Effectiveness of enhanced cognitive behavioral therapy (CBT-E) for eating disorders: study protocol for a randomized controlled trial

Abstract

BackgroundWhile eating disorder not otherwise specified (EDNOS) is the most common eating disorder (ED) diagnosis in routine clinical practice, no specific treatment methods for this diagnosis have yet been developed and studied. Enhanced cognitive behavioral therapy (CBT-E) has been described and put to the test as a transdiagnostic treatment protocol for all EDs, including EDNOS. Initial research in the UK suggests that CBT-E is more effective for EDs, especially bulimia nervosa (BN) and EDNOS, than the earlier version of CBT. These positive results of CBT-E have to be replicated in more detail, preferably by independent researchers in different countries. Being the first Dutch study into CBT-E, the results from this national multicenter study – on three sites specialized in EDs – will deliver important information about the effectiveness of CBT-E in several domains of ED pathology, while providing input for the upcoming update of the Dutch Multidisciplinary Guideline for the Treatment of Eating Disorders.Methods/designA multicenter randomized controlled trial will be conducted. One hundred and thirty-two adult outpatients (aged 18 years and older) with an ED diagnosis and a Body Mass index (BMI) of between 17.5 and 40 will be randomly allocated to the control or the intervention group. Subjects in the control group will receive Treatment as Usual (standard outpatient treatment provided at the participating sites). Subjects in the intervention group will receive 20 sessions of CBT-E in 20 weeks. The design is a 2 (group) × 5 (time) repeated measures factorial design in which neither therapists nor patients will be blinded for treatment allocation. The primary outcome measure is recovery from the ED. Secondary outcome measures include ED psychopathology, common mental disorders, anxiety and depressive symptoms, health-related quality of life, health care use and productivity loss. Self-esteem, perfectionism and interpersonal problems will be examined as putative predictors and mediators of the effect of treatment. Also, an economic evaluation from a societal perspective will be undertaken. All relevant effects, direct and indirect costs will be included. Utility scores will measure the effects. Measurements will take place at pretreatment, 6 weeks, 20 weeks, 40 weeks and 80 weeks.DiscussionThis effectiveness study into CBT-E has the aim of broadening the scope and generalizability of former studies. If CBT-E appears to be at least as effective as traditional diagnosis-specific treatments for a broad range of ED patients, training in one protocol would be sufficient for clinicians to treat patients with different kinds of EDs. It gives the opportunity to offer treatment for a severe mental disorder with fewer resources, thereby increasing the accessibility of specialized care for patients with an ED.Trial registrationNetherlands Trial Register, NTR4485. Registered on 2 April 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1716-3) contains supplementary material, wh...

Effectiveness of enhanced cognitive behavior therapy for eating disorders: A randomized controlled trial

“…The trial was also registered in the Netherlands Trial Register (NTR4485). For details of the rationale, design, methods, and procedure, we refer to de Jong et al ().…”

“…Moreover, there are no empirical data about the content, effectiveness and efficiency of treatments as usual (TAU). Independent ED experts in Belgium and the Netherlands have estimated that TAU for EDs is probably more intensive, longer‐term and less effective than CBT‐E (de Jong et al, ). If time‐limited CBT‐E is indeed at least as effective as TAU for a broad range of ED patients, then the effectiveness, efficiency and accessibility of an evidence‐based treatment for patients with an ED could be improved.…”

Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder

“…Cognitive behavioral therapy (CBT), as well as intrapersonal therapy (IPT), are considered standard effective therapies for eating disorders 7–9 . Like other psychiatric disorders, interdisciplinary approaches for treating eating disorders are often combined with pharmacotherapy 10 .…”

Becoming Known: A Relational Model Utilizing Gestalt and Ego State-Assisted EMDR in Treating Eating Disorders

“…Concomitantly, there must be psychotherapeutic attention to the mental, emotional, and relational challenges that are part and parcel of EDs. In the psychotherapeutic arena, preferred approaches to EDs have included cognitive behavioral therapy (de Jong et al, 2016;Linardon & Brennan, 2017;Murphy, Straebler, Cooper, & Fairburn, 2010), mindfulness (Cook-Cottone, 2016;Kristeller, Wolever, & Sheets, 2014), dialectical behavioral therapy, and awareness and commitment therapy ( Juarascio et al, 2013). Creative art-and body-based interventions have also found their way into ED treatment (Ressler, Kleinman, & Mott, 2010).…”