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Which Psychotherapy for Acute Anorexia Nervosa?

Patients in the acute phase of the disease may respond well to nonspecific supportive management.

Studies of psychotherapy in acute anorexia nervosa are difficult to conduct because many patients are reluctant to engage in psychotherapy and dropout rates are high. These researchers conducted a controlled study of three types of manual-based psychotherapy in 56 female outpatients with anorexia nervosa (age range, 17–40; mean baseline BMI, 17.3). Patients were randomly assigned to receive cognitive-behavioral therapy, interpersonal therapy, or nonspecific supportive clinical management (NSSCM). This last therapy involved fostering a therapeutic relationship as well as education, care, and support consisting of praise, reassurance, and advice.

All therapies consisted of 20 sessions over a minimum of 20 weeks; 35 patients (63%) completed therapy. Four dropouts were hospitalized for illness-related reasons. In an analysis of completers, 14% had very good outcomes, 31% improved considerably, and 54% made only small gains. Contrary to the authors' initial hypotheses, NSSCM recipients did as well as or better than those receiving the specialized psychotherapies in both weight gain and improved global functioning. On several measures, CBT’s effectiveness was intermediate between the other two therapies.

Comment: These findings underscore the difficulties of treating patients with anorexia nervosa. In other studies conducted after patients gained weight, CBT has shown some advantage for relapse prevention in adults, and family psychotherapies have been shown to be more effective than other therapies for younger patients. This small study, which is worth trying to replicate, suggests that during the early phases of treatment, when clinicians are encouraging weight gain, the elements of NSSCM (listed above) are important fundamentals.

— Joel Yager, MD

Published in Journal Watch Psychiatry May 18, 2005

Citation(s):

McIntosh VVW et al. Three psychotherapies for anorexia nervosa: A randomized, controlled trial. Am J Psychiatry 2005 Apr; 162:741-7.

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