Page 156 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

156 Chapter 8
training. At the same time, in sensitivity analyses including high-quality studies only, no differences between psychological and control conditions were found.
Our hypothesis that specialised psychological treatments would be superior to control conditions was not met. It may, however, be premature to state that special- ized, recommended treatments lack sufficient strength compared with control treat- ments. Due to the lack of high-quality randomized controlled trials, the number of eligible studies which can be included in a meta-analysis is limited. In addition, the found high heterogeneity may have confounded findings; due to this high hetero- geneity two, potential powerful, outlier studies on recently developed treatments had to be excluded from the analyses. Furthermore, one reason hindering detecting additional benefits of psychological treatments has to do with the nature of control conditions. Key interventions as nutritional & physical rehabilitation and engaging patients in participating in weight restoration, are offered within every treatment (Hay et al., 2015), including in control conditions. Consequently, comparative research treatment conditions inevitably overlap.
Further methodologically sound, clinical research is needed to be able to substan- tially broaden the evidence base of psychological treatments for anorexia nervosa.
Part II
Status Cognitive behavioral therapy-Enhanced
Examining effectiveness and cost-effectiveness of offering CBT-E compared to treatment-as-usual
The second part of this thesis examines the effectiveness and the cost-effective- ness of Cognitive behavior therapy-Enhanced (CBT-E), an evidence-based psycho- logical treatment developed by C. Fairburn et al. from Oxford University (Fairburn, 2008). Novarum replaced their previously offered eclectic treatment-as-usual with CBT-E, in their outpatient and their inpatient units. Chapter 3 presents a consecutive cohort study in which differential (cost-)effectiveness of treatment-as-usual and CBT-E for patients with bulimia, binge eating disorder or other specified feeding or eating disorder and a body mass index over 17.5 kg/m2 was examined. Chapter 4 presents findings on examining differential (cost-)effectiveness of CBT-E compared to treatment-as-usual, for patients with anorexia nervosa.
We hypothesized that both effectiveness and cost-effectiveness would be superior in the CBT-E cohort, both for underweight patients and for normal weight patients. We assumed that, in line with the literature, offering a specialized psychological treat- ment would enhance clinical outcome compared with offering an eclectic treatment