Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review

Abstract

Background: Efficacy studies on the treatment of anorexia nervosa (AN) in childhood and adolescence are scarce and systematic reviews are almost non-existent. Objective: Systematic review of the literature regarding the modalities of psychological intervention based on evidence used in the treatment of AN in childhood and adolescence. Methods: The research was carried out in the databases: PubMed, PsycINFO and Cochrane, using the combined keywords: anorexia nervosa and evidence-based therapy. Articles published between 1990 and 2015 were assessed. Results: Of the 139 eligible articles, 14 were selected, of which 10 (71.4%) were conducted in the United States and England. The sample ranged from 9 to 167 participants. Randomized Clinical Trial represented the most frequent design (n = 9; 63.4%), with more than half of the interventions structured in 20 or more sessions (n = 9, 64.3%). Nine types of treatments were tested, with the most tested being Family-Based Treatment (FBT) (n = 7; 50%). Interventions involving the family seem to be more effective, however, the rates for complete remission are modest. Discussion: Although evidence of efficacy was verified in the treatments analyzed, the limited number of studies, the various methodological limitations and the methodological heterogeneity between studies make the findings inconclusive.

Evidence-Based and Novel Psychological Therapies for People with Anorexia Nervosa

“…Additionally, there is a consensus that despite a growing evidence-base for treatments for anorexia and a preference for psychotherapy as treatment, there still remains no established leading treatment [9,80]. A number of treatment reviews conclude that among a variety of psychotherapies, including the aforementioned treatments recommended by the NICE guidelines, there is no convincing evidence to suggest one consistently superior intervention for treating adults, children or adolescents with anorexia nervosa [44,50,69,81]. This is largely due to the difficulty of trialling treatments for anorexia because of difficulty recruiting participants, high rates of patient drop-out or non-adherence to treatment and withdrawal from clinicians as a result of risk not being stabilised [50].…”

“…This is largely due to the difficulty of trialling treatments for anorexia because of difficulty recruiting participants, high rates of patient drop-out or non-adherence to treatment and withdrawal from clinicians as a result of risk not being stabilised [50]. Still, psychotherapies that include the family seem to be more promising and tentatively deemed most appropriate and preferred in the treatment of children and adolescents with anorexia [81].…”

“…For example, the severity of the illness makes recruiting participants challenging and participant that are recruited are almost always female only samples, with very few studies investigating the efficacy of treatments for males or minority groups with anorexia [50,126]. This leaves an absence of knowledge regarding the way males respond to treatment and the impact of culture, race, gender and sexuality on treatment, creating a large gap in the literature regarding the efficacy of treatments for males and minority groups with anorexia [81]. Additionally, drop-out rates are particularly high leading to small or incomplete data sets, or a lack of follow-up data.…”

Psychopathology and adaptive functioning of parents of adolescents with anorexia nervosa

“…Literature indicates that parents' participation in the treatment of their children with Anorexia Nervosa (AN) is associated with better prognosis 1 . In family-based treatment 2 , the most tested form of psychotherapy for AN in childhood and adolescence, parents are protagonists in the behavioral management for weight recovery and control of symptoms 3 .…”

Development, applicability and effects of a pilot program of group cognitive-behavioral therapy in Brazilian adolescents with anorexia nervosa

“…A recent systematic review 3 indicated that the most tested model of treatment in childhood and adolescence is family-based therapy (FBT) 4 , which is recommended by the international reference guidelines in mental health, such as those of the National Institute for Health and Clinical Excellence 5 . However, even this treatment modality may not be adequate for all families or patients 5 and the results are considered to be modest 3 . The authors of the study consider further studies to be needed due to the scarcity of clinical trials, the methodological weaknesses and the different designs tested.…”