Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa

2013 ◽  
Vol 51 (4-5) ◽  
pp. 216-220 ◽  
Author(s):  
Amy Brown ◽  
Victoria Mountford ◽  
Glenn Waller
Keyword(s):  
Anorexia Nervosa ◽  
Weight Gain ◽  
Therapeutic Alliance ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Cognitive Behavioural

Clinician and practice characteristics influencing delivery and outcomes of the early part of outpatient cognitive behavioural therapy for anorexia nervosa

2014 ◽  
Vol 7 ◽  
Author(s):  
Amy Brown ◽  
Victoria Mountford ◽  
Glenn Waller
Keyword(s):  
Anorexia Nervosa ◽  
Weight Gain ◽  
Therapeutic Alliance ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Effective Implementation ◽  
Practice Characteristics ◽  
Cognitive Behavioural ◽  
The Relationship

AbstractCognitive-behavioural therapy (CBT) can be effective for anorexia nervosa. However, there is evidence that the delivery of treatments for the eating disorders is inconsistent. This study examined evidence that clinician characteristics and practice can influence the effective implementation of CBT. The participants were 100 qualified clinicians who routinely offered outpatient CBT to adults with anorexia nervosa. They completed a survey of their demographic characteristics, level of anxiety, clinical practice in CBT for anorexia nervosa, and beliefs about the relationship between weight gain and therapeutic alliance in the early part of such treatment. Greater reported levels of weight gain were associated with the use of manuals, early focus on weight gain as a target, structured eating, and a belief that weight gain precedes a good working alliance. Clinician anxiety and early focus on the therapeutic alliance rather than structured eating were associated with poorer outcomes. These conclusions need to be tested within clinical and research settings. However, they suggest that clinicians should be encouraged to use manual-based approaches when treating anorexia nervosa using CBT, as focusing on techniques might result in the best possible outcome in this early part of treatment.

scholarly journals Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive–behavioural therapy in out-patients with anorexia nervosa

2016 ◽  
Vol 46 (16) ◽  
pp. 3291-3301 ◽  
Author(s):  
N. Egger ◽  
B. Wild ◽  
S. Zipfel ◽  
F. Junne ◽  
A. Konnopka ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Patient Treatment ◽  
Base Case ◽  
Adult Women ◽  
Net Benefit ◽  
Cognitive Behavioural

BackgroundAnorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive–behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN.MethodThe analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost–utility and assumptions underlying the base case were investigated in exploratory analyses.ResultsCosts of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends.ConclusionsDepending on the WTP, FPT proved cost-effective in the treatment of adult AN.

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