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The Effectiveness of Enhanced Cognitive Behavioural Therapy (CBT-E): A Naturalistic Study within an Out-Patient Eating Disorder Service

Published online by Cambridge University Press:  19 June 2017

Rachel Signorini ,
Jeanie Sheffield ,
Natalie Rhodes ,
Carmel Fleming  and
Warren Ward
Rachel Signorini*
Affiliation:
The University of Queensland – School of Psychology, Brisbane, Queensland 4072, Australia
Jeanie Sheffield
Affiliation:
The University of Queensland – School of Psychology, Brisbane, Queensland 4072, Australia
Natalie Rhodes
Affiliation:
Queensland Health – Eating Disorders Outreach Service, Brisbane, Queensland, Australia
Carmel Fleming
Affiliation:
Queensland Health – Eating Disorders Outreach Service, Brisbane, Queensland, Australia
Warren Ward
Affiliation:
Queensland Health – Eating Disorders Outreach Service, Brisbane, Queensland, Australia
*
Correspondence to Rachel Signorini, The University of Queensland – School of Psychology, St Lucia, QLD 4072, Australia. E-mail: rachel.signorini@uqconnect.edu.au
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Abstract

Background: The effectiveness of enhanced cognitive behavioural Therapy (CBT-E) for adults with a range of eating disorder presentations within routine clinical settings has been examined in only two known published studies, neither of which included a follow-up assessment period. Aim: The current study aimed to evaluate the effectiveness of CBT-E within an out-patient eating disorder service in Brisbane, Queensland, Australia, and incorporated a follow-up assessment period of approximately 20 weeks post-treatment. Method: The study involved 114 adult females with a diagnosed eating disorder, who attended an average of 20–40 individual CBT-E sessions with a psychologist or a psychiatry registrar between 2009 and 2013. Results: Of those who began treatment, 50% did not complete treatment, and the presence of psychosocial and environmental problems predicted drop-out. Amongst treatment completers, statistically and clinically significant improvements in eating disorder and general psychopathology were observed at post-treatment, which were generally maintained at the 20-week follow-up. Statistically significant improvements in eating disorder and general psychopathology were observed amongst the total sample. Conclusions: The findings, which were comparable to the previous Australian effectiveness study of CBT-E, indicate that CBT-E is an effective treatment for adults with all eating disorders within out-patient settings. Given the high attrition rate, however, minimizing drop-out appears to be an important consideration when implementing CBT-E within clinical settings.

Keywords

Eating disorderstreatmentcognitive behavioural therapyeffectiveness
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 1 , January 2018 , pp. 21 - 34
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

