Page 134 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

134 Chapter 7
The present chapter provides a discussion on the main findings of the studies included in the three parts of the thesis, and some concluding remarks. It concludes by discussing methodological issues, suggestions for further research, and implica- tions for clinical practice.
Part I
Treatment of anorexia nervosa
For adults with anorexia nervosa, treatments are limitedly effective. For recom- mended specialized psychological treatments, the therapy results also seems very modest (Waller, 2016). As mentioned earlier, there is a lack of evidence for the supe- riority of specialized psychological treatments over non-specialized, control treat- ments (Zeeck et al., 2018; Murray, Quintana, Loeb, Griffiths, & Le Grange, 2019). The aim of the study presented in Part I, was therefore to expand the evidence base of specialized treatments by conducting a meta-analysis including RCTs on recently developed, specialized treatments.
Main findings
In the meta-analysis, 17 studies were included, six of them (35%) were assessed as having a low risk of bias and so regarded as high-quality studies. Three of the 17 studies were solely inpatient studies, though in several included outpatient studies, patients were hospitalized during participation in the trial. In six of the included 17 studies, at least one of the arms consisted of a recommended treatment for adults with anorexia nervosa (Royal Australian and New Zealand College of Psychiatrists, 2014; National Institute for Health and Care Excellence, 2017). The recommended eating-disorder-focused CBT (CBT-E, Fairburn 2008) and Maudsley Anorexia Nervo- sa Treatment for Adults (MANTRA, Schmidt, Wade & Treasure, 2014) were includ- ed in the psychological treatment condition, the recommended Specialist Support- ive Clinical Management (SSCM; McIntosh et al., 2006) was included in the control condition. Two main end-of-treatments outcomes were assessed, weight gain and improvement of eating disorder pathology; improved quality of life was a secondary outcome measure.
Findings of meta-analyses indicate no differences between psychological treat- ments and control conditions on weight gain, on eating disorder pathology or on quality of life.
Studies which included patients over 18 years were more effective on weight gain than studies also including younger patients. In high-quality studies and in studies in