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Comparing the effectiveness and predictors of cognitive behavioural therapy-enhanced between patients with various eating disorder diagnoses: a naturalistic study

Published online by Cambridge University Press:  11 April 2022

Bernou Melisse Open the ORCID record for Bernou Melisse [Opens in a new window] ,
Jack Dekker ,
Elske van den Berg ,
Margo de Jonge ,
Eric F. van Furth ,
Jaap Peen  and
Edwin de Beurs
Bernou Melisse*
Affiliation:
Novarum Center for Eating Disorders & Obesity, Laan van de Helende Meesters 2, 1186 AM Amstelveen, The Netherlands
Jack Dekker
Affiliation:
Arkin Mental Health Institute, Research Department, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
Elske van den Berg
Affiliation:
Novarum Center for Eating Disorders & Obesity, Laan van de Helende Meesters 2, 1186 AM Amstelveen, The Netherlands
Margo de Jonge
Affiliation:
Novarum Center for Eating Disorders & Obesity, Laan van de Helende Meesters 2, 1186 AM Amstelveen, The Netherlands
Eric F. van Furth
Affiliation:
Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, 2333 ZZ, Leiden, The Netherlands Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
Jaap Peen
Affiliation:
Arkin Mental Health Institute, Research Department, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
Edwin de Beurs
Affiliation:
Arkin Mental Health Institute, Research Department, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands Leiden University, Section Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
*
*Corresponding author. Email: bernou.melisse@novarum.nl
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Abstract

Cognitive behaviour therapy-enhanced (CBT-E) is an effective treatment for non-underweight patients with eating disorders. Its efficacy and effectiveness is investigated mostly among transdiagnostic samples and remains unknown for binge eating disorder. The aim of the present study was to assess several treatment outcome predictors and to compare effectiveness of CBT-E among adult out-patients with bulimia nervosa (n=370), binge eating disorder (n=113), and those with a restrictive food pattern diagnosed with other specified feeding and eating disorders (n=139). Effectiveness of CBT-E was assessed in routine clinical practice in a specialised eating disorders centre. Eating disorder pathology was measured with the EDEQ pre- and post-treatment, and at 20 weeks follow-up. Linear mixed model analyses with fixed effect were performed to compare treatment outcome among the eating disorder groups. Several predictors of treatment completion and outcome were examined with a regression analysis. No predictors for drop-out were found, except the diagnosis of bulimia nervosa. Eating disorder pathology decreased among all groups with effect sizes between 1.43 and 1.70 on the EDE-Q total score. There were no differences in remission rates between the three groups at end of treatment or at follow-up. Eating disorder severity at baseline affected treatment response. The results can be generalised to other specialised treatment centres. No subgroup of patients differentially benefited from CBT-E supporting the transdiagnostic perspective for the treatment of eating disorders. Longer-term follow-up data are necessary to measure persistence of treatment benefits.

Key learning aims

  1. (1) What is the effectiveness of CBT-E among patients suffering from binge eating disorder?

  2. (2) Does any subgroup of patients suffering from an eating disorder differentially benefit from CBT-E?

  3. (3) What factors predict treatment response?

Keywords

binge eating disorderbulimia nervosacognitive behaviour therapy-enhancedeating disordersother specified feeding and eating disorder
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 15 , 2022 , e20
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Moore, E., Hinde, M., & Waller, G. (2021). Brief cognitive behavioural therapy for binge-eating disorder: clinical effectiveness in a routine clinical setting. The Cognitive Behaviour Therapist, 14. doi: https://doi.org/10.1017/S1754470X21000131 CrossRefGoogle Scholar
van den Berg, E., Melisse, B., Koenders, J., de Jonge, M., Blankers, M., de Beurs, E., & Dekker, J. (2020). Online cognitive behavioral therapy enhanced for binge eating disorder: study protocol for a randomized controlled trial. BMC Psychiatry, 20, 190. doi: 10.1186/s12888-020-02604-1 CrossRefGoogle ScholarPubMed
Waller, G., Tatham, M., Turner, H., Mountford, V. A., Bennetts, A., Bramwell, K., Dodd, J., Ingram, L. (2018). A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: outcomes from a case series of nonunderweight adult patients. International Journal of Eating Disorders, 51, 262–269. https://doi.org/10.1002/eat.22837 CrossRefGoogle ScholarPubMed

