Treating severe and enduring anorexia nervosa: a randomized controlled trial

Touyz, Stephen; Grange, Daniel Le; Lacey, Hubert; Hay, Phillipa; Smith, Rebecca; Maguire, Sarah; Bamford, Bryony; Pike, Kathleen M.; Crosby, Ross D.

doi:10.1017/s0033291713000949

Cited by 238 publications

(247 citation statements)

References 34 publications

(39 reference statements)

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“…Only in later incarnations of CBT for different eating disorders (Fairburn, 2008;Gowers & Green, 2009;Touyz et al, 2013;Waller et al, 2007) has there evolved a consistent recommendation that the therapist should always weigh the patient within the session, whatever the nature of their disorder, and that this weight should be discussed with the patient overtly. Even then, this pattern is not replicated in more meta-cognitive approaches, where weighing is not specified as a task of therapy at all (e.g., Cooper et al, 2009).…”

Section: __________________________mentioning

confidence: 99%

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why

Waller

Mountford

2015

Behaviour Research and Therapy

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Section: __________________________mentioning

confidence: 99%

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why

Waller

Mountford

2015

Behaviour Research and Therapy

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“…127,156 Comparison of our data against these trials is difficult. One of these trials was carried out in patients with a significantly milder form of AN (baseline mean BMI of 17.3 kg/m 2 ), 127 and the other specifically focused on chronic patients (mean illness duration of 15.5 and 17.7 years in the CBT and SSCM group, respectively).…”

Section: Comparison Of Main Findings With Those Of Other Trialsmentioning

confidence: 91%

“…One of these trials was carried out in patients with a significantly milder form of AN (baseline mean BMI of 17.3 kg/m 2 ), 127 and the other specifically focused on chronic patients (mean illness duration of 15.5 and 17.7 years in the CBT and SSCM group, respectively). 156 In the McIntosh study, SSCM BMI outcomes were superior to CBT and IPT BMI outcomes at end of treatment, but not at long-term follow-up. 157 In the Touyz et al…”

Section: Comparison Of Main Findings With Those Of Other Trialsmentioning

confidence: 94%

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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“…In a multisite (Sydney, Australia, and London, UK) randomized controlled trial, Touyz et al [8] compared CBT and specialist supportive clinical management in 63 female patients with severe and enduring anorexia nervosa (at least a 7-year illness history). All patients met the DSM-IV criteria for anorexia nervosa, excluding criterion D (amenorrhea) - this actually conforms to the DSM-5 diagnosis, which does not require the presence of amenorrhea.…”

Section: Anorexia Nervosamentioning

confidence: 99%

Clinical Factor 2013

Balon

2014

Psychother Psychosom

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Treating severe and enduring anorexia nervosa: a randomized controlled trial

Abstract: Patients with SE-AN can make meaningful improvements with both therapies. Both treatments were acceptable and high retention rates at follow-up were achieved. Between-group differences at follow-up were consistent with the nature of the treatments given.

Cited by 238 publications

References 34 publications

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Clinical Factor 2013

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