Page 141 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

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Limitations
With regard to the (cost-) effectiveness studies presented Part II, the limitation of not being able to have included longer term effects of both underweight cohorts, has already been mentioned. Since, even after successful treatment, there is a high risk of relapse (National Institute for Health and Care Excellence, 2017), particularly with regard to the weight regain of underweight patients, examining follow-up data will be a valuable addition.
In 2015, when Novarum changed to CBT-E treatment, no published randomized controlled trial in which the efficacy of CBT-E Underweight was firmly established for anorexia nervosa patients was available. Redesigning the inpatient units according to CBT-E Underweight principles and changing all offered psychological interven- tions into CBT-E interventions could therefore be argued to be somewhat early. At the same time, waiting would take an excessive period, as definitively establishing the superiority of a psychological treatment for anorexia nervosa, is probably still some distance away.
Suggestions for further research
As mentioned in Part I, for nearly all severely underweight patients, a (short) period of hospitalization aimed at physical rehabilitation is an essential part of treatment, usually offered prior to further outpatient treatment. There are consid- erable differences in the nature of these hospitalizations with regard to offered treatment methods. How those differences relate to clinical outcome is rarely examined. Consequently, possible additional clinical benefits of an inpatient stay designed according to a specialized treatment method are yet to be examined. Since few of the recommended specialized treatments have been tested as the basis of a
residential program, within a randomized controlled trial (Thompson-Brenner et al., 2018), research on randomized controlled trials examining differences in inpatient, residential treatments, followed by a subsequent outpatient treatment using a similar treatment method, would be valuable. Clinical outcomes including both the inpatient stay and the subsequent outpatient treatment need to be examined. It would be of particular interest to test inpatient CBT-E within a randomized controlled trial, to examine whether the comparative improved weight gain of CBT-E found in Chapter 4, can also be established in a controlled study. First, specialized inpatient treatment programs could be compared with eclectic, general inpatient programs; next, specialized inpatient programs could be compared with other specialized inpatient
programs.