Time to restore body weight in adults and adolescents receiving cognitive behaviour therapy for anorexia nervosa

Journal of Eating Disorders

Christopher G Fairburn²  Massimiliano Sartirana¹  Riccardo Dalle Grave¹  Simona Calugi¹ 

[1] Department of Eating and Weight Disorder, Villa Garda Hospital, Via Montebaldo, 89, Garda, I-37016, VR, Italy;Department of Psychiatry, Oxford University, Warneford Hospital, Oxford OX3 7JX, UK

关键词: Outcome;    Eating disorder;    Cognitive behaviour therapy;    Treatment;    Anorexia nervosa;   

Others  :  1206730
DOI  :  10.1186/s40337-015-0057-z

 received in 2015-02-04, accepted in 2015-04-20,  发布年份 2015

【 摘 要 】

Background

The aim of the present study was to provide benchmark data on the duration of treatment required to restore body weight (to BMI ≥18.5 or a corresponding BMI centile) in adolescents and adults with anorexia nervosa treated with outpatient cognitive behaviour therapy.

Methods

Ninety-five participants (46 adolescents and 49 adults) were recruited from consecutive referrals to a specialist eating disorder clinic. Each was offered 40 sessions of enhanced cognitive behaviour therapy (CBT-E) over 40 weeks, the conventional length of this treatment.

Results

Twenty-nine (63.1%) of the adolescents and 32 (65.3%) of the adults completed all 40 sessions of treatment (P = 0.818). Significantly more adolescents reached the goal BMI than adults (65.3% vs. 36.5%; P = 0.003). The mean time required by the adolescents to restore body weight was about 15 weeks less than that for the adults (14.8 (SE = 1.7) weeks vs. 28.3 (SE = 2.0) weeks, log-rank = 21.5, P < 0.001).

Conclusions

The findings indicate that adolescent patients receiving CBT-E are able to regain weight more successfully than adults and at a faster rate. If these findings are replicated and extend to eating disorder psychopathology, then their treatment could be shorter than that of adults.

【 授权许可】

   
2015 Calugi et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Halmi KA, Agras WS, Crow S, Mitchell J, Wilson GT, Bryson SW et al.. Predictors of treatment acceptance and completion in anorexia nervosa: Implications for future study designs. Arch Gen Psychiatry. 2005; 62(7):776-781.
• [2]Agras WS, Brandt HA, Bulik CM, Dolan-Sewell R, Fairburn CG, Halmi KA et al.. Report of the National Institutes of Health workshop on overcoming barriers to treatment research in anorexia nervosa. Int J Eat Disord. 2004; 35(4):509-521.
• [3]Bulik CM, Berkman ND, Brownley KA, Sedway JA, Lohr KN. Anorexia nervosa treatment: A systematic review of randomized controlled trials. Int J Eat Disord. 2007; 40(4):310-320.
• [4]Fairburn CG. Evidence-based treatment of anorexia nervosa. Int J Eat Disord. 2005; 37 Suppl:S26-S30.
• [5]Halmi KA. The perplexities of conducting randomized, double-blind, placebo-controlled treatment trials in anorexia nervosa patients. Am J Psychiatry. 2008; 165(10):1227-1228.
• [6]Lock J, Brandt H, Woodside B, Agras S, Halmi WK, Johnson C et al.. Challenges in conducting a multi-site randomized clinical trial comparing treatments for adolescent anorexia nervosa. Int J Eat Disord. 2012; 45(2):202-213.
• [7]Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: A "transdiagnostic" theory and treatment. Behav Res Ther. 2003; 41:509-528.
• [8]Fairburn CG, Cooper Z, Shafran R, Bohn K, Hawker DM, Murphy R et al.. Enhanced cognitive behavior therapy for eating disorders: The core protocol. In: Cognitive Behavior Therapy and Eating Disorders. Fairburn CG, editor. Guilford Press, New York; 2008: p.45-193.
• [9]Fairburn CG. Cognitive behavior therapy and eating disorders. Guilford Press, New York; 2008.
• [10]Fairburn CG, Cooper Z, Doll HA, O'Connor ME, Bohn K, Hawker DM et al.. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: A two-site trial with 60-week follow-up. Am J Psychiatry. 2009; 166:311-319.
• [11]Poulsen S, Lunn S, Daniel SI, Folke S, Mathiesen BB, Katznelson H et al.. A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. Am J Psychiatry. 2014; 171(1):109-116.
• [12]Wonderlich SA, Peterson CB, Crosby RD, Smith TL, Klein MH, Mitchell JE et al.. A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychol Med. 2014; 44(3):543-553.
• [13]Dalle Grave R, Calugi S, Doll HA, Fairburn CG. Enhanced cognitive behaviour therapy for adolescents with anorexia nervosa: An alternative to family therapy? Behav Res Ther. 2013; 51(1):R9-R12.
• [14]Fairburn CG, Cooper Z, Doll HA, O'Connor ME, Palmer RL, Dalle GR. Enhanced cognitive behaviour therapy for adults with anorexia nervosa: A UK-Italy study. Behav Res Ther. 2013; 51(1):R2-R8.
• [15]Zipfel S, Wild B, Gross G, Friederich HC, Teufel M, Schellberg D et al.. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): Randomised controlled trial. Lancet. 2014; 383(9912):127-137.
• [16]Dalle Grave R, Calugi S, Conti M, Doll H, Fairburn CG. Inpatient cognitive behaviour therapy for anorexia nervosa: A randomized controlled trial. Psychother Psychosom. 2013; 82(6):390-398.
• [17]Dalle Grave R, Calugi S, El Ghoch M, Conti M, Fairburn CG. Inpatient cognitive behavior therapy for adolescents with anorexia nervosa: immediate and longer-term effects. Front Psychiat. 2014; 5:14.
• [18]Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Association, Washington, DC; 2000.
• [19]Fairburn CG, Beglin SJ. Eating Disorder Examination Questionnaire (EDE-Q 6.0). In: Cognitive Behavior Therapy and Eating Disorders. Fairburn CG, editor. Guilford Press, New York; 2008: p.309-313.
• [20]Dalle Grave R, Calugi S. La Terapia cognitivo comportamentale dei disturbi dell’alimentazione. In: Fairburn CG, editor. Versione Italiana dell’Eating Disorder Examination Questionnaire (EDE-Q 6.0). Eclipsi. Firenze ed., 2010. p. 401–7.
• [21]Derogatis LR. The SCL-90 manual: Scoring, administration and procedures for the SCL-90. Baltimore, Clinical Psychometric Research; 1977.
• [22]Prunas A, Sarno I, Preti E, Madeddu F, Perugini M. Psychometric properties of the Italian version of the SCL-90-R: a study on a large community sample. Eur Psychiatry. 2012; 27(8):591-597.
• [23]Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ. 2007; 335(7612):194.
• [24]Kleinbaum DG. Survival Analysis: A Self-Learning Text. 1996.
• [25]Hay P, Rodgers B, Owen C. Eating Disorder Examination Questionnaire (EDE-Q): norms for young adult women. Behaviour Research and Therapy. 2006; 44:53-62.
• [26]Turner H, Marshall E, Stopa L, Waller G. Cognitive-behavioural therapy for outpatients with eating disorders: Effectiveness for a transdiagnostic group in a routine clinical setting. Behav Res Ther. 2015; 68:70-5.
• [27]Byrne SM, Fursland A, Allen KL, Watson H. The effectiveness of enhanced cognitive behavioural therapy for eating disorders: An open trial. Behav Res Ther. 2011; 49(4):219-26.