CBT-E) is a potential option as it is a treatment for adult patients with eating disorders of this type and it has been shown to be effective with adolescent patients who are underweight. The aim of the present cohort study was to evaluate the effects of CBT-E on non-underweight adolescents with an eating disorder. Sixty-eight adolescent patients with an eating disorder and a body mass index (BMI) centile corresponding to an adult BMI ≥18.5 were recruited from consecutive referrals to a community-based eating disorder clinic. Each was offered 20 sessions of CBT-E over 20 weeks. Three-quarters completed the full 20 sessions. There was a marked treatment response with two-thirds (67.6%, intent-to-treat) having minimal residual eating disorder psychopathology by the end of treatment. CBT-E therefore appears to be a promising treatment for those adolescents with an eating disorder who are not underweight. Copyright © 2015. Published by Elsevier Ltd.
    Behaviour Research and Therapy 10/2015; 73:79-82. DOI:10.1016/j.brat.2015.07.014 · 3.85 Impact Factor
    • "There was also a significant reduction in anxiety and depression, as well as an overall improvement in general psychological functioning. These broader improvements in general mental health and quality of life reflect those found in previous studies (Byrne et al., 2011; Waller, Gray, et al., 2014). Furthermore, those patients who had an AN-spectrum presentation also benefitted. "
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    ABSTRACT: Whilst there is a growing evidence to support the impact of cognitive-behavioural therapy (CBT) in the treatment of adults with eating disorders, much of this evidence comes from tightly controlled efficacy trials. This study aimed to add to the evidence regarding the effectiveness of CBT when delivered in a routine clinical setting. The participants were 203 adults presenting with a range of eating disorder diagnoses, who were offered CBT in an out-patient community eating disorders service in the UK. Patients completed measures of eating disorder pathology at the start of treatment, following the sixth session, and at the end of treatment. Symptoms of anxiety, depression, and psychosocial functioning were measured pre- and post-treatment. Approximately 55% of patients completed treatment, and there were no factors that predicted attrition. There were significant improvements in eating disorder psychopathology, anxiety, depression and general functioning, with particular changes in eating attitudes in the early part of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. These findings confirm that evidence-based forms of CBT can be delivered with strong outcomes in routine clinical settings. Clinicians should be encouraged to deliver evidence-based treatments when working in these settings. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Behaviour Research and Therapy 03/2015; 68. DOI:10.1016/j.brat.2015.03.001 · 3.85 Impact Factor
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    • "" Nonentrants " were those who reached the top of the treatment waiting list and did not enter their first appointment, and those who attended their first appointment but decided not to engage with treatment. The 272 patients (60.3% of the 451 receiving an initial assessment) beginning treatment is larger than the 42.7% of patients entering Fairburn et al.&apos;s (2009) trial, but closer to the 70% of clients entering the Byrne et al. (2011) open trial from original referral and assessment. Characteristics of treatment starters are presented in Table 1. "
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    ABSTRACT: Background: Enhanced Cognitive Behaviour Therapy (CBT-E) (Fairburn, Cooper and Shafran, 2003) was developed as a treatment approach for eating disorders focusing on both core psychopathology and additional maintenance mechanisms. Aims: To evaluate treatment outcomes associated with CBT-E in a NHS Eating Disorders Service for adults with bulimia and atypical eating disorders and to make comparisons with a previously published randomized controlled trial (Fairburn et al., 2009) and "real world" evaluation (Byrne, Fursland, Allen and Watson, 2011). Method: Participants were referred to the eating disorder service between 2002 and 2011. They were aged between 18-65 years, registered with a General Practitioner within the catchment area, and had experienced symptoms fulfilling criteria for BN or EDNOS for a minimum of 6 months. Results: CBT-E was commenced by 272 patients, with 135 completing treatment. Overall, treatment was associated with significant improvements in eating disorder and associated psychopathology, for both treatment completers and the intention to treat sample. Conclusions: Findings support dissemination of CBT-E in this context, with significant improvements in eating disorder psychopathology. Improvements to global EDE-Q scores were higher for treatment completers and lower for the intention to treat sample, compared to previous studies (Fairburn et al., 2009; Byrne et al., 2011). Level of attrition was found at 40.8% and non-completion of treatment was associated with higher levels of anxiety. Potential explanations for these findings are discussed.
    Behavioural and Cognitive Psychotherapy 10/2014; DOI:10.1017/S1352465814000393 · 1.69 Impact Factor
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