References

Aardoom, J. J., Dingemans, A. E., Slof Op’t Landt, M. C., & Van Furth, E. F. (2012). Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q). Eating Behaviors, 13, 305–309. https://doi.org/10.1016/j.eatbeh.2012.09.002 CrossRefGoogle Scholar
Anderson, L. M., Smith, K. M., Schaefer, L. M., Crosby, R. D., Cao, L., Engel, S. G., Crow, S. J., Wonderlich, S. A., Peterson, C. B. (2020). Predictors and moderators of treatment outcome in a randomized clinical trial for binge-eating disorder. Journal of Consulting and Clinical Psychology, 88, 631–642. https://doi.org/10.1037/ccp0000503 CrossRefGoogle Scholar
APA (2013). American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders – fifth edition (DSM-5). American Psychiatric Publishing.Google Scholar
Berg, E., Schlochtermeier, D., Koenders, J., Mooij, L., Goudriaan, A., Blankers, M., Peen, J., Dekker, J. (2020). Implementing cognitive behavioral therapy-enhanced in a routine inpatient and outpatient setting: comparing effectiveness and treatment costs in two consecutive cohorts. International Journal of Eating Disorders, 53, 461–471. https://doi.org/10.1002/eat.23229 CrossRefGoogle Scholar
Berg, K. C., Swanson, S. A., Stiles-Shields, E. C., Eddy, K. T., Peterson, C. B., & Le Grange, D. (2013). Response patterns on interview and questionnaire versions of the Eating Disorder Examination and their impact on latent structure analyses. Comprehensive Psychiatry, 54, 506–516. https://doi.org/10.1016/j.comppsych.2012.12.006 CrossRefGoogle ScholarPubMed
Bohn, K., Doll, H. A., Cooper, Z., O’Connor, M., Palmer, R. L., Fairburn, C. G. J. (2008). The measurement of impairment due to eating disorder psychopathology. Behaviour Research and Therapy, 46, 1105–1110. doi: 10.1016/j.brat.2008.06.012 CrossRefGoogle ScholarPubMed
Byrne, S., Wade, T., Hay, P., Touyz, S., Fairburn, C. G., Treasure, J., Schmidt, U., McIntosh, V., Allen, K., Fursland, A., Crosby, R. D. (2017). A randomised controlled trial of three psychological treatments for anorexia nervosa. Psychological Medicine, 47, 2823–2833. https://doi.org/10.1017/S0033291717001349 CrossRefGoogle ScholarPubMed
Byrne, S. M., Fursland, A., Allen, K. L., & Watson, H. (2011). The effectiveness of enhanced cognitive behavioural therapy for eating disorders: an open trial. Behaviour Research and Therapy, 49, 219–226. https://doi.org/10.1016/j.brat.2011.01.006 CrossRefGoogle Scholar
Castellini, G., Mannucci, E., Lo Sauro, C., Benni, L., Lazzeretti, L., Ravaldi, C., Rotella, C. M., Faravelli, C., Ricca, V. (2012). Different moderators of cognitive-behavioral therapy on subjective and objective binge eating in bulimia nervosa and binge eating disorder: a three-year follow-up study. Psychotherapy and Psychosomatics, 81, 11–20. https://doi.org/10.1159/000329358 CrossRefGoogle ScholarPubMed
Coffino, J. A., Udo, T., & Grilo, C. M. (2019). The significance of overvaluation of shape or weight in binge-eating disorder: results from a national sample of U.S. adults. Obesity, 27, 1367–1371. doi: 10.1002/oby.22539 CrossRefGoogle ScholarPubMed
Cohen, J. (1977). Statistical Power Analysis for the Behavioral Sciences (rev. edn). Academic Press. http://www.gbv.de/dms/bowker/toc/9780121790608.pdf Google Scholar
Cooper, Z., Allen, E., Bailey-Straebler, S., Basden, S., Murphy, R., O’Connor, M. E., & Fairburn, C. G. (2016). Predictors and moderators of response to enhanced cognitive behaviour therapy and interpersonal psychotherapy for the treatment of eating disorders. Behaviour Research and Therapy, 84, 9–13. https://doi.org/10.1016/j.brat.2016.07.002 CrossRefGoogle ScholarPubMed
Cooper, Z., & Fairburn, C. G. (2011). The evolution of ‘enhanced’ cognitive behavior therapy for eating disorders: learning from treatment nonresponse. Cognitive and Behavioral Practice, 18, 394–402. https://doi.org/10.1016/j.cbpra.2010.07.007 CrossRefGoogle ScholarPubMed
Dalle Grave, R., Calugi, S., Sartirana, M., & Fairburn, C. G. (2015). Transdiagnostic cognitive behaviour therapy for adolescents with an eating disorder who are not underweight. Behaviour Research and Therapy, 73, 79–82. https://doi.org/10.1016/j.brat.2015.07.014 CrossRefGoogle Scholar
