A 10-year follow-up study of completers versus dropouts following treatment with an integrated cognitive-behavioral group therapy for eating disorders

Abstract

BackgroundCognitive-behavioral therapy (CBT) has been recommended for the treatment of eating disorders, and group therapy is known to have certain advantages over individual therapy. The aim of the current study was to compare the 10-year prognosis of patients who completed integrated group CBT with those who dropped out and to examine the effect of completion of group CBT on the prognosis.MethodsThe participants were 65 adult patients with eating disorders. All patients were women and Japanese. The average age (19–37) of the patients was 25.1 ± 3.8 years, and the average body mass index (BMI) was 17.7 ± 2.0. We conducted integrated group CBT with the patients and compared eating disorder symptoms, mood states, coping styles, and self-esteem before and after therapy. Furthermore, we compared clinical features and the 10-year prognosis of patients who completed the treatment and those who dropped out.ResultsAfter 10 sessions of group therapy, Eating Attitudes Test scores, Profile of Mood States depression scores, and Coping Inventory for Stressful Situations emotion-oriented scores decreased, while Rosenberg’s Self-Esteem Scale scores increased. Regarding the results of the 10-year follow up, the completer group had more patients with a good prognosis. In contrast, the dropout group had more patients with a poor prognosis.ConclusionsThose who completed the integrated group CBT had a good prognosis. Group therapy gives the patients an opportunity to form peer relationships, and helps them to develop communication and socialization skills. Furthermore, in the group therapy sessions, the patients develop self-awareness by listening to other members of the group and they also develop interpersonal relationships. This effect may be temporary, but experience of group therapy may provide hope for the patient and increase the chance of the patient continuing treatment.Trial registrationRetrospectively registered in University Hospital Medical Information Network in Japan: No. 000028868 (May 19th, 2017).

The effectiveness and cultural adaptations of psychological interventions for eating disorders in East Asia: A systematic scoping review

“…Assertiveness training was included as authors noticed that Japanese individuals with ED were not assertive (Okamoto et al, 2017;Shiina et al, 2005); addition of make-up technique session (Kong, 2005).…”

“…Adapting individual treatments to group treatments. This is due to the lack of specialist treatment centres and trained personnel, yet the demand was high (Okamoto et al, 2017); It was less costly to patients given the healthcare system was not free (Gu et al, 2021;Okamoto et al, 2017); Group treatments can help build confidence and for Japanese individuals to feel less guilty about having an ED (Okamoto et al, 2017) Use of lower intensity treatments (e.g., guided self-help) to increase access due to the lack of specialized services in the community (Setsu et al, 2018); Shortening of treatment to 10 sessions (e.g., Shiina et al, 2005) to make treatment more affordable and acceptable, as some people lived far away (Gu et al, 2021) Theoretical framework Use of the Formative Method for Adapting Psychotherapy (FMAP) when culturally adapting treatment (Hamatani et al, 2022, b) lack of specialist treatment centres, so that trained clinicians could see more patients (Okamoto et al, 2017). Another reason for shortening treatments, was to make them more affordable, as most healthcare systems described were not free and people lived far away from any specialist centres (Gu et al, 2021).…”

“…For AN interventions, within-group, studies found significant improvements in ED psychopathology (Amemiya et al, 2012;Gu et al, 2021;Kim et al, 2019). However, in one of the RCTs which compared group CBT with treatment as usual (TAU), results in both groups were comparable (Gu et al, 2021) symptoms (Hamatani et al, 2019;Kwag et al, 2022;Okamoto et al, 2017;Setsu et al, 2018). However, despite the moderate to large effect sizes, the results were not significant in Hamatani et al (2019), likely due to low power.…”

Changes in Eating Attitudes and Risk for Developing Disordered Eating Behaviors in College Students with Subthreshold Eating Disorders: A Cohort Study

“…Peterson et al [30] reported that stress reactivity appears to be especially important for understanding EDs. We previously reported that patients with EDs showed that depressive symptoms and stress coping were improved following treatment [31]. However, there are few studies showing the relationship between subthreshold EDs and stress coping.…”

Cohort survey of college students’ eating attitudes: interventions for depressive symptoms and stress coping were key factors for preventing bulimia in a subthreshold group

“…Interventions for depression are important because individuals with eating disorders are often suicidal. In addition, we previously reported on the relationships between eating disorders, depressive symptoms and stress coping, and the results showed improvements following treatment [ 23 , 24 ]. We hypothesized that partial symptoms of bulimia would appear early and would be related to depressive symptoms; in addition, this tendency would be noticeable in female students.…”