Disseminating Evidence-Based Psychological Treatment
Eating disorders (EDs) affect individuals from every socioeconomic status, race, ethnicity, and gender, with approximately 10% of the population affected by an ED at some point in their lifetime.1 EDs are associated with high medical and psychiatric comorbidity, poor quality of life, and high mortality, and mortality from anorexia nervosa (AN) is the highest of all mental disorders.2 Fortunately, there are a number of evidence-based psychological treatment approaches for EDs. Three well-established treatments have emerged for patients who are medically and psychiatrically stable enough for outpatient care.3
The basic tenets of family-based treatment—often referred to as the Maudsley method—for adolescents with anorexia nervosa include4:
1) The family is not blamed as the cause of the illness.
2) The adolescent’s acceptance of family and parent involvement in therapy is crucially important; thus, parents are tasked with taking charge of weight gain in their malnourished child.
3) The entire family is an important part of treatment success.
4) Normal adolescent development is seen as having been interrupted by the illness.
The treatment typically consists of 10 to 20 sessions over the course of 6 to 12 months. Full nutrition is viewed as a critical first step toward recovery, and the early part of treatment is focused on the therapist coaching the parents to provide this nutrition by actively feeding their child.
Cognitive behavioral therapy (CBT) is a treatment for bulimia nervosa and binge eating disorder. According to the cognitive-behavioral theory of EDs, the over-evaluation and control of shape and weight is central to ED maintenance, with most of the other clinical features understood as directly resulting from this psychopathology, including extreme weight-control behavior and preoccupation with thoughts about eating, shape, and weight.
The core components of CBT are designed to be delivered in 20 sessions over 5 months. Key strategies include establishing control over eating with behavioral techniques, such as self-monitoring and establishing a regular pattern of eating and addressing maintaining factors (eg, control and over-evaluation of shape and weight, dietary restraint). In the enhanced version of CBT for EDs (CBT-E), modules can be added to address one or more external processes that may be maintaining the ED, including perfectionism, low self-esteem, and interpersonal problems.
Dr Fitzsimmons-Craft is Assistant Professor of Psychiatry, and Dr Wilfley is the Scott Rudolph University Professor of Psychiatry, Medicine, Pediatrics, and Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO. The authors report no conflicts of interest concerning the subject matter of this article.
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