Page 17 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 1 17
At the same time, a psychological, specialized treatment method offers a frame- work, a language in which the multifarious interventions are offered, rather than the eclectic framework usually offered in control conditions. As an eclectic approach may dilute the efficacy of the interventions offered, we hypothesized that a special- ized treatment would enhance clinical outcome.
Part II includes Chapter 3 and Chapter 4 which examine the effects of the CBT-E implementation in 2015 within the outpatient and inpatient settings of our treat- ment center. In these chapters, two consecutive cohort studies are presented, using a nonequivalent control group pretest-posttest design in consecutive cohorts, in which we examined differential effectiveness and cost-effectiveness between two cohorts, one was offered treatment-as-usual, thereafter, the next cohort was offered CBT-E.
The first cohort of outpatients and inpatients received optimized treatment-as-usu- al between 2012-2014, the next cohort of all referred outpatients and inpatients was offered CBT-E between 2015-2017. The aims of the studies presented in Chapter 3 and 4 were twofold; first, to examine whether similar treatment outcomes as in CBT-E efficacy studies can be found in a real-world setting. Second, we examined differ- ential cost-effectiveness of CBT-E compared to treatment-as-usual. Examining cost- effectiveness of recommended, specialized treatments beside effectiveness is valu- able (Crow et al., 2013), and may contribute to decision making on what treatment best to offer in clinical practice. Cost-effectiveness studies in the field of eating disor- ders are rare.
Chapter 3 examines differential (cost-) effectiveness for eating disorder patients with a body mass index (kg/m2) over 17.5, and Chapter 4 examines differen- tial outcome for patients with anorexia nervosa who regularly get to be admitted in an inpatient unit in the course of their treatment. We hypothesized that for both normal weight eating disorder patients and underweight eating disorder patients, CBT-E would be superior to treatment-as-usual, both on effectiveness and on cost- effectiveness, as we assumed that offering a specialized psychological treatment would enhance clinical outcome compared to a more eclectic approach. As out- patient CBT-E treatment has a fixed duration, and as the duration of the CBT-E based inpatient stay is limited by nature, we assumed a reduction in direct treatment costs in both the CBT-E normal weight and the underweight cohorts.
In Part III, including the Chapters 5 and 6, the focus shifts from underweight eating disorders and normal weight eating disorders to obesity. Both chapters focus on the psychological and behavioral factors associated with effects of bariatric surgery. A brief report is presented in Chapter 5 describing how, from 2004 onwards, when the knowledge of the association between psychological and behavioral factors and clinical outcome after bariatric surgery was still limited, Novarum developed a