The challenges of treating anorexia nervosa are plenty; some of these challenges — like low prevalence rate and high treatment dropout rate — make conducting randomised controlled trials aimed at identifying effective treatment methods really hard as well.
So I was pretty excited about the recently published randomised controlled trial comparing focal psychodynamic therapy (FPT), cognitive behaviour therapy (CBT), and optimised treatment as usual in adult (a harder to treat demographic than adolescents) anorexia nervosa patients.
Reading the paper, I was pretty impressed with how good the study design was; I’m not going to go into all the nitty-gritty details, but if you have access to and the chance to read the paper, do it. You’ll appreciate, I think, the amount of effort that went into this.
Patients were recruited from ten universities across Germany. They had to be adult females with a BMI between 15-18 and with no current substance use, psychotic or bipolar disorders. In total, 242 individuals started the study (80 in the FPT and CBT groups, and 82 in the treatment as usual group). …
In this post I will continue my discussion on weight suppression in bulimia nervosa (click here to read Part I). Just in case you happen to be reading the posts out of sequence, I will summarize the main points of that entry:
THE RELATIONSHIP BETWEEN WEIGHT SUPPRESSION AND WEIGHT GAIN DURING BN TREATMENT
Because most individuals with BN have undergone significant weight loss, this makes them susceptible to weight regain — much like obese individuals usually regain the weight they have lost. Indeed, evidence suggests that weight suppression predicts weight gain in individuals with BN during inpatient (Lowe et al., 2006) and outpatient treatment (Carter et al., 2008).
WHY WOULD WEIGHT SUPPRESSION PREDICT WEIGHT GAIN DURING BN TREATMENT?
Cognitive-behavioural therapy (CBT) is commonly described as the evidence-based treatment for bulimia nervosa. But do the findings from nearly perfectly crafted trials, with stringently followed protocols and “ideal” participants apply to the “real world”? How generalizable are the findings from carefully selected participants to clinical populations where, for one, the prevalence of psychiatric comorbidities is relatively high?
In other words, CBT has been shown to be efficacious (i.e., it works in a controlled experimental research trial setting) but is it effective (i.e., does it work in a clinical setting where clients might have multiple diagnoses and complex needs)?
This is precisely the question that Glenn Waller and colleagues sought to answer. They wanted to see whether CBT would work in a “routine clinical setting, where none of the exclusion-and protocol-based constraints […] apply.”
Participants were recruited from a publicly-funded outpatient ED service in the UK. The only exclusion criteria were psychosis, learning difficulties, and inability to communicate in English.
Since the purpose of the study was to see how effective CBT is in a clinical setting, the treatment …
Cognitive-behavioural therapy (CBT) is one of the most commonly used approaches to treat bulimia nervosa, but even CBT (or any treatment) doesn’t work for everyone. Sometimes, even if CBT is helping, a weekly 50 minute therapy session is just not enough. Moreover, like with many other eating disorder treatments, drop-out and relapse rates are high.
What can be done to help the individuals that don’t benefit (or benefit fully) from CBT, or those that relapse after CBT?
Shapiro and colleagues had the idea that maybe using text-messaging (in conjunction with CBT) would increase self-monitoring and accountability of bulimia nervosa patients.
The rationale is that text-messaging might provide an immediate way of engaging with the therapist. The patients are provided feedback and support immediately, and have the knowledge (or a sense of) being held accountable for their actions (i.e., binges and purges).
It is like a daily check-in. It means you don’t have to remember or wait until your next appointment to talk about how a particular day went, or get feedback on your behaviours. You also don’t have to write …
Here’s a quick tip: when a study that purports to find evidence of treatment effectiveness–preliminary or not–doesn’t have a control group (a group that doesn’t undergo treatment but is otherwise similar to the group that does), you should raise your eyebrows. Or shake your head. Or roll your eyes. Whichever you prefer.
Why do we need a control group? If the treatment works, we will see improvement in the patients, so isn’t that evidence enough? Well, no.
(By the way, I recommend reading the article I just quoted, ”How to Be a Wise Consumer of Psychological Research” from the American Psychological Association.)
In the introduction, the authors of this study make the case that anorexia nervosa (AN) is difficult to treat and difficult to study (low prevalence, high dropout, necessary long-length of follow-up, etc…) and so if we could have treatment approach that would be successful on an outpatient basis, that would be great.
No argument there. There is a lot of consensus that long-term continuous low-intensity care is crucial for sustained recovery. (A short stay at a …
Eating disorders don’t discriminate against gender, age, sexual orientation or race. Veteran men in their 50′s can struggle with eating disorders, as can trans men and women of all ages and backgrounds, and so can congenitally blind (and deaf) individuals.
Besides the barriers that many of these patients face in simply getting diagnosed with an eating disorder, yes, even if they’ve passed that hurdle, many face an even bigger problem: getting appropriate treatment.
Naturally, no one treatment method will work for everyone, especially when the patient population is so diverse. What works for a 13-year-old female may not work for a man in his 40′s or 50′s. Unfortunately, treatment options (at least those that have some empirical evidence) are limited. As I’ve recently blogged, new treatments are being developed and utilized in treating adults and/or patients with with long-standing eating disorders - sub-populations that have largely been ignored for a long-time.
Following this trend of broadening the types of interventions available to treat eating disorder patients is UCAN: Uniting Couples in the treatment of Anorexia Nervosa.…
Treating anorexia nervosa is hard. Treating chronic and severe anorexia nervosa is a lot harder. Although the situation seems to be improving, there are really no evidence-based treatments for anorexia nervosa – particularly for those who have been sick for a long time.
The treatments that many often claim are evidence-based are often only applicable to a select subgroup of ED patients, and even then, the evidence is usually weak. (I’m referring to Maudsley/FBT (family-based therapy) for adolescents with <3 yrs duration of AN and CBT for bulimia nervosa.) But what about those with long-standing anorexia nervosa? In a recent review, Phillipa Hay and colleagues set out to conduct a systematic review of randomized controlled trials of treatment for chronic AN.
Randomized controlled trials or RCTs are at the heart of evidence-based medicine:
Hay et al searched the literature to identify RCTs where, among other criteria, the mean duration of illness was at least three years. They found eleven studies, but they could only confirm that a majority had a mean duration of over 3 years in just four of …