From the Journal of Psychotherapy and Psychosomatics media release:
Cognitive behavioral therapy (CBT) is widely recommended for eating disorders (ED) by most evidence-based treatment guidelines. However, less than a half of ED patients report a full recovery in the short term, and a consistent rate of patients only obtains partial remission of symptoms.
The authors conducted an analysis of treatment moderators to identify patients with a lower likelihood of response to therapy. Outpatients referred to the Clinic for Eating Disorders of the Psychiatric Unit of the University of Florence, (Italy) between June 1998 and February 2003 were enrolled in the study.
Analyses were performed on a final sample consisting of 564 patients who participated in all 3 follow-ups (at the end of an individual CBT – T1; 3 years after the end of treatment – T2 ; and 3 years after the first follow-up – T3). CBT was provided over a minimum of 40 weeks for anorexia nervosa (AN), 20 weeks for bulimia nervosa (BN), and 24 weeks for binge eating disorder (BED).
Patients were defined as ‘CBT non responders’ when no significant clinical improvement was observed at all 3 assessments after the baseline in terms of the DSM-IV diagnostic criteria.
The overall recovery rate at the 6-year follow-up was 52.1% for AN, 49.6% for BN and 59.2% for BED.
The BN patients showed highest nonresponse rate (39 patients; 28.5%), followed by the AN patients (33; 20.0%) and the BED patients (37; 14.1%). AN and BN nonresponders showed higher ED psychopathology (EDE-Q scores) than other patients.
AN subjects with a duration of illness longer than 2 years (94 patients, 57%) showed a greater likelihood of becoming nonresponders, while within the BED group, nonresponders showed higher EES and Beck Depression Inventory scores, higher rates of unipolar depression comorbidity, and a duration of illness longer than 7 years.
This finding challenged the target of standard CBT. Indeed, according to recent new CBT protocols, going beyond symptoms at the cognitive/behavioral level and expanding the therapeutic focus to the underlying, implicit emotional meanings would improve the effectiveness of CBT approaches.
Moreover, these findings confirm that, after a period of time, the effects of the disorder significantly reduce the likelihood of a change in symptoms and highlight the importance of early intervention, reducing the time period in which the disorder is untreated and allowing patients to gain weight rapidly.