Page 140 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

140 Chapter 7
for decision makers in the field of mental health, as it may speed up implement- ing empirically supported treatments like CBT-E. For patients, a shorter duration of treatment is beneficial and adds to better value based health care (Porter, 2010).
For anorexia nervosa, implementing CBT-E led to better weight gain at higher costs
Replacing offering treatment-as-usual by offering CBT-E for patients with anorexia nervosa seems to enhance weight gain, which is a main benefit of a psychological treatment. This found superiority on weight regain of CBT-E appears to be in contrast with the literature and also seemingly with the reported findings of the meta-analysis presented in Part I of this thesis. However, in none of the included inpatient condi- tions in the meta-analysis, were the inpatient units designed based on key principles of specialized psychological treatment (i.e. CBT-E), as was done in the inpatient unit of Novarum. It is possible, therefore, that the power of a specialized treatment may be strengthened when a similar treatment method is offered both during the inpa- tient stay and during the outpatient part of treatment.
With regard to the find higher costs in the anorexia nervosa sample, it is worth noting that the found direct treatment costs are still modest compared to interna- tionally reported treatment costs, for example the reported mean costs of € 13625,- for hospitalized patients in a German study (Stuhldereher et al., 2015). One of the drivers of the higher costs in the CBT-E cohort was the higher admission rat and, as staff grow more experienced in treating low weight anorexia nervosa patients on an outpatient base, the admission rate may eventually lower over time.
With the exception of weight gain, no differences in clinical outcome between CBT-E and treatment-as-usual were found
Changing Novarum, the treatment center in which the effectiveness studies took place, into a solely CBT-E based center was a huge effort; the intensive outpatient units were halted, as were all outpatient group-based therapy groups, two inpatient unites were merged into one, and an inpatient program had to be designed. All staff members had to be trained and a lot of effort continues to be spent on monitoring adherence to the method. From that perspective, the findings that, with the excep- tion of improved weight gain in the CBT-E period, no differences on clinical outcome were found, is probably humbling. On the other hand, as the treatment-as-usual previously offered in Novarum included various elements of cognitive behavioral therapy, establishing differences would have been challenging due to possible simi- larities in interventions offered during both periods.