Page 45 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 2 45
In recent guidelines SSCM is one of the psychological treatments to be considered (NICE, 2017). In this meta-analysis, SSCM is regarded a control treatment, in line with the original design in all RCTs but one (Touyz et al., 2013) including SSCM. Subgroups analyses did not show a difference in effect size on weight gain, eating disorder pathology or Qol between SSCM and other TAU conditions.
To our knowledge, there are no previous studies in line with our finding that for patients over 18 a larger effect on weight gain is found; former theorizing did postu- late that treatment targeted at adolescents was more efficacious (Murray et al., 2018). In the recent meta-analysis of Murray et al. (2018), age did not moderate treatment outcome. Zeeck et al. (2018) stated that psychotherapeutic interventions seemed to be more effective in terms of weight gain for adolescents. In both studies, however, it is unclear whether “adolescent” was strictly defined as being under 18. With the small number of included high-quality studies, it’s of interest, when more high-quali- ty studies are becoming available for conducting meta-analyses, whether our finding can be replicated.
The finding that training therapists leads to better outcome, at least on QoL, matches earlier studies that proper training is related to improved outcome (Gyani, Shafran, Layard, & Clark, 2013). Literature suggests that manualized based approach- es led by a specialist (i.e. trained) therapist show the most promising evidence base (Hay et al., 2014).
Limitations
Our meta-analysis has several limitations and therefore, the results should be interpreted with caution. Due to the high statistical heterogeneity, we had to exclude two outlier studies (Schmidt et al., 2015; Zipfel et al., 2014) from all further analyses. Schmidt et al. (2015) compared the Maudsley Model of Anorexia Nervosa Treatment for Adults with SSCM. In the study from Zipfel et al. (2014), focal psychodynamic therapy was compared with enhanced cognitive behavior therapy and with a broad optimized treatment-as-usual condition. In both studies, no significant differences between the conditions were found. The treatment and control arms differed greatly from each other and the five comparisons showed outcomes in different directions; with regard to weight gain, in the Zipfel study, one treatment arm was more effective than control and one treatment arm was less effective. On eating disorder patholo- gy, both treatment conditions were more effective than control. In the Schmidt 2015 study, the treatment condition did better than control with regard to both weight gain and eating disorder pathology. In both studies, none of the found differences were statistically significant. These studies are recent, large RCTs and it is possible that their findings may be closer to true effect size of psychological interventions. However,