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.
    Full-text · Article · Oct 2015 · Behaviour Research and Therapy
    • "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.
    No preview · Article · Mar 2015 · Behaviour Research and Therapy
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    • "However, given that the three clusters did not differ significantly in their reported use of manuals, it is possible that the clinicians' attitudes to manuals (and structured treatment) matters over and above their use per se (Wiborg et al. 2011). As clinicians seek to replicate the results of intensively supervised research trials for anorexia nervosa (Fairburn et al. 2013) in 'real life' settings (Byrne et al. 2011), adhering to all aspects of the manual will be crucial. Importantly, the current research provides clear information about what factors will be valuable to address in supervision – particularly encouraging inexperienced clinicians to maintain the focus on structured eating alongside the therapeutic alliance. "
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    ABSTRACT: Cognitive-behavioural therapy (CBT) can be effective for anorexia nervosa. However, there is evidence that the delivery of treatments for the eating disorders is inconsistent. This study examined evidence that clinician characteristics and practice can influence the effective implementation of CBT. The participants were 100 qualified clinicians who routinely offered outpatient CBT to adults with anorexia nervosa. They completed a survey of their demographic characteristics, level of anxiety, clinical practice in CBT for anorexia nervosa, and beliefs about the relationship between weight gain and therapeutic alliance in the early part of such treatment. Greater reported levels of weight gain were associated with the use of manuals, early focus on weight gain as a target, structured eating, and a belief that weight gain precedes a good working alliance. Clinician anxiety and early focus on the therapeutic alliance rather than structured eating were associated with poorer outcomes. These conclusions need to be tested within clinical and research settings. However, they suggest that clinicians should be encouraged to use manual-based approaches when treating anorexia nervosa using CBT, as focusing on techniques might result in the best possible outcome in this early part of treatment.
    Full-text · Article · Dec 2014 · The Cognitive Behaviour Therapist
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