Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: A non-randomized effectiveness trial

Family-based treatment (FBT) is an efficacious intervention for adolescents with an eating disorder. Evaluated to a lesser degree among adolescents, enhanced cognitive-behavior therapy (CBT-E) has shown promising results.

A new study published in Psychological Medicine compared the relative effectiveness of FBT and CBT-E delivered by the Center for the Treatment of Eating Disorders (CTED) at Children’s Minnesota, MN, a pediatric specialty clinic in the USA, provides inpatient and outpatient treatment to youth and their families.

Over the course of the study period (July 2015–November 2019), 107 patients met the eligibility criteria for the study. Of those, 10 families withdrew consent, and 97 patients (83%) and their families were enrolled and offered a choice between one of two manualized treatments: FBT or CBT-E. Fifty-one (52.5%) chose FBT, and 46 (47.5%) CBT-E.

The sample was divided into a lower weight cohort [<90% median body mass index (mBMI); 38% of participants) and higher weight choort. Regardless of weight cohort, participants who selected CBT-E were older, had been ill longer, presented with higher depression and anxiety, more prior mental health treatment, and higher rates of psychosocial impairment due to eating disorder features (all ps 0.034–0.0001).

Assessments were administered at baseline, end-of-treatment (EOT), and follow-up (6 and 12 months). Treatment comprised of 20 sessions over 6 months, except for the lower weight cohort where CBT-E comprised 40 sessions over 9-12 months. Primary outcomes were slope of weight gain and change in Eating Disorder Examination (EDE) Global Score at EOT.

Regardless of weight cohort, FBT was more efficient than CBT-E in terms of the slope of weight gain from baseline to the EOT. However, this was no longer the case at either the 6- or 12-month follow-up.

Initial more gradual weight gains achieved by CBT-E compared to FBT at EOT seems due to distinct strategies used to achieve weight gain across these two treatments. In CBT-E, weight gain (when indicated) is addressed after 4 weeks of treatment, and only when patients reach the conclusion that they need to attend to their low weight. In contrast, weight gain in FBT (when indicated) is addressed at the outset, while parents are supported to drive this agenda.

However, for a substantial minority of patients in the higher weight cohort (∼22%), weight gain was not a treatment goal. Therefore, relative effectiveness was defined in terms of weight gain and/or improvement in eating disorders psychopathology. In this domain, both treatments demonstrated improvements in the EDE/Q Global Score with no significant differences across time. In terms of the secondary outcomes (controlling for baseline differences), the two treatments largely established similar gains across measures of general psychopathology and clinical impairment.

An interesting data is that choosing between FBT and CBT-E resulted in older and less well participants opting for CBT-E. Albeit speculatively, it seems that parents considered an individual therapy rather than a family-based one to be more appropriate when their offspring was older and more unwell.

In conclusion, results show that FBT and CBT-E achieved similar outcomes in the treatment of adolescents with eating disorders, making CBT-E a viable treatment for adolescents with an eating disorder.

Le Grange, D., Eckhardt, S., Dalle Grave, R., Crosby, R. D., Peterson, C. B., Keery, H., Lesser, J. Martell, C. (2020). Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: a non-randomized effectiveness trial. Psychological Medicine, 1-11. doi:10.1017/s0033291720004407

 

Online One-To-One Skills Based Training

Several Dates Available in 2020
A one-to-one skills based training session for CBT-E practitioners

This workshop is suitable for all CBT-E practitioners who have attended our Skills Based CBT-E Clinical Workshop.
In response to queries, CREDO have decided to offer a follow-up one-to-one training session for those who have attended our Skills Based CBT-E Clinical Workshop. This will focus on two key CBT-E procedures, of your choice, covered in the workshop. You will be invited to participate in role plays and receive personalised constructive feedback to improve your competence in implementing CBT-E.

Option
  • Formulation
  • Self-Monitoring
  • Motivation
  • Body Checking
  • Feeling Fat
  • Food Avoidance
Practicalities

Cost: £80 for an individual hour long session
Format: Online

For further details or booking information, please email: Charandeep.khera@psych.ox.ac.uk

Online Skills-Based CBT-E Clinical Workshop

Available Dates in 2021
Friday 2nd July
A one day workshop for CBT-E practitioners

This workshop is suitable for all CBT-E practitioners. It is focused on developing competence in implementing key procedures in CBT-E. It will include experiential elements with a particular focus on developing practical skills. It is designed to complement CREDO’s web-based training programme. It will comprise a small group of delegates.

Programme

Detailed guidance on each of the procedures below will be provided, as well as guidance on therapist style of delivering CBT-E. Please be prepared to participate in role-play in the context of a supportive environment.

