We have known for a while that early change in eating behaviours is correlated with a better outcome in target behaviours, and that this is common across most disorders. There are some studies that indicate having a good outcome from CBT is associated with changes in anxiety and depression, impulsive behaviour and harm avoidance. However, is the impact of early symptom change predictive of a better overall outcome?
A recent study by Turner et al. (2016) in Behavior Research and Therapy investigated if mood and personality changes are effected by early symptom changes in an eating disorder outpatient community. A total of 179 outpatients engaged in a CBT program completed measures of anxiety and depression and “Personality Beliefs”, which identifies beliefs associated with personality disorders. Rapid change was defined as changes in eating psychopathology (as rated by the Eating Disorders Examination (Questionnaire) after six sessions.
As was predicted by the authors, early behaviour change in eating psychopathology resulted in positive changes to anxiety/depression scores and personality disorder pathology scores. The most significant result of early symptom change was found on the personality questionnaire. Early reductions in restraint were related to changes in “Cluster B” personality (Histrionic and Borderline) and also in “Cluster C” personality (Avoidant, Obsessive Compulsive and Dependent). Of interest is that where there was an early change in eating disorder thoughts (such as body image concerns) this was negatively associated with changes in personality pathology. The authors reflect that this may be a disadvantage of therapeutic drift away from a focus on early behaviour change. This finding would need to be replicated to see if that conclusion holds.
I know I am showing selective bias in summarizing this paper. It adds to a bunch of studies that show that early behaviour change – which is the focus of CBT and FBT – leads to better outcomes. If therapy does not initially start with a behavioural focus there is a need to question why. Of course, not all patients will be able to achieve early behavioural change. My inclination is to look at where the patient is on the stages of change and work at increasing readiness to change. I suspect the authors of this study would disagree and suggest that taking a motivational approach reduces the focus on early behaviour change and does a disservice to the patient. The question then is, if you aren’t able to achieve early behaviour change what do you do? This is a question for the whole ED community – therapists, researchers, families and those suffering from the illness.
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