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A randomised controlled trial of three psychological treatments for anorexia nervosa

Published online by Cambridge University Press:  29 May 2017

S. Byrne ,
T. Wade ,
P. Hay ,
S. Touyz ,
C. G. Fairburn ,
J. Treasure ,
U. Schmidt ,
V. McIntosh ,
K. Allen  and
A. Fursland
...Show all authors
S. Byrne*
Affiliation:
School of Psychology, The University of Western Australia, Perth, Australia Centre for Clinical Interventions, Perth, Australia
T. Wade
Affiliation:
School of Psychology, Flinders University, Adelaide, Australia
P. Hay
Affiliation:
School of Medicine & Centre for Health Research, Western Sydney University, Sydney, Australia
S. Touyz
Affiliation:
School of Psychology, Sydney University, Sydney, Australia
C. G. Fairburn
Affiliation:
Department of Psychiatry, Oxford University, Oxford, UK
J. Treasure
Affiliation:
Department of Psychological Medicine, Kings College London, London, UK
U. Schmidt
Affiliation:
Department of Psychological Medicine, Kings College London, London, UK
V. McIntosh
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
K. Allen
Affiliation:
School of Psychology, The University of Western Australia, Perth, Australia Department of Psychological Medicine, Kings College London, London, UK Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
A. Fursland
Affiliation:
Centre for Clinical Interventions, Perth, Australia School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia
R. D. Crosby
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA Department of Biostatistics, Neuropsychiatric Research Institute, Fargo, ND, USA
*
*Address for correspondence: Susan Byrne, University of Western Australia, School of Psychology, 35 Stirling Highway, CRAWLEY, Perth, Western Australia 6009, Australia. (Email: sue.byrne@uwa.edu.au)
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Abstract

Background

There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy.

Method

A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25–40 sessions over a 10-month period. Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and psychosocial impairment.

Results

Treatment was completed by 60% of participants and 52.5% of the total sample completed 12-month follow-up. Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes; all resulted in clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission (mean = 28.3%) at 12-month follow-up.

Conclusion

The findings add to the evidence base for these three psychological treatments for adults with AN, but the results underscore the need for continued efforts to improve outpatient treatments for this disorder.

Trial Registration

Australian New Zealand Clinical Trials Registry (ACTRN 12611000725965) http://www.anzctr.org.au/

Keywords

Adultsanorexia nervosapsychological treatmentsrandomised controlled trial.
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 16 , December 2017 , pp. 2823 - 2833
Copyright
Copyright © Cambridge University Press 2017 

