Page 57 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 3 57
International guidelines propose eating-disorder-focused cognitive behavior therapy as preferred, EST for bulimia nervosa and binge eating disorder (RANZCP, 2014; NICE, 2017). For adults with anorexia nervosa, eating-disorder-focused cogni- tive behavioral therapy (CBT) is also one of the recommended treatments, besides Maudsley Anorexia Nervosa Treatment for Adults and Specialist Supportive Clinical Management. For other specified eating disorders, guidelines recommend treat- ments for the eating disorder it most resembles (NICE, 2017). A specific transdiag- nostic, enhanced eating-disorder-focused individual cognitive behavior therapy (CBT-E) has been developed by C. Fairburn (Fairburn, 2008). Originally an outpatient treatment, CBT-E has been further developed as a treatment framework for inpatient settings (Dalle Grave, Bohn, Hawker & Fairburn, 2008; Dalle Grave, Calugi, El Ghoch, Conti, & Fairburn, 2014; Van den Berg, Schlochtermeier, Goudriaan, & Dekker, 2017).
Previous eating disorder effectiveness studies on adult patients have showed that ESTs can successfully be delivered in routine settings with clinical outcome resembling results found in research trials (Byrne, Fursland, Allen, & Watson, 2011; Knott, Woodward, Hoefkens, & Limbert, 2015; Turner, Marshall, Stopa, & Waller, 2015). These outpatient studies did not, however, include inpatients and/or day care patients, and the reported number of therapists involved in these studies was limited (N = 4, Byrne et al., 2011; N = 11, Turner et al., 2015; N = 10, Knott et al., 2015). In addition, from these publications it is unclear whether the ESTs were offered to all referred patients rather than to a selected patient sample and were delivered by all staff members rather than by a selected therapist group.
Almost no effectiveness studies concerning implementation of ESTs in routine inpatient eating disorders settings exist (Thompson-Brenner et al., 2018). Though examining the cost-effectiveness of ESTs next to effectiveness, is valuable (Crow et al., 2013), cost-effectiveness studies for eating disorders are limited. One recent systematic review of economic evaluations, including studies published up to March 2017, found that no conclusive recommendations could be drawn regarding the most cost-effective eating disorder interventions (Le, Hay, & Mihalopoulous, 2018). In that review, only one study comparing face-to-face psychological treatments for adult patients was included.
To our knowledge, no (cost) effectiveness studies have been done on large samples of referred patients receiving empirically-supported inpatient and / or outpatient treatment in a routine setting. The study aims, therefore, are to exam- ine (a) effectiveness and (b) cost-effectiveness of an EST, CBT-E, compared to treat- ment-as-usual (TAU). In it, CBT-E was offered to all referred patients (N = 320), with a body mass index (BMI: kg/m2) between 17.5 and 40, inpatients as well as outpatients, between 2015 and 2017. TAU, offered to patients (N = 239) between 2012 and 2014,