Implementation of enhanced cognitive behaviour therapy (CBT-E) for adults with anorexia nervosa in an outpatient eating-disorder unit at a public hospital

Stein Frostad, Yngvild S Danielsen, Guro Å Rekkedal, Charlotte Jevne, Riccardo Dalle Grave, Øyvind Rø, Ute Kessler, Stein Frostad, Yngvild S Danielsen, Guro Å Rekkedal, Charlotte Jevne, Riccardo Dalle Grave, Øyvind Rø, Ute Kessler

Abstract

Background: Anorexia nervosa (AN) in adults is difficult to treat, and no current treatment is supported by robust evidence. A few studies, most of which were performed by highly specialized research units, have indicated that enhanced cognitive behaviour therapy (CBT-E) for eating disorders can be effective. However, the dropout rate is high and the evidence from non-research clinical units is sparse.

Methods: This quality assessment project implemented CBT-E in an outpatient setting at a public hospital. Forty-four patients with AN started therapy. Each patient received at least 40 sessions of CBT-E over a 12-month period. Their body mass index (BMI) was recorded at baseline and after 3, 6 and 12 months. Reasons for not starting therapy or for leaving therapy prematurely were recorded.

Results: Half (n = 22) of the 44 patients who started outpatient CBT-E did not complete the treatment. In the remaining sample there was a large (and statistically significant) weight gain after 12 months. The percentage of patients achieving the target BMI of > 18.5 kg/m2 was 36.4, 50.0 and 77.3% after 3, 6 and 12 months, respectively.

Conclusions: This quality assessment project shows that it is possible to establish effective CBT-E in an outpatient eating-disorder unit at a public hospital. Although half of the patients did not complete CBT-E, the remaining patients achieved a significant increase in BMI at 1 year after the start of therapy.

Keywords: Adults; Anorexia nervosa; Body mass index; Cognitive behaviour therapy.

Conflict of interest statement

This project is a part of the quality-improvement work at the DED at Haukeland University Hospital and was approved by the data protection officer at that hospital (approval no. 2015/12991). The project protocol was submitted for consideration to the Regional Ethical Committee and deemed exempt from review as it was classified as quality improvement (2018/275/REK vest). Consent to participate is not required for quality improvement projects.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart over the patients referred to the Department of Eating Disorders during 2013 and 2014
Fig. 2
Fig. 2
BMI over the course of treatment for 22 patients who completed CBT-E

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