Page 132 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

132 Chapter 7
This thesis examines the effectiveness of psychological treatments for adults with eating disorders, from emaciated, underweight patients struggling with anorex- ia nervosa in part I, patients with bulimia or a binge eating disorder in Part II, to morbidly obese patients struggling with disturbed eating behavior in part III. For each different eating disorder classification, treatment effects vary considerably (Waller, 2016; De Jong, Schoorl & Hoek, 2018).
In Part I, we focused on psychological treatments for adults with anorexia nervosa, the eating disorder classification with the poorest treatment outcome. For anorexia nervosa, there is a lack of evidence for prioritizing one specialized psychological treatment over the other (Hay, Claudino, Touyz, & Abd Elbaky, 2015). Evidence is also lacking for prioritizing specialized over non-specialized, control treatments (Zeeck et al., 2018; Murray, Quintana, Loeb, Griffiths, & Le Grange, 2019). As recently new specialized treatments have been developed and their efficacy was being examined in high-quality randomized controlled trials, conducting a meta-analysis to examine whether the evidence base for specialized psychological treatments can be broad- ened, made sense. Part I of this thesis presents this meta-analysis.
Part II examines whether changing to offering a recommended psychological treatment to Novarum patients with the full range of eating disorders, would improve recovery rates, compared with care-as-usual. Besides being effective whether a treat- ment offers optimal health effects at the most reasonable costs is important. Conse- quently, differential effectiveness and cost-effectiveness of Cognitive behavioral therapy-Enhanced (CBT-E; Fairburn 2008) was compared with treatment-as-usual. In the first study in Part II differential (cost-) effectiveness was examined for patients with bulimia, binge eating disorder or other specified feeding or eating disorder. In the second study presented in Part II, the examined samples included patients with anorexia nervosa.
The number of published effectiveness studies examining the feasibility of recommended treatments is increasing, especially for patients with bulimia nervo- sa or binge eating disorder (Thompson-Brenner et al., 2018). With regard to treat- ments for anorexia nervosa, there is, however, a paucity of effectiveness studies. Despite findings that offering of recommended treatments in routine practice is feasible, in the field of eating disorders however, it is still uncommon to make actu- al use of recommended treatments (Thompson-Brenner et al., 2018). Not offering recommended treatments on a regular base may contribute to a suboptimal treat- ment effect, as clinical outcome may be enhanced by replacing the usually eclectic approach by so-called evidence-based practice (Waller & Turner, 2016).