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EDRS 2012
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Multidimensional assessment of decision-
making processes in anorexia nervosa
Sebastien Guillaume
1,2
, Cecile Adoue
1,2
, Isabelle Jaussent
2
,
Severine Beziat
2
, Frederique Van den Eynde
3
, Philippe
Courtet
1,2
1
CHU Montpellier, Montpellier, France,
2
INSERM U1061,
Montpellier, France,
3
Mac Gill University, Montreal, Canada
Introduction: Decision-making involves multiple cognitive
processes depending on the choice situation and context.
Most studies suggest impairment in decision-making in
people with anorexia nervosa (AN), however, the assessment
of this complex cognitive function was done with a single test,
the Iowa Gambling Gask (IGT). The objective of this study
is to evaluate the cognitive processes involved in choice in
people with AN. In addition with an impairement in decision-
making under uncertainty, we hypothesised that decision-
making impairments in anorexia are underpinned by two other
cognitive processes: a lack of reversal learning and inhibition
during risky choice. Method: Sixty-seven adult women
suffering from AN and 49 female controls were included. All
completed a clinical assessment (MINI, Eating Disorders
Inventory, history of eating disorders, National Adult Reading
Test, etc.) and a battery of neuropsychological tests [IGT,
Balloon Analogue Risk Task (BART), Probabilistic Reversal
Learning Task (PRLT) and Brixton Test]. Results: Preliminary
analyses indicate poorer performance in AN participants
on the IGT, PRLT and Brixton, compared to controls. In
addition, the AN group made less risky choices during the
BART. Conclusion: These finding suggest a disturbance of
decision making-process in people with AN. Various cognitive
processes such as reversal learning , inhibition against
risk-taking, mismanagement of uncertainty may underlie this
impairment.
30
Improving the impact of psychotherapy by
expanding research based practice
Louis Castonguay
Penn State Univeristy,
The goal of this presentation is to describe two strategies
aimed at improving the impact of psychotherapy. With
the first strategy, it will be propose that empirically
supported treatments (EST) could be complemented by
guidelines derived from research on principles of change,
psychopathology, as well as psychotherapy process and
integration. With the second strategy, it will be propose
that the movement of evidence-based practice (including
EST and non-EST guidelines mentioned above) could be
complemented by findings related to “practice-oriented
research” (POR). Involving different approaches (patient-
focused research, practice-based evidence, practice research
network), POR provides clinicians with opportunities to be
active participants in research, use data collected in their
setting to inform their own practice, examine questions that
they see as clinically relevant, and contribute to advancement
of scientific knowledge.
31
Treating Severe and Enduring Anorexia
Nervosa: A Randomized Control Trial
Stephan Touyz, Daniel Le Grange, Hubert Lacey, Phillipa
Hay, Rebecca Smith, Sarah Maguire, Bryony Bamford,
Kathleen M. Pike, Ross D. Crosby
University of Sydney, Australia, Sydney, Australia
Abstract Context: There are no evidence-based treatments for
severe and enduring anorexia nervosa. Objective: To evaluate
the relative efficacy of Cognitive Behavioral Therapy (CBT)
and Specialist Supportive Clinical Management (SSCM)
for adults with severe and enduring anorexia nervosa.
Design: Randomised controlled trial. Setting: The University
of Sydney, the University of London and The University of
Chicago from July 2007 through June 2011. Participants:
Sixty-three participants aged 18 and over (range 20-62)
with a DSM-IV diagnosis of anorexia nervosa with at least
a seven year illness history. Interventions: Thirty outpatient
visits over 8 months of CBT or SSCM modified for severe and
enduring anorexia nervosa. Participants were assessed at
baseline, end of treatment (EOT), and 6-month and 12-month
post-treatment follow-up. Main Outcome Measures: Quality
of life, mood disorder symptoms, and social adjustment
were the main outcome measures. Weight (BMI), eating
disorder psychopathology, motivation for change, and health
care burden were secondary outcomes. Results: Thirty-one
participants were randomized to CBT and 32 to SSCM and a
retention rate of 85% was achieved at the end of the study.
At EOT and follow-up, both groups improved significantly
on the majority of outcome measures. However, there were
no differences between treatment groups at EOT. At 6- and
12-month follow-up, analyses indicate greater improvement
for those in CBT compared to SSCM. At 6-month follow-up,
CBT participants had higher scores on the social adjustment
scale (p = .038), and at 12-month they reported lower eating
disorder examination global score (p = .004), and higher
readiness for recovery (p = .013) compared to SSCM.
Conclusions: Patients with severe and enduring anorexia
nervosa can make significant and meaningful improvements
with therapy. CBT shows significant advantage over SSCM
in terms of social adjustment, core eating pathology, and
readiness for change over time.
32
The ANTOP study - a randomized multicentre
outpatient treatment trial in Anorexia
nervosa. Study design, baseline
characteristics and first results.
Stephen Zipfel
1
, B Wild
2
, G Gross
1
, W. Herzog
2
1
University of Tuebingen, Australia, Tuebingen, Germany,
2
Department of Psychosomatic Medicine, University of
Heidelberg, Heidelberg, Germany
1. Introduction: Because of the scarcity of randomized
intervention studies in Anorexia nervosa (AN) with sufficient
power and adequate evaluation of outcome no definite
conclusion as to the impact of treatment on the long-term
course of the illness can be made. The so-called ANTOP
(Anorexia Nervosa Treatment of OutPatients) study
represents the first multisite outpatient intervention trial on
adults with AN. Its purpose was to examine the efficacy of two
specific manualized psychotherapeutic outpatient treatments
for patients with AN, based on either focal psychodynamic
(FPT) or cognitive-behavioral therapy (CBT-E), in comparison
to an enhanced treatment as usual (TAU-E). The primary
hypothesis stated that compared to TAU-E, both FPT and
CBT-E would show a significantly better outcome in terms of
BMI increase at the end of treatment and at 1-year follow-up
(T4). A further focus was the investigation of psychotherapy
process variables. 2. Methods: 242 female AN patients were
recruited within a network of 10 German university study
sites and randomized to one of the three conditions. FPT and
CBT-E involved 40 individual therapy sessions over a period
of 10 months. Psychotherapy sessions were audiotaped for
adherence monitoring and supervision purposes. Due to the
ethical problem of denying active treatment to AN patients,
TAU-E involved the option of external out- and inpatient
PLENARY/ORAL ABSTRACTS