de Beurs, E., den Hollander-Gijsman, M. E., van Rood, Y. R., van der Wee, N. J., Giltay, E. J., van Noorden, M. S., van der Lem, R., van Fenema, E., Zitman, F. G. (2011). Routine outcome monitoring in the Netherlands: practical experiences with a web-based strategy for the assessment of treatment outcome in clinical practice. Clinical Psychology & Psychotherapy, 18, 1–12. https://doi.org/10.1002/cpp.696 CrossRefGoogle ScholarPubMed
de Beurs, E., Van Dyck, R., Marquenie, L. A., Lange, A., & Blonk, R. W. (2001). De DASS: een vragenlijst voor het meten van depressie, angst en stress. Gedragstherapie, 34, 35–54.Google Scholar
de Beurs, E., Warmerdam, L., & Twisk, J. (2019). Bias through selective inclusion and attrition: representativeness when comparing provider performance with routine outcome monitoring data. Clinical Psychology and Psychotherapy, 26, 430–439.CrossRefGoogle ScholarPubMed
de Jong, K., Nugter, M. A., Polak, M. G., Wagenborg, J. E. A., Spinhoven, P., & Heiser, W. J. (2007). The Outcome Questionnaire (OQ-45) in a Dutch population: a cross-cultural validation. Clinical Psychology & Psychotherapy, 14, 288–301. https://doi.org/10.1002/cpp.529 CrossRefGoogle Scholar
de Jong, M., Schoorl, M., & Hoek, H. W. (2018). Enhanced cognitive behavioural therapy for patients with eating disorders: a systematic review. Current Opinion in Psychiatry, 31, 436. https://doi.org/10.1097/YCO.0000000000000452 CrossRefGoogle ScholarPubMed
Fairburn, C. (2008). Cognitive Behavior Therapy and Eating Disorders. Guilford Press.Google ScholarPubMed
Fairburn, C. G., Bailey-Straebler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R., O’Connor, M. E., Cooper, Z. (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour Research and Therapy, 70, 64–71. https://doi.org/10.1016/j.brat.2015.04.010 CrossRefGoogle ScholarPubMed
Fairburn, C. G., & Beglin, S. J. (2008). Eating Disorder Examination-Questionnaire (6.0). https://www.corc.uk.net/media/1273/ede-q_quesionnaire.pdf Google Scholar
Fairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Bohn, K., Hawker, D. M., Wales, J. A., Palmer, R. L. (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. https://doi.org/10.1176/appi.ajp.2008.08040608 CrossRefGoogle ScholarPubMed
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy, 41, 509–528. https://doi.org/10.1016/s0005-7967(02)00088-8 CrossRefGoogle ScholarPubMed
Hay, P., Girosi, F., & Mond, J. (2015). Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. Journal of Eating Disorders, 3, 19. https://doi.org/10.1186/s40337-015-0056-0 CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence (NICE) (2017). Eating Disorders: Recognition and Treatment. https://www.nice.org.uk/guidance/ng69 Google Scholar
Hedges, L. V. (1981). Distribution theory for Glass’s estimator of effect size and related estimators. Journal of Educational Statistics, 6, 107–128. https://doi.org/10.3102/10769986006002107 CrossRefGoogle Scholar
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefGoogle ScholarPubMed
Knott, S., Woodward, D., Hoefkens, A., & Limbert, C. (2015). Cognitive behaviour therapy for bulimia nervosa and eating disorders not otherwise specified: translation from randomized controlled trial to a clinical setting. Behavioural and Cognitive Psychotherapy, 43, 641–654. https://doi.org/10.1017/S1352465814000393 CrossRefGoogle Scholar
Kraemer, H. C. (2013). Discovering, comparing, and combining moderators of treatment on outcome after randomized clinical trials: a parametric approach. Statistics in Medicine, 32, 1964–1973. https://doi.org/10.1002/sim.5734 CrossRefGoogle ScholarPubMed
Leichsenring, F. (2004). Randomized controlled versus naturalistic studies: a new research agenda. Bulletin of the Menninger Clinic, 68, 137–151. https://doi.org/10.1521/bumc.68.2.137.35952 CrossRefGoogle ScholarPubMed
Linardon, J. (2017). Correlates of the over-evaluation of weight and shape in binge eating disorder and mixed eating disorder samples: a meta-analytic review. Eating Disorders, 25, 183–198. doi: 10.1080/10640266.2016.1260374 CrossRefGoogle ScholarPubMed
Linardon, J., de la Piedad Garcia, X., & Brennan, L. (2017a). Predictors, moderators, and mediators of treatment outcome following manualised cognitive-behavioural therapy for eating disorders: a systematic review of predictors, moderators, and mediators of outcome for eating disorders. European Eating Disorders Review, 25, 3–12. https://doi.org/10.1002/erv.2492 CrossRefGoogle ScholarPubMed
