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Porto, Portugal | September 20-22, 2012
23
psychotherapy funded by the health insurance plus regular
GP monitoring. It was systematically investigated in that
therapeutic dosage and treatment conditions were assessed.
3. Results: Both FPT and CBT-E were perceived as helpful
by patients according to feedback questionnaires. Dropout
rates were 22.3% at the end of treatment and 30.1% at
1-year follow-up. At the end of follow-up (T4) there was no
difference in the overall dosage of outpatient psychotherapy
in all three arms. However patients in the TAU-E arm showed
a significantly higher proportion of inpatient admissions
compared with FPT. Patients gained significantly weight
in both active therapy arms as well as in the TAU-E arm.
However, the FPT group showed a significantly better
combined outcome (Psychiatric Status Rating Scale (PSR)
plus BMI) than the TAU-E group at 1-year follow-up. 4.
Conclusions: ANTOP surmounted some of the disadvantages
of previous studies in terms of providing a randomized
controlled design, a large sample size, adequate inclusion
criteria and manualised treatments. The therapies provided
were well received by patients and dropout rates were
modest. The primary hypothesis could not be confirmed in
that all three groups successfully gained significantly weight.
However, adding an independent expert rating for eating
psychopathology and psychiatric comorbidity to the BMI
outcome resulted in a less favorable long-term outcome in the
control condition compared with the FPT condition.
33
A TRANSDIAGNOSTIC COMPARISON OF CBT-E AND IPT
Christopher G. Fairburn, Zafra Cooper, Helen Doll, Rebecca
Murphy, Suzanne Straebler, Shawnee Basden , Marianne E.
O’Connor
University of Oxford UK,
Introduction: Enhanced CBT (CBT-E) is designed to be a
“transdiagnostic” treatment for patients with eating disorders
and the evidence indicates that this is the case as it has been
shown to be effective in anorexia nervosa, bulimia nervosa
and eating disorder NOS. The present study addresses the
question whether another evidence-based psychological
treatment, interpersonal psychotherapy (IPT), is also
transdiagnostic in its scope rather than just being suitable
for those who binge eat. It also seeks to determine whether
the delayed effect of IPT seen in bulimia nervosa also occurs
in patients with eating disorder NOS. The third aim is to
investigate the likely mechanisms of action of both CBT-E and
IPT. Methods: 132 consecutive adult patients with an eating
disorder of clinical severity (with a BMI between 17.5 and
39.9) were randomized to 20 sessions of either CBT-E or IPT
delivered over 20 weeks. They then entered a closed period
of follow-up lasting 60 weeks. The patients were evaluated
by independent assessors who were blind to the patient’s
treatment condition. The main assessment points were before
and after treatment, and at 20, 40 and 60 weeks follow-up.
Results: The final 60-week follow-up assessment took place
in June 2012. The results will be presented for the first time at
EDRS 2012. Conclusions: Not yet known.
34
An Examination of Two Psychological
Treatments for Bulimia Nervosa: Integrative
Cognitive- Affective Therapy vs. Cognitive
Behavior Therapy-Enhanced
Stephen Wonderlich, Carol B. Peterson, James E. Mitchell,
Scott Crow, Marjorie Klein, Tracey Smith, Ross D. Crosby
University of North Dakota,
Objective: To compare two psychological treatments for
bulimia nervosa, Integrative Cognitive-Affective Therapy
(ICAT) and Cognitive Behavior Therapy-Enhanced (CBT-E),
on measures of abstinence from bulimic symptoms,
reductions in binge eating and purging behaviors, attrition,
comorbid psychopathology, cognitive self-discrepancy, and
emotion regulation. Method: Eighty adults meeting full or
sub-threshold DSM-IV diagnostic criteria for bulimia nervosa
were randomized to ICAT or CBT-E at one of two USA sites
(Fargo, North Dakota and Minneapolis, Minnesota). Patients
were assessed at baseline, end of treatment, and four-
month follow-up using semi-structured interviews and self-
report questionnaires to examine bulimic symptoms (Eating
Disorder Examination), comorbid psychiatric symptoms
(Beck Depression Inventory, Spielberger State/Trait Anxiety
Inventory), cognitive self-discrepancy (Selves Interview), and
emotion regulation (Difficulties in Emotion Regulation Scale).
Results: Statistical analysis revealed that participants in both
treatment conditions showed significant improvement in
bulimic symptoms, comorbid psychopathology, cognitive self-
discrepancy, and emotion regulation at end of treatment and
follow-up compared to baseline assessment. Abstinence rates
for binge eating and purging were 37.5% for ICAT and 22.5%
for CBT-E at end of treatment and 32.5% for ICAT and 22.5%
for CBT-E at follow-up. On global severity as measured by
the Eating Disorder Examination, 47.5% of the ICAT sample
and 37.5% of the CBT-E sample were within one standard
deviation of the community mean at end of treatment , with
55% of the ICAT sample and 50% of the CBT-E sample within
one standard deviation of the community mean at follow-up.
Treatment completion rates were 85% for ICAT and 75%
for CBT-E. No statistically significant differences were found
between the two treatments on any measures of outcome.
Discussion: These results provide preliminary evidence that
ICAT is an efficacious treatment for bulimia nervosa and
that this new treatment is comparable to CBT-E on outcome
measures of eating disorder and associated symptoms .
The high rate of treatment completion (85%) in the ICAT
sample also suggests that this treatment is acceptable to
patients. Future research is needed to replicate and expand
these findings using larger samples as well as to identify
mechanisms of treatment efficacy in both ICAT and CBT-E
35
ARE RESTRICTING AND BINGE/PURGE SUBTYPES
OF ANOREXIA NERVOSA DIFFERENT DISORDERS?
EVIDENCE FROM OBSTETRIC COMPLICATION RATES IN
A LARGE CLINICAL SAMPLE.
Ian Frampton
1,2,3
, Salma Suri
2
, Julie O’Toole
4
, Bryan Lask
1,2,5
1
Regional Eating Disorder Service, Oslo, Norway,
2
Gt. Ormond
St Hospital NHS Trust, London, United Kingdom,
3
Peninsula
College of Medicine and Dentistry, Truro, United Kingdom,
4
Kartini Clinic, Portland, OR, USA,
5
Ellern Mede Centre for
Eating Disorders, London, United Kingdom
Introduction There is a consensus that the existing diagnostic
systems for Anorexia Nervosa (AN) fail to delineate different
subtypes based on their ‘surface’ characteristics. A potential
neurodevelopmental subtype should theoretically be
associated with an increased rate of obstetric complication
(OC) markers of subtle disruption to brain functioning in
utero and early post-natal life. We therefore predict that the
Restricting subtype should exhibit a significantly different
group profile in rates and types of OCs, compared with
a Binge/Purge subtype group. Methods 696 consecutive
admissions to a specialist eating disorder treatment service
were clinically categorized as Restricting (n = 385) or Binge/
Purge (n = 311) subtype by a senior clinician. Parental
report of OCs was obtained using a structured interview
based on the McNeil-Sjostrom Scale, a well-validated and
reliable measure. Results Significant differences between
subtypes were observed for a range of OCs, including rates
of premature birth, anemia and toxemia, breech birth and
fetal distress. There were no significant differences in rates of
OCs between diagnostic subtypes on a wide range of other
variables. Conclusions These data lend partial support to
the hypothesis that subgroups of AN can be characterized
by different rates of OCs. The results of the current study
are compared with data previously reported by Favaro
and colleagues, and the implications for AN diagnosis and
treatment explored.
PLENARY/ORAL ABSTRACTS