A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up

Abstract

BackgroundNo specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12 weeks of daycare, regarding recovery and risk of relapse up to five years.MethodsPatients with a full, sub-threshold or partial AN diagnosis from an adult eating disorder unit at a hospital were randomized to ACT (n = 24) and TAU (n = 19). The staff at the hospital, as well as the participants, were unaware of the allocation until the last week of daycare. Primary outcome measures were body mass index (BMI) and specific eating psychopathology. Analyses included mixed model repeated measures and odds ratios.ResultsGroups did not differ regarding recovery and relapse using a metric of BMI and the Eating Disorder Examination Questionnaire (EDE-Q). There were only significant time effects. However, odds ratio indicated that ACT participants were more likely to reach good outcome. The study was underpowered due to unexpected low inflow of patients and high attrition.ConclusionLonger treatment, more focus on established perpetuating factors and weight restoration integrated with ACT might improve outcome. Potential pitfalls regarding future trials on AN are discussed. Trial registration number ISRCTN 12106530. Retrospectively registered 08/06/2016.

Advances in the treatment of anorexia nervosa: a review of established and emerging interventions

“…However, many of the more established treatments also explicitly target these processes. Drop-out from some of these newer treatments appears to be quite high (Wildes et al 2014; Parling et al 2016). All in all, it remains to be seen, whether these new multi-component treatments have specific advantages over other psychological interventions.…”

“…A related approach is Acceptance and Commitment Therapy ( ACT ), which involves a range of experiential exercises and aims to promote emotional awareness and acceptance as well as adaptive values and goals. ACT has been examined as a potential treatment for AN in one small RCT (Parling et al 2016). No difference was found between ACT and TAU.…”

The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review

“…Acceptance and commitment therapy. To date, only one RCT of ACT for eating disorders has been conducted (Parling, Cernvall, Ramklint, Holmgren, & Ghaderi, 2016). In this study, individuals with AN were randomized to either a 19 session ACT-based intervention (n=24) or to a TAU condition (n=19).…”

Recent advances in therapies for eating disorders

“…The ACT formulation appears to be well suited to addressing some of the underlying maladaptive cognitions and behaviors that are associated with eating disorders 31 . Yet, despite earlier case studies with preliminary support for the treatment 32 , more recent evidence has not shown ACT to perform above and beyond TAU 33 . In 2017, Juarascio et al 34 published results of a pilot study examining the effects of an ACT adaptation for BED.…”