  • Creating a Collaborative Formulation
  • Self-Monitoring
  • Motivation
  • Body Checking
  • Feeling Fat
  • Food Avoidance
Practicalities

Cost: £250
Format: Online

Please note: if there is not sufficient interest for a particular date, we may need to cancel that workshop. In that instance, we will offer you an alternative date, if available. If you do not wish to attend another date, we will refund your payment in full.

In the future, we plan to deliver this training face-to-face, however due to current world circumstances we are unsure when that will be possible.

Please book early to avoid disappointment as spaces are limited.

For further details or booking information, please email: Charandeep.khera@psych.ox.ac.uk

AED Special Interest Group Annual Meeting

Date for your diary!
Thursday, June 4th at 8:00 AM EDT (US)

If you are a member of the Academy for Eating Disorders (AED) then you may wish to join our new special interest group (SIG) which focuses on CBT for eating disorders.

Practicalities

Our SIG annual meeting, will be held via Zoom at this link: https://zoom.us/j/93956107865.

NOTE
That the time given is EDT (US) and is NOT European time so if you are not in this time zone and you need a tool to convert the time for scheduling purposes, TimeandDate.com may be useful to you.

New AED Special Interest Group

If you are a member of the Academy for Eating Disorders (AED) then you may wish to join our new special interest group (SIG) which focuses on CBT for eating disorders.

SIG description: The CBT-ED SIG intends to be a network of clinical and research professionals focused on the implementation, development and evaluation of evidence-based Cognitive Behavioral Therapy for Eating Disorders. Our work is based on manualized treatment protocols both for adults and adolescents with eating disorders. The main goals of this SIG are to provide a community that (1) supports clinicians in implementing these evidence-based treatments for eating disorders in real-world clinical settings and (2) to support researchers conducting studies of CBT-ED. It will also enable professionals to come together to discuss ways to further refine CBT-ED and extend its use, as well as to identify areas of need for future research.

If you wish to find out more about AED and its membership, please follow the link below:

For information: https://www.aedweb.org/home

Cognitive Behavior Therapy for Adolescents with Eating Disorders

Authors: Riccardo Dalle Grave, Simona Calugi
Foreword by Christopher G. Fairburn

ISBN 9781462542734, 304 Pages

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This book is available as a print or e-book.

 

 

About the book

This state-of-the-art guide provides a powerful transdiagnostic approach for treating adolescent eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, and others) in either outpatient or inpatient settings. It describes how enhanced cognitive behavior therapy (CBT-E)—the gold-standard treatment for adult eating disorders—has been systematically adapted and tested with younger patients. With a strong motivational focus, CBT-E gives the adolescent a key role in decision making. The book presents session-by-session guidelines for assessing patients, determining whether CBT-E is appropriate, developing case conceptualizations, conducting individualized interventions, addressing medical issues, and involving parents. User-friendly features include case vignettes and reproducible forms; purchasers get access to a Web page where they can download and print the reproducible materials in a convenient 8½” x 11″ size.

CBT-E is recognized as a best practice for the treatment of adolescent eating disorders by the U.K. National Institute for Health and Care Excellence (NICE).

 

About the authors

Riccardo Dalle Grave, MD, is Director of the Department of Eating and Weight Disorders at Villa Garda Hospital in Verona, Italy. In collaboration with Christopher G. Fairburn, Dr. Dalle Grave has developed an inpatient treatment program for eating disorders at Villa Guarda based entirely on enhanced cognitive behavior therapy (CBT-E), including an adapted program for adolescents. His current research includes assessing the effectiveness of CBT-E in treatment of significantly underweight adults and adolescents with eating disorders in both outpatient and inpatient settings. Dr. Dalle Grave is editor of the CBT-E website (cbt.co) and Director of the Advanced Training Course on the Treatment and Prevention of Eating Disorders and Obesity sponsored by the Italian Eating and Weight Disorder Association. He also provides CBT-E supervision for clinical services in Europe, the United States, Australia, and the Middle East. He is a Fellow of the Academy of Eating Disorders and serves on the editorial boards of several journals in the field.

Simona Calugi, PhD, is Clinical Research Director of the Department of Eating and Weight Disorders at Villa Garda Hospital in Verona, Italy. In collaboration with Riccardo Dalle Grave and Christopher G. Fairburn, Dr. Calugi is involved in assessing the effectiveness of CBT-E in treatment of significantly underweight adults and adolescents with eating disorders in both outpatient and inpatient settings. She is a member of the online CBT-E training group (cbt.co) and is on the teaching faculty of the Advanced Training Course on the Treatment and Prevention of Eating Disorders and Obesity sponsored by the Italian Eating and Weight Disorder Association (AIDAP). She also serves on the faculties of several CBT-based psychotherapy schools in Italy. Dr. Calugi has extensive clinical experience in delivering outpatient CBT-E to adolescent and adult patients with eating disorders. She is President of the AIDAP.