In 2005 a fascinating paper emerged from Christchurch, New Zealand that helped us look at the outpatient treatment of adults with anorexia. This paper started to compare Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) in the treatment of anorexia (broadly defined) and used a treatment as usual comparison group call Specialist Specific Clinical Management (SSCM). As has happened a few times in studies of eating disorders the comparison group, SSCM, appeared to be somewhat more effective in achieving a more positive global outcome than either CBT or IPT, at least for patients that completed treatment.
Looking at the clinical implications of the trial (rather than criticizing the methodology) of the study the results are interesting because SSCM is a little known and poorly disseminated treatment and yet is apparently one of the more effective theapies we have. For a link to the original article click here.
Frances Carter and colleagues have recently published a long term, 6-7 year, follow up study of the participants in this study. For a link to this study click here.
What the group found was the the at long term follow up around 50% of patients were in a (somewhat black and white) "good category" and 50% in the "poor"outcome category. Obviously, we would like better results, and need to keep working to obtain these, but this does mean that 50% of patients get well and stay well after 6 years following 20 sessions of a therapy six years previously.
Interestingly there were no differences between the types of therapy at long term follow up. This result is another that shows not all therapies are the same. Different therapies have different rates of improvement and stability duting follow up. Initially SSCM showed the better outcome but over the 6 year follow up period the outcome for SSCM declined. The outcome for those who received CBT remained satble from end of treatment to followup, whereas the IPT group improved (which is a consistent finding in terms of ongoing response from IPT from studies with bulimia nervosa).
One interpretation of these results would be it dosent matter what you do, (as long as it follows one of the three manualised therapies - I'm not advocating ecclectisism here). However, importantly one must consider the physical consequences of having anorexia nervosa. Maybe a quicker response in terms of weight gain and the more rapid alleviation of the physical symptoms is an important outcome in the treatment of anorexia nervosa. This seemed to have been best achieved by SSCM. However, over the intervening period of 6 years this outcome declined somewhat. It may be that the initial focus of the adult treatment of anorexia needs to be focused on eating and weight restoration, but then broadened to include other factors, including a focus on the interpersonal context of the eating disorders.
As usual, more research is needed into the treatment of adults with eating disorders. There is a large trial currently underway in Australia looking at comparing SSCM, CBT -E and MANTRA. For information about this trial click here.
Looking at the clinical implications of the trial (rather than criticizing the methodology) of the study the results are interesting because SSCM is a little known and poorly disseminated treatment and yet is apparently one of the more effective theapies we have. For a link to the original article click here.
Frances Carter and colleagues have recently published a long term, 6-7 year, follow up study of the participants in this study. For a link to this study click here.
What the group found was the the at long term follow up around 50% of patients were in a (somewhat black and white) "good category" and 50% in the "poor"outcome category. Obviously, we would like better results, and need to keep working to obtain these, but this does mean that 50% of patients get well and stay well after 6 years following 20 sessions of a therapy six years previously.
Interestingly there were no differences between the types of therapy at long term follow up. This result is another that shows not all therapies are the same. Different therapies have different rates of improvement and stability duting follow up. Initially SSCM showed the better outcome but over the 6 year follow up period the outcome for SSCM declined. The outcome for those who received CBT remained satble from end of treatment to followup, whereas the IPT group improved (which is a consistent finding in terms of ongoing response from IPT from studies with bulimia nervosa).
One interpretation of these results would be it dosent matter what you do, (as long as it follows one of the three manualised therapies - I'm not advocating ecclectisism here). However, importantly one must consider the physical consequences of having anorexia nervosa. Maybe a quicker response in terms of weight gain and the more rapid alleviation of the physical symptoms is an important outcome in the treatment of anorexia nervosa. This seemed to have been best achieved by SSCM. However, over the intervening period of 6 years this outcome declined somewhat. It may be that the initial focus of the adult treatment of anorexia needs to be focused on eating and weight restoration, but then broadened to include other factors, including a focus on the interpersonal context of the eating disorders.
As usual, more research is needed into the treatment of adults with eating disorders. There is a large trial currently underway in Australia looking at comparing SSCM, CBT -E and MANTRA. For information about this trial click here.
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