Page 135 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 7 135
which therapist training was reported, larger effects were found on both weight gain and on quality of life, compared to low quality studies and studies without reported training. At the same time, in sensitivity analyses including high-quality studies only, no differences between psychological and control conditions were found. Subgroup analyses on outpatient studies only, did not lead to a different finding either. A meta-regression analysis on year of publication did also not show any differences between psychological and control conditions.
Our hypothesis that the meta-analysis would indicate that specialised psycholog- ical treatments would be superior to control conditions was not met.
The finding of not being able to establish a superiority of psychological treatments over control treatments, is in line with the literature (Hay et al., 2015; Zeeck et al., 2018). Including RCTs on the recently developed psychological treatments MANTRA and CBT-E Underweight, did not lead to different findings. Subgroup analyses on treatment arms including the optimized control condition SSCM versus other control conditions, did not show a difference in pooled effect size either, nor on weight gain, on eating disorder pathology or on quality of life.
Understanding the lack of difference on clinical outcome between specialized treatments and treatment-as-usual
Our findings may suggest that even recently developed, well thought through, manual-based psychological treatments lack sufficient strength for added value to be detected compared with control conditions, despite the fact that they are recom- mended treatments in both national and international guidelines (Zorgstandaard Eetstoornissen, 2017; Royal Australian and New Zealand College of Psychiatrists, 2014; National Institute for Health and Care Excellence, 2017). However, stating that specialized, recommended treatments lack sufficient strength superiority over control treatments to be established, may be premature. Due to the paucity of high-quality randomized controlled trials, the number of eligible studies which could be included in a meta-analysis was limited. Next, the found high heterogeneity may have confounded findings; due to this high heterogeneity two, potential power- ful, outlier studies on recently developed treatments had to be excluded from the analyses. In addition, the nature of control conditions gave rise to another difficulty with detecting additional benefits of specialized psychological treatments. Since key interventions as nutritional & physical rehabilitation and engaging patients in partici- pating in weight restoration are offered within every treatment (Hay et al., 2015), also in control conditions, within a randomized controlled trial, the different research conditions inevitably overlap. With inpatient research conditions, establishing additional benefits of specialized treatment is even more challenging. In an inpatient