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References

Agras, WS, Walsh, BT, Fairburn, CG, Wilson, GT, Kraemer, HC (2000). A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry 57, 459–466.CrossRefGoogle ScholarPubMed
Andony, LJ, Tay, E, Allen, KL, Wade, TD, Hay, P, Touyz, S, McIntosh, VV, Treasure, J, Schmidt, UH, Fairburn, CG, Erceg-Hurn, D, Fursland, A, Crosby, R, Byrne, SM (2015). Therapist adherence in the strong without anorexia nervosa (SWAN) study: a randomized controlled trial of three treatments for adults with anorexia nervosa. International Journal of Eating Disorders 48, 1170–1175.Google Scholar
Arcelus, J, Mitchell, AJ, Wales, J, Nielsen, S (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of General Psychiatry 68, 724–731.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR® . American Psychiatric Association: Washington, DC.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-V® . American Psychiatric Association: Washington, DC.Google Scholar
Borkovec, TD, Nau, SD (1972). Credibility of analogue therapy rationales. Journal of Behavioural Therapy and Experimental Psychiatry 3, 257–260.CrossRefGoogle Scholar
Boutron, I, Moher, D, Altman, DG, Schulz, KF, Ravaud, P, CONSORT Group (2008). Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Annals of Internal Medicine 148, 295–309.Google Scholar
Carter, FA, Jordan, J, McIntosh, VV, Luty, SE, McKenzie, JM, Frampton, C, Bulik, CM, Joyce, PR (2011). The long-term efficacy of three psychotherapies for anorexia nervosa: a randomized, controlled trial. International Journal of Eating Disorders 44, 647–654.CrossRefGoogle ScholarPubMed
Dalle Grave, R, Calugi, S, Doll, HA, Fairburn, CG (2013). Enhanced cognitive behaviour therapy for adolescents with anorexia nervosa: an alternative to family therapy? Behavioural Research and Therapy 51, R9–R12.Google Scholar
Devilly, GJ, Borkovec, TD (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavioural Therapy and Experimental Psychiatry 31, 73–86.CrossRefGoogle ScholarPubMed
Fairburn, CG (2008). Cognitive Behavior Therapy and Eating Disorders. Guilford Press: London.Google ScholarPubMed
Fairburn, CG, Cooper, Z (2011). Therapist competence, therapy quality, and therapist training. Behavioural Research Therapy 49, 373–378.Google Scholar
Fairburn, CG, Cooper, Z, Doll, HA, O’Connor, ME, Bohn, K, Hawker, DM, Wales, JA, Palmer, RL (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.CrossRefGoogle ScholarPubMed
Fairburn, CG, Cooper, Z, Doll, HA, O’Connor, ME, Palmer, RL, Dalle Grave, R (2013). Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK–Italy study. Behavioural Research and Therapy 51, R2–R8.Google Scholar
Fairburn, CG, Cooper, Z, Shafran, R (2003). Cognitive behaviour therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behavioural Research and Therapy 41, 509–528.Google Scholar
Fairburn, CG, Wilson, GT (1993). Binge Eating: Nature, Assessment, and Treatment. Guilford Press: London, UK.Google Scholar
Hay, PJ, Claudino, AM, Touyz, S, Abd Elbaky, G (2015). Individual psychological therapy in the outpatient treatments of adults with anorexia nervosa. The Cochrane Library (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003909.pub2/pdf). Accessed 17 November 2016.Google Scholar
Hedeker, D, Gibbons, RD, Waternaux, C (1999). Sample size estimation for longitudinal designs with attrition: comparing time-related contrasts between two groups. Journal of Educational and Behavioural Statistics 24, 70–93.Google Scholar
le Grange, D, Eisler, I (2009). Family interventions in adolescent anorexia nervosa. Child and Adolescent Psychiatric Clinics of North America 18, 159–173.CrossRefGoogle ScholarPubMed
Lovibond, SH, Lovibond, PF (1995). Manual for the Depression, Anxiety and Stress Scales, 2nd edn. Psychology Foundation: Sydney.Google Scholar
McIntosh, V, Jordan, J, Luty, SE, Carter, FA, McKenzie, JM, Bulik, CM, Joyce, PR. (2006). Specialist supportive clinical management for anorexia nervosa. International Journal of Eating Disorders 39, 625–632.Google Scholar
McIntosh, VV, Jordan, J, Bulik, CM (2010). Specialist supportive clinical management for anorexia nervosa. In The Treatment of Eating Disorders: A Clinical Handbook (ed. Grilo, M and Mitchell, JE), pp. 108–129. Guilford Press: New York.Google Scholar
McIntosh, VV, Jordan, J, Carter, FA, Luty, SE, McKenzie, JM, Bulik, CM, Frampton, CM, Joyce, PR (2005). Three psychotherapies for anorexia nervosa: a randomized, controlled trial. American Journal of Psychiatry 162, 741–747.CrossRefGoogle ScholarPubMed
Mitchison, D, Hay, P, Mond, J, Slew-Younan, S (2013). Self-reported history of anorexia nervosa and current quality of life: findings from a community-based study. Quality of Life Research 1, 273–281.Google Scholar
