Page 136 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg
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  136 Chapter 7
 unit, a range of multifarious interventions is offered, multiple times per day, for multiple days per week (Thompson-Brenner et al, 2018), and this is true for both a specialized inpatient condition and for a treatment-as-usual inpatient condition.
Despite these factors reminding us to be cautious stating that psychological treat- ments do not seem to be superior to control treatments, added value of those psycho- logical treatments has not been detected, not even in high-quality, controlled outpa- tient studies on recently developed therapies. Thus, it may be fair to say that the psychological treatments MANTRA and CBT-E, and the optimized control condition SSCM which all three are recommended in clinical guidelines, may lack evidence to support their recommendation (Royal Australian and New Zealand College of Psychiatrists, 2014; National Institute for Health and Care Excellence, 2017; Zorg- standaard Eetstoornissen, 2017). The Dutch guideline on eating disorders however, recommends MANTRA, CBT-E and SSCM partly because they are manual-based, as opposed to more eclectic, non-manual based approaches.
Limitations
A general limitation of the meta-analysis presented in Part I, arises from the paucity of therapy research on anorexia nervosa, as a consequence, only a small number of eligible studies could be included, and even smaller number of those studies could be assessed as a high-quality study.
Asecondlimitationarisesfromthenatureofanorexianervosatreatmentswhereby, in a randomized controlled trial, both control conditions and specialized treatments partially overlap, potentially limiting the extent to which eventual additional benefits of psychological interventions can be detected, as is discussed in the previous paragraph.
In none of the three included inpatient controlled trials, the treatment method offered within the inpatient unit was included as a variable of interest. In those three inpatient studies, patients were allocated to specific short-term modules superim- posed on general medical and psychotherapeutic inpatient care (Pillay & Crisp, 1981; Geist, Heinmaa, Stephens, Davis, & Katzman, 2000; Wade, Frayne, Edwards, Robertson, & Gilchrist, 2009). In the one controlled study in which inpatient care was compared with outpatient care, inpatient care was offered by different services and was labeled “multidisciplinary psychiatric inpatient treatment approach”, suggesting that eclectic care was offered (Gowers et al., 2007).
In the outpatient trials included in the meta-analysis, randomized patients were either withdrawn from the study, or their participation was temporally interrupted



























































































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