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Individual cognitive behavioral therapy and combined family/individual therapy for young adults with Anorexia nervosa: A randomized controlled trial
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-9808-5414
Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Örebro University, School of Medical Sciences. University Health Care Research Center.ORCID iD: 0000-0002-3227-2487
Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.ORCID iD: 0000-0003-1460-4238
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2020 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 30, no 8, p. 1011-1025Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: In this study, we evaluate the efficacy of outpatient individual cognitive behavioral therapy for young adults (CBT-YA) and combined family/individual therapy for young adults (FT-YA) for anorexia nervosa (AN).

METHOD: Participants (aged 17-24 years) with AN in Sweden were recruited and assigned to 18 months of CBT-YA or FT-YA. Treatment efficacy was assessed primarily using BMI, presence of diagnosis, and degree of eating-related psychopathology at post-treatment and follow-up. Secondary outcomes included depression and general psychological psychopathology. The trial was registered at http://www.isrctn.com/, ISRCTN (25181390).

RESULTS: Seventy-eight participants were randomized, and seventy-four of them received allocated treatment and provided complete data. Clinical outcomes from within groups resulted in significant improvements for both groups. BMI increased from baseline (CBT-YA 16.49; FT-YA 16.54) to post-treatment (CBT-YA 19.61; FT-YA 19.33) with high effect sizes. The rate of weight restoration was 64.9% in the CBT-YA group and 83.8% in the FT-YA group. The rate of recovery was 76% in both groups at post-treatment, and at follow-up, 89% and 81% had recovered in the CBT-YA and FT-YA groups respectively.

CONCLUSIONS: Outpatient CBT-YA and FT-YA appear to be of benefit to young adults with AN in terms of weight restoration and reduced eating disorder and general psychopathology.

Place, publisher, year, edition, pages
Routledge, 2020. Vol. 30, no 8, p. 1011-1025
Keywords [en]
Anorexia nervosa, cognitive behavioral therapy, family therapy, outpatient treatment, randomized controlled trial
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:oru:diva-77871DOI: 10.1080/10503307.2019.1686190ISI: 000495523000001PubMedID: 31709920Scopus ID: 2-s2.0-85074978953OAI: oai:DiVA.org:oru-77871DiVA, id: diva2:1370291
Note

Funding Agencies:

Vardal Foundation, Sweden  

Krica Foundation, Sweden  

Örebro University, Sweden 

Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2022-08-24Bibliographically approved
In thesis
1. Anorexia nervosa - The journey towards recovery: A randomized controlled treatment trial: assessment, prediction, treatment outcome and clinical change
Open this publication in new window or tab >>Anorexia nervosa - The journey towards recovery: A randomized controlled treatment trial: assessment, prediction, treatment outcome and clinical change
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study young adult women with anorexia nervosa (AN) participating in an randomized controlled trial in relation to assessment, treatment outcome, prediction, and clinical change. 

The results confirm the Eating Disorder Inventory-3 as a valid instrument for measuring eating disorder symptoms and general psychopathology. AN patients, however, rate themselves significantly lower than patients with other eating disorder diagnoses, and interoceptive deficits are the best predictive subscale for AN diagnosis. Patients significantly improved in terms of weight and eating disorder psychopathology, with no differences between individual CBT and family therapy (FT). Most patients did not fulfill the diagnostic criteria at post-assessment, at 76% and 86% at followup. Patients in FT were considered completers to a higher extent than patients receiving CBT, and 8% were prematurely discharged, in comparison to 30% for CBT. Bulimic symptoms and emotional dysregulation at baseline had a negative effect on diagnostic symptoms, and lower levels of interoceptive deficits predicted weight increase in the FT group. Lower levels of emotional dysregulation and higher levels of interoceptive deficits explained 37% of the variance in BMI changes in the CBT group. The classifications of CS/RCI were shown to be valid when compared to normal controls. Patients classified as clinically significantly improved constituted 35-47% of all patients, and only three patients fulfilled the proposed definition of recovery. The agreement of the diagnostic criteria was fair.

The results suggest that individual CBT and FT are effective treatments for young adults. The ability to acknowledge, interpret, and handle emotions is an important aspect of treatment. Self-report measurements are useful for evaluating individual changes; however, diagnostic criteria do not accord with self-reported symptom changes and physical, behavioral, and psychological measurements are important for a complete estimation of recovery.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2021. p. 98
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 245
Keywords
Anorexia nervosa, young adults, randomized controlled trial, outpatient psychotherapy, treatment outcome, predictors, recovery
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-92420 (URN)978-91-7529-396-7 (ISBN)
Public defence
2021-09-17, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2021-06-17 Created: 2021-06-17 Last updated: 2022-08-24Bibliographically approved

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Nyman-Carlsson, ErikaEngström, IngemarGustafsson, Sanna Aila

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