Page 142 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

142 Chapter 7
Suggestions for further research on bulimia and on binge eating disorder differ from anorexia nervosa. In contrast to anorexia nervosa, the efficacy and effectiveness of CBT-E for bulimia and binge eating disorder are well established and, as the cost-effectiveness study in Part II suggests, cost-effectiveness also appears promising. For bulimia, in order to enhance treatment effects, research is needed on identify- ing possible moderating and mediating factors of treatment effect. For binge eating disorder research could focus on lowering the dose in which treatment can be offered while maintaining the same outcome; literature suggests the regularly used 20 face-to- face sessions therapy may be reduced in number of sessions offered and/or through the way it is delivered (National Institute for Health and Care Excellence, 2017; Waller, 2016). Examining clinical outcome and cost-effectiveness of a less intensive treatment, whether or not partly digital, may also be interesting. The findings in Part III indicate that the treatment of binge eating disorder pathology in patients who are severely obese, appears to be more challenging compared to normal weight eating disorder patients.
Recommendations for clinical practice
As both included effectiveness studies did not take place within the limiting context of a selective clinical trial, with a select group of therapists, but involved all staff members, findings may be generalizable to other real-world inpatient and outpatient settings. Findings of the anorexia nervosa study and of the normal weight eating disorder study may both boost implementing specialized treatments. For normal weight eating disorder patients, cost-effectiveness, an important factor, favors CBT-E compared to treatment-as-usual. With regard to the anorexia nervosa study, improved weight gain and a comparative lower dropout rate during the CBT-E period, are important benefits; the higher costs found are reasonable and justify broader use of CBT-E.