Linardon, J., Wade, T. D., de la Piedad Garcia, X., & Brennan, L. (2017b). The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85, 1080–1094.CrossRefGoogle ScholarPubMed
Moore, E., Hinde, M., & Waller, G. (2021). Brief cognitive behavioural therapy for binge-eating disorder: clinical effectiveness in a routine clinical setting. The Cognitive Behaviour Therapist, 14. https://doi.org/10.1017/S1754470X21000131 CrossRefGoogle Scholar
Poulsen, S., Lunn, S., Daniel, S. I., Folke, S., Mathiesen, B. B., Katznelson, H., & Fairburn, C. G. (2014). A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. American Journal of Psychiatry, 171, 109–116. https://doi.org/10.1176/appi.ajp.2013.12121511 CrossRefGoogle ScholarPubMed
Preti, A., Girolamo, G., Vilagut, G., Alonso, J., Graaf, R., Bruffaerts, R., Demyttenaere, K., Pinto-Meza, A., Haro, J. M. & Morosini, P. (2009). The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. Journal of Psychiatric Research, 43, 1125–1132. https://doi.org/10.1016/j.jpsychires.2009.04.003 CrossRefGoogle ScholarPubMed
Rubin, D. B. (2004). Multiple Imputation for Nonresponse in Surveys (vol. 81). John Wiley & Sons.Google Scholar
Signorini, R., Sheffield, J., Rhodes, N., Fleming, C., & Ward, W. (2018). The effectiveness of enhanced cognitive behavioural therapy (CBT-E): a naturalistic study within an out-patient eating disorder service. Behavioural and Cognitive Psychotherapy, 46, 21–34. https://doi.org/10.1017/S1352465817000352 CrossRefGoogle ScholarPubMed
Thompson-Brenner, H., Shingleton, R. M., Thompson, D. R., Satir, D. A., Richards, L. K., Pratt, E. M., & Barlow, D. H. (2016). Focused vs. broad enhanced cognitive behavioral therapy for bulimia nervosa with comorbid borderline personality: a randomized controlled. International Journal of Eating Disorders, 49, 36–49. https://doi.org/10.1002/eat.22468 CrossRefGoogle ScholarPubMed
Timman, R., Jong, K., & de Neve-Enthoven, N. G. M. (2017). Cut-off scores and clinical change indices for the Dutch Outcome Questionnaire (OQ-45) in a large sample of normal and several psychotherapeutic populations. Clinical Psychology & Psychotherapy, 24, 72–81.CrossRefGoogle Scholar
Vall, E., & Wade, T. D. (2015). Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. International Journal of Eating Disorders, 48, 946–971. https://doi.org/10.1002/eat.22411 CrossRefGoogle ScholarPubMed
van den Berg, E., Melisse, B., Koenders, J., de Jonge, M., Blankers, M., de Beurs, E., & Dekker, J. (2020). Online cognitive behavioral therapy enhanced for binge eating disorder: study protocol for a randomized controlled trial. BMC Psychiatry, 20, 190. doi: 10.1186/s12888-020-02604-1 CrossRefGoogle ScholarPubMed
Wade, S., Byrne, S., & Allen, K. (2017). Enhanced cognitive behavioral therapy for eating disorders adapted for a group setting. International Journal of Eating Disorders, 50, 863–872. https://doi.org/10.1002/eat.22723 CrossRefGoogle ScholarPubMed
Waller, G., Gray, E., Hinrichsen, H., Mountford, V., Lawson, R., & Patient, E. (2014). Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: effectiveness in clinical settings. International Journal of Eating Disorders, 47, 13–17. https://doi.org/10.1002/eat.22181 CrossRefGoogle ScholarPubMed
Waller, G., Tatham, M., Turner, H., Mountford, V. A., Bennetts, A., Bramwell, K., Dodd, J., Ingram, L. (2018). A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: outcomes from a case series of nonunderweight adult patients. International Journal of Eating Disorders, 51, 262–269. https://doi.org/10.1002/eat.22837 CrossRefGoogle ScholarPubMed
Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E., & Crow, S. J. (2014). A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychological Medicine, 44, 543–553. https://doi.org/10.1017/S0033291713001098 CrossRefGoogle ScholarPubMed
World Medical Association (2001). World Medical Association Declaration of Helsinki. Swiss Medical Forum – Schweizerisches Medizin-Forum. https://doi.org/10.4414/smf.2001.04031 CrossRefGoogle Scholar
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