Page 81 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 4 81
Two effect measures for cost-effectiveness analyses were used: (a) the propor- tion of patients reaching BMI ≥18.5, the World Health Organization cut-off point for healthy weight, as weight regain is key in supporting psychological and physical changes needed for recovery (NICE, 2017) and (b) the proportion of patients achieving an EDE-Q global score under one SD above community mean, i.e. under 2.77 (UK norms, used for comparison; Mond, Hay, Rodgers & Owen, 2006).
Interventions
Treatment-as-usual during July 1, 2012 - December 31, 2014
Treatment during the TAU period consisted of regular medical care, weight resto- ration, psychoeducation, psychomotor inventions and an eclectic psychological approach of cognitive, behavioral, schema focused and psychodynamic interven- tions. TAU was delivered in outpatient, day-care and / or inpatient units. Outpatient treatment was preferably group based; day-care was offered to patients with a BMI between around 16.5 and 17.5; inpatient treatment was offered to patients with a BMI under 16.5, and usually lasted until healthy weight was reached. During TAU, struc- tured supervision was not offered.
CBT-E during July 1, 2015 - December 31, 2017
Outpatients were offered CBT-E Underweight, an individual, outpatient treatment, originally designed for adult patients with a minimum BMI of 15, but now offered to all underweight outpatients. Treatment takes up to about 40 sessions; in accord- ance with CBT-E guidelines (Fairburn, 2008), the number of sessions depends on the degree of underweight. CBT-E Underweight consists of three phases, the first phase aims at preparing for change, the second at regaining weight and tackling eating disorder pathology, the last phase at developing personalized relapse prevention skills.
CBT-E states that restoring underweight, at least from BMI 15 upwards, can take place within an outpatient setting, so hospitalization is indicated only when patients are psychiatrically and/or somatically unstable (Dalle Grave et al., 2008), and only for so long as they are unstable. Inpatient care does not aim at regaining a healthy weight. In the inpatient unit, the assistance around mealtimes and the ‘therapeutic climate’ are built on CBT-E strategies and comprises individual sessions, psycho- educational group meetings, a physical exercise group and a weekly review meeting between patients and their therapists (Dalle Grave et al., 2008).