Page 137 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 7 137
when they had to be admitted. Consequently, an important element of treatment, which for severely underweight patients inevitably still includes a period of hospita- lization, was not included and clinical findings of the inpatient stay were excluded from outcome analyses. Possible additional clinical benefits of an inpatient stay designed according to a specialized treatment method could also not be examined.
Suggestions for further research
For anorexia nervosa, replicating randomized clinical trials including conditions on MANTRA, SSCM and on CBT-E, may be valuable for further research. Ideally, to lower heterogeneity, those replicating RCTs should be on homogenous patient groups, using standardized outcome measures. To avoid possible researcher alle- giance, those controlled trials should preferably not be conducted by the original team developing one of the specialized treatments.
It would also be of particular interest to conduct inpatient RCTs on specialized psychological treatments. Being hospitalized is a regular element of recommend- ed treatment for severely underweight patients, and to examine the efficacy of an anorexia treatment, clinical outcome of all parts of care should considered; inpatient care as well as the offered outpatient care. For an inpatient condition to be included in a RCT, it is essential that the interventions of the inpatient program are recogniz- able as specialized treatment and are, if possible, distinguishable from treatment-as- usual interventions. The inpatient program should therefore be designed according to key principles of the specialized psychological treatment, and all multidiscipli- nary staff should be properly trained in order for all to work in univocally. To our knowledge, up till now, few of the recommended specialized treatments have been tested in RCTs as the basis of residential or day-hospital programs (Thompson-Brenner et al., 2018).
When designing a randomized controlled trial including severely underweight patients, due to the high medical risks associated with underweight, medical ethical committees will not approve a waiting list condition in the trial, patients who are severely underweight cannot be allocated to a waiting list condition. Consequently, as severe patients will always be offered some kind of support aimed at nutritional and physical stabilization as discussed earlier, some overlap between an active and a comparative condition is inevitable.
Finally, exploring moderating is a direction for further research, enabling the field of eating disorder to move to a precision medicine approach in which therapists will be able to match treatments in order to optimize outcome.