Page 9 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg
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  9
 Chapter 1
Introduction
This thesis is about the effectiveness of psychological treatments for adult patients with eating disorders, a range of psychiatric disorders for which treatment outcome is still rather poor. Since 1996, when I first started working with eating disorder patients, I was struck by the profound impact eating disorder psychopathology has on daily life of the women and men seeking treatment. For patients with anorexia nervosa, in particular, there is considerable room for improvement when it comes to remission rates. This motivated us to seriously reconsider the treatment we were offering to patients with anorexia nervosa at Novarum, the center for eating disor- ders & obesity in Amsterdam, were I started working in 2003. For anorexia nervosa, only a limited number of specialized psychological treatments is available and, as research on their clinical outcome is still at an early stage, findings about their effica- cy are inconclusive as solid research on clinical outcome is still early. Exploring liter- ature on the efficacy of psychological treatments of anorexia nervosa was a rather humbling experience, which will be discussed in the first part of this thesis.
The second part of this thesis focuses on the effectiveness of cognitive behavior therapy-enhanced (CBT-E), a psychological treatment developed by Professor Fair- burn et al. at Oxford University, which, due to its richness, impressed us at Novarum. The reported outcome of two CBT-E, academic efficacy studies run by Fairburn et al. in 2009 (including normal weight eating disorder patients) and in 2013 (including underweight patients from BMI 17.5 onwards) were promising. With regard to feasi- bility of CBT-E, in 2011, an Australian CBT-E effectiveness study including low weight patients, set in a routine setting, showed findings in line with the 2009 CBT-E original efficacy study (Byrne et al., 2011). In 2013, an Italian inpatient efficacy study including severely underweight patients was published, in which the inpatient unit of an eating disorder treatment center was redesigned according to CBT-E key principles (Dalle Grave, 2012; Dalle Grave et al., 2013).
After being trained by Professor Fairburn, we started planning implementation of CBT-E throughout Novarum, hoping that, in line with earlier findings, changing to offering empirically supported treatment interventions might improve clinical outcome (Kazdin, Fitzsimmons-Craft, & Wifley, 2017; Waller & Turner, 2016). In 2015, we redesigned our treatment center according to CBT-E principles and started offer- ing CBT-E to all our inpatients and outpatients with anorexia nervosa, bulimia nervo- sa, binge eating disorder or with other specified feeding or eating disorders. After the implementation, we examined whether outcomes of academic trials can be repli-
 




























































































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