Page 12 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

12 Chapter 1
2017). For adults with anorexia nervosa, eating-disorder-focused CBT, Maudsley Anorexia Nervosa treatment for Adults (MANTRA; Schmidt, Wade, & Treasure, 2014) and Specialist Supportive Clinical Management (SSCM; McIntosh et al., 2006) are the recommended psychological treatments (National Institute for Health and Care Excellence, 2017). There is a lack of evidence for prioritizing one specialized psychological treatment over the other (Hay, Claudino, Touyz, & Abd Elbaky, 2015). Furthermore, evidence is lacking for prioritizing specialized over non-specialized, control treatments regularly offered in routine practice (Zeeck et al., 2018; Murray, Quintana, Loeb, Griffiths, & Le Grange, 2019).
Treatment is being offered in outpatient, day patient (partial hospitalization), and inpatient settings, and no conclusive recommendations can be made with regard to optimum treatment setting (Madden, Hay & Touyz, 2015; Hay et al., 2019). Guidelines do however agree on hospital admission in case of high medical or psychiatric risk (Hay et al., 2019).
Anorexia nervosa is the most difficult to treat eating disorder, with outcomes for adult patients being weaker compared with non-underweight eating disorder patients (Waller, 2016). Around 30% of patients recover in the first decade of the disorder (Wonderlich, Bulik, Schmidt, Steiger, & Hoek, 2020) and recent data suggest that approximately another third of patients followed through a second decade will also recover (Eddy et al., 2017; Wonderlich, Bulik, Schmidt, Steiger, & Hoek, 2020). At the same time, reluctance to engage in treatment is common (Fairburn et al., 2013).
In clinical practice, making actual use of the recommended specialized treat- ments is slow, especially for (inpatient) underweight eating disorders patients, despite findings indicating that the use of evidence-based interventions can enhance clini- cal outcomes (Thompson-Brenner et al., 2018; Kazdin, Fitzsimmons-Craft, & Wifley, 2017; Waller & Turner, 2016).
Treating bulimia nervosa and binge eating disorder
For adult patients with bulimia nervosa, international guidelines recommend bulimia-nervosa-focused guided self-help, using cognitive behavioral self-help mate- rials for eating disorders. If guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, individual eating-disorder-focused cognitive behavioral therapy is recommended as preferred, empirically-supported treatment (Royal Australian and New Zealand College of Psychiatrists, 2014; National Institute for Health and Care Excellence, 2017). For adults with binge eating disorder, the National Institute for Health and Care Excellence recommends a binge-eating-dis- order-focused guided self-help program, based on cognitive behavioral self-help