Page 25 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 2 25
Abstract
Objective: This meta-analysis examines the efficacy of recently developed psycho- logical treatments for anorexia nervosa, compared with control condition. Outcome criteria are weight gain, eating disorder pathology and quality of life.
Method: Twelve thousand nine hundred ninety-seven abstracts, published between 1980 and 2017, were retrieved. End-of-treatment data from 1,279 partici- pants, from 15 of 17 eligible studies, were used to calculate pooled effect sizes (Hedg- es’ g) for outcome using random-effects model. Subgroup analyses were used to explore the influence of various patient- and study characteristics.
Results: No significant differences between psychological treatment and controls were found on weight gain, g = 0.07, 95% CI [-0.09, 0.23], eating disorder pathology, g = 0.06, 95% CI [-0.10, 0.21] and quality of life, g = -0.11, 95% CI [-0.36, 0.15]. Studies including only patients over 18 years of age were more effective on weight gain than studies including adolescents as well. High-quality studies and studies with reported therapist training, had larger effects on weight gain and quality of life compared with low-quality studies and studies without reported training.
Conclusions: Despite progress in the development of specialized treatments, the efficacy of psychological treatment over an active control condition could not be established. Outcomes, however, are obscured by low-quality and heterogenous studies.
Introduction
Anorexia nervosa is a mental disorder with a poor prognosis (Galsworthy-Francis & Allan, 2014) and significant impact on the psychological and physical well-being of affected individuals (Hay et al., 2014). Anorexia nervosa has one of the highest mortality rates of all mental disorders (American Psychiatric Association, 2006). The American Psychiatric Association DSM-5 diagnostic criteria for anorexia (American Psychiatric Association, 2013) include self-imposed or maintained weight loss such that the person is underweight (for age and height) and associated over-evaluation of (the control of) shape and weight.
Although there is a growing body of evidence that supports the efficacy of family treatment for adolescents and children, (Hay et al., 2014; NICE, 2017), there is a lack of high-quality evidence to guide the clinician in the treatment of adults who have anorexia nervosa. Specialized psychological treatments have not proven to be more effective than routine treatment control conditions (Fairburn, 2005). When compar-