American Psychiatric Association (APA) (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision). Washington, DC.Google Scholar
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Arlington, VA: American Psychiatric Publishing.Google Scholar
Bohn, K. and Fairburn, C. G. (2008). Clinical Impairment Assessment Questionnaire. In Fairburn, C.G. (ed), Cognitive Behavior Therapy and Eating Disorders (pp. 315–317). New York: Guilford Press.Google Scholar
Byrne, S. M., Fursland, A., Allen, K. L. and Watson, H. (2011). The effectiveness of enhanced cognitive behavioural therapy for eating disorders: an open trial. Behaviour Research and Therapy, 49, 219–226. doi: 10.1016/j.brat.2011.01.006 Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioural Sciences. New Jersey: Elbaum Associates.Google Scholar
Dalle Grave, R., Calugi, S., Doll, H. A. and Fairburn, C. G. (2013). Enhanced cognitive behaviour therapy for adolescents with anorexia nervosa: an alternative to family therapy? Behaviour Research and Therapy, 51, R9–412. doi: 10.1016/j.brat.2012.09.008 Google Scholar
Fairburn, C. G, Bailey-Strabler, S., Basden, S., Doll, H. A., Jones, Murphy, R. et al. (2015). A transdiagnostic comparison of enhanced cognitive behavior therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour Research and Therapy, 70, 64–71. doi: 10.1016/j.brat.2015.04.010 Google Scholar
Fairburn, C. G. and Beglin, S. J. (1994). Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–370. doi: 10.1002/1098108X(199412) 3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Fairburn, C. G. and Cooper, Z. (1993). The eating disorder examination. In Fairburn, C. G. and Wilson, G. T. (eds), Binge Eating: Nature, Assessment and Treatment (12th edn), pp. 317–360. New York: Guilford Press.Google Scholar
Fairburn, C. G., Cooper, Z., Doll, H. A., O'Connor, M. E., Bohn, K., Hawker, D. M. et al. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two- site trial with 60-week follow-up. American Journal of Psychiatry, 166, 311–319. doi: 10.1176/appi.ajp.2008.0804060 Google Scholar
Fairburn, C. G., Cooper, Z., Doll, A., O'Connor, M. E., Palmer, R. L. and Dalle Grave, R. (2013). Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK–Italy study. Behaviour Research and Therapy, 51, R2–8. doi: 10.1016/j.brat.2012.09.010 Google Scholar
Fairburn, C. G., Cooper, Z. and O'Connor, M. E. (2008). Eating disorder examination (edition 16.0D). In Fairburn, C. G. (ed), Cognitive Behavior Therapy and Eating Disorders, pp. 265–308. New York: Guilford Press.Google ScholarPubMed
Fairburn, C. G., Cooper, Z. and Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy, 41, 509–528. doi: 10.1016/s0005-7967(02)00088-8 CrossRefGoogle ScholarPubMed
Fairburn, C. G., Cooper, Z., Shafran, R., Bohn, K., Hawker, D. M., Murphy, R. and Straebler, S. (2008). Enhanced cognitive behaviour therapy for eating disorders: the core protocol. In Fairburn, C. G. (ed), Cognitive Behaviour Therapy and Eating Disorders, pp. 47–193. New York: Guilford Press.Google Scholar
Fairburn, C. G., Stice, E., Cooper, Z., Doll, H. A., Norman, P. A. and O'Connor, M. E. (2003). Understanding persistence in bulimia nervosa: a 5-year naturalistic study. Journal of Consulting and Clinical Psychology, 71, 103–109. doi: 10.1037/0022-006X.71.1.103 Google Scholar
Fassino, S., Piero, A., Tomba, E. and Abbate-Daga, G. (2009). Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry, 9, 1–9. doi: 10.1159/000070784 Google Scholar
IBM Corporation (2012). IBM SPSS Statistics for Windows, version 21.0. Armonk, NY: IBM Corporation.Google Scholar
Kendall, P. C., Marrs-Garcia, A., Nath, S. R. and Sheldrick, R. C. (1999). Normative comparisons for the evaluation of clinical significance. Journal of Consulting and Clinical Psychology, 67, 285–299. doi: 10.1037/0022-006X.67.3.285 CrossRefGoogle ScholarPubMed
Knott, S., Woodward, D., Hoefkens, A. and Limbert, C. (2015). Cognitive behavior therapy for bulimia nervosa and eating disorder not otherwise specified: translation from randomised controlled trial to a clinical setting. Behavioural and Cognitive Psychotherapy, 43, 641–654. doi: 10.1017/S1352465814000393 Google Scholar
Lovibond, S. H. and Lovibond, P. F. (1995). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343. doi: 10.1016/00057967(94)00075-U Google Scholar
Mond, J. M., Hay, P. J., Rodgers, B. and Owen, C. (2006). Eating disorder examination questionnaire (EDE-Q): norms for young adult women. Behaviour Research and Therapy, 44, 53–62. doi: 10.1016/S0005-7967(03)00161-X CrossRefGoogle ScholarPubMed
Poulsen, S., Lunn, S., Daniel, S. I. F., Folke, S., Mathiesen, B. B., Katznelson, H. and Fairburn, C. G. (2014). A randomized controlled trial of psychoanalytic psychotherapy versus cognitive behavior therapy for bulimia nervosa. American Journal of Psychiatry, 171, 109–116. doi: 10.1176/appi.ajp.2013.12121511 Google Scholar
Turner, H., Marshall, E., Stopa, L. and Waller, G. (2015). Cognitive-behavioural therapy for outpatients with eating disorders: effectiveness for a transdiagnostic group in a routine clinical setting. Behaviour Research and Therapy, 68, 70–75. doi: 10.1016/j.brat.2015.03.001 Google Scholar
Waller, G., Corstorphine, E., Cordery, H., Hinrichsen, H., Lawson, R., Mountford, V. et al. (2007). Cognitive-Behavioral Therapy for the Eating Disorders: A Comprehensive Treatment Guide. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Waller, G., Gray, E., Hinrichsen, H., Mountford, V., Lawson, R. and Patient, E. (2014). Cognitive-behavioural therapy for bulimia nervosa and atypical bulimic nervosa: effectiveness in clinical settings. International Journal of Eating Disorders, 47, 13–17. doi: 10.1002/eat.22181 CrossRefGoogle ScholarPubMed
Waller, G., Stringer, H. and Meyer, C. (2012). What cognitive-behavioral techniques do therapists report using when delivering cognitive-behavioral therapy for the eating disorders? Journal of Consulting and Clinical Psychology, 80, 171–175. doi: 10.1037/a0026559 Google Scholar
Wilson, G. T., Grilo, C. M. and Vitousek, K. M. (2007). Psychological treatments of eating disorders. American Psychologist, 62, 199–216. doi: 10.1037/0003-066X.62.3.199 CrossRefGoogle ScholarPubMed
Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E. and Crow, S. J. (2014). A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioural therapy (CBT-E) for bulimia nervosa. Psychological Medicine, 44, 543–553. doi: 10.1017/S0033291713001098 CrossRefGoogle ScholarPubMed
World Health Organization (2014). Global database on Body Mass Index. Retrieved from World Health Organization website: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html (accessed 9 May 2017).Google Scholar
Zipfel, S., Wild, B., Groß, G., Friederich, H. C., Teufel, M., Schellberg, D. et al. (2014). Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. The Lancet, 383, 127–137. doi: https://doi.org/10.1016/S0140-6736(13)61746-8 CrossRefGoogle ScholarPubMed
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