Mond, JM, Hay, PJ, Rodgers, B, Owen, C, Beumont, PJV. (2004). Validity of the eating disorder examination questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour, Research and Therapy 42, 551–567.Google Scholar
National Collaborating Centre for Mental Health (2004). Eating disorders: Core Interventions in the Treatment and Management of AN, Bulimia Nervosa, and Related Eating Disorders. British Psychological Society and Royal College Psychiatrists: London.Google Scholar
Paxton, S, Hay, P, Touyz, SW, Forbes, D, Madden, S, Girosi, F, Doherty, A, Cook, L, Morgan, C (2012). Paying the Price: The Economic and Social Impact of Eating Disorders in Australia. Butterfly Foundation.Google Scholar
Schmidt, U, Magill, N, Renwick, B, Keyes, A, Kenyon, M, Dejong, H, Lose, A, Broadbent, H, Loomes, R, Yasin, H, Bonin, E, Richards, L, Johnson-Sabine, E, Beecham, J, Treasure, J, Landau, S (2015). The Maudsley outpatient study of treatments for anorexia nervosa and related conditions (MOSAIC): comparison of the Maudsley model of anorexia nervosa treatment for adults (MANTRA) with specialist supportive clinical management (SSCM) in outpatients with broadly defined anorexia nervosa: a randomized controlled trial. Journal of Consulting and Clinical Psychology 83, 796.Google Scholar
Schmidt, U, Oldershaw, A, Jichi, F, Sternheim, L, Startup, H, McIntosh, V, Jordan, J, Tchanturia, K, Wolff, G, Rooney, M (2012). Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. British Journal of Psychiatry 201, 392–399.Google Scholar
Schmidt, U, Renwick, B, Lose, A, Kenyon, M, DeJong, H, Broadbent, H, Loomes, R, Watson, C, Ghelani, S, Serpell, L, Richards, L, Johnson-Sabine, E, Boughton, N, Whitehead, L, Beecham, J, Treasure, J, Landau, S (2013). The MOSAIC study-comparison of the maudsley model of treatment for adults with anorexia nervosa (MANTRA) with specialist supportive clinical management (SSCM) in outpatients with anorexia nervosa or eating disorder not otherwise specified, anorexia nervosa type: study protocol for a randomized controlled trial. Trials 14, 16.CrossRefGoogle Scholar
Schmidt, U, Ryan, EG, Bartholdy, S, Renwick, B, Keyes, A, O’Hara, C, McClelland, J, Lose, A, Kenyon, M, Dejong, H, Broadbent, H, Loomes, R, Serpell, L, Richards, L, Johnson-Sabine, E, Boughton, N, Whitehead, L, Bonin, E, Beecham, J, Landau, S, Treasure, J (2016). Two-year follow-up of the MOSAIC trial: a multicenter randomized controlled trial comparing two psychological treatments in adult outpatients with broadly defined anorexia nervosa. International Journal of Eating Disorders 49, 793–800.CrossRefGoogle Scholar
Schmidt, U, Treasure, J (2006). Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology 45, 343–366.Google Scholar
Schmidt, U, Wade, TD, Treasure, J (2014). The Maudsley model of anorexia nervosa treatment for adults (MANTRA): development, key features, and preliminary evidence. Journal of Cognitive Psychotherapy 28, 48–71.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The mini-international neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 22–33.Google Scholar
Steinhausen, H-C (2002). The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry 159, 1284–1293.Google Scholar
Stice, E, Marti, CN, Rohde, P (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology 122, 445–457.Google Scholar
Touyz, S, Le Grange, D, Lacey, H, Hay, P, Smith, R, Maguire, S, Bamford, B, Pike, KM, Crosby, RD (2013). Treating severe and enduring anorexia nervosa: a randomized controlled trial. Psychological Medicine 43, 2501–2511.CrossRefGoogle ScholarPubMed
Treasure, J, Murphy, T, Szmukler, T, Todd, G, Gavan, K, Joyce, J (2001). The experience of caregiving for severe mental illness: a comparison between anorexia nervosa and psychosis. Social Psychiatry and Psychiatric Epidemiology 36, 343–347.Google Scholar
Treasure, J, Schmidt, U (2013). The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of Eating Disorders 13. (http://jeatdisord.biomedcentral.com/articles/10.1186/2050-2974-1-13). Accessed 17 November 2016.Google Scholar
Watson, HJ, Bulik, CM (2013). Update on the treatment of anorexia nervosa: review of clinical trials, practice guidelines and emerging interventions. Psychological Medicine 43, 2477–2500.CrossRefGoogle ScholarPubMed
Zipfel, S, Giel, KE, Bulik, CM, Hay, P, Schmidt, U (2015). Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry 2, 1099–1111.Google Scholar
Zipfel, S, Wild, B, Groß, G, Friederich, HC, Teufel, M, Schellberg, D, Giel, KE, de Zwaan, M, Dinkel, D, Herpertz, S, Burgmer, M, Lowe, B, Tagay, S, von Wietersheim, J, Zeeck, A, Schade-Brittinger, C, Schauenburg, H, Herzog, W, on behalf of the ANTOP study group (2014). Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet 383, 127–137.Google Scholar