Page 82 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

82 Chapter 4
Implementation of CBT-E
In early 2015, after training all staff of all disciplines, the treatment center trans- formed the inpatient and the outpatient units into CBT-E based programs. Over a six months period, outpatient therapy groups and day-care programs were phased out. In the outpatient unit, the only psychological treatment offered was CBT-E Underweight, focused version. The complete implementation plan, including a description of the CBT-E based inpatient care, has been published previously (Van den Berg et al., 2017).
Therapist Training
During TAU, 24 psychologists, psychotherapists, psychiatrists and nurse practi- tioners delivered psychological treatments. Other staff members, 16 in total, consist- ing of psychiatric nurses, dieticians and a psychomotor therapist, delivered partial treatment interventions within the intensive settings.
Before implementing CBT-E, all staff completed the web based CBT-E training and exam offered by Centre for Research on Eating Disorders at Oxford and worked through the guide (Fairburn, 2008). In addition, the staff attended two workshops run by C. Fairburn. Since CBT-E Underweight is difficult to master, only after completing around 15 CBT-E normal weight, staff members were allowed to offer CBT-E Under- weight for outpatients after working through the additional digital CBT-E Underweight modules. During CBT-E, outpatient treatments were delivered by 13 therapists, in the inpatient unit 11 staff members delivered partial interventions; these 24 staff members also delivered treatment during TAU. Throughout 2015-2017, to maximize adherence, all therapists attended a weekly, two hour peer intervision, supervised by senior therapists. Case load records were used to ensure all patients were discussed regularly. To monitor adherence, audiotaped sessions were randomly reviewed.
Statistical analysis
Statistical analyses were performed with SPSS version 25 and the R statistical computing environment. Group differences for continuous data were expressed as mean difference, categorical data as difference in proportion. Categorical measures between two groups were compared using chi-square or Fisher’s exact tests (as appropriate); to compare continuous data, t-tests or Mann-Whitney U tests were used. Differences within groups were compared using paired t-tests for continuous data. Statistical significance was defined as α=.05, two-sided, with 95% confidence intervals (CI) to express data uncertainty. To analyze repeated continuous outcomes, linear mixed model analyses were conducted according to a two-level structure