Predictors of Weight Restoration in a Day-Treatment Program that Supports Family-Based Treatment for Adolescents with Anorexia Nervosa.

Family-Based Treatment (FBT) is considered a first-line treatment for adolescents with eating disorders. The traditional outpatient model of FBT may not, however, be appropriate for adolescents requiring more intensive treatment due to severe medical complications or insufficient progress in traditional outpatient FBT. In response, efforts have been made to incorporate FBT into higher levels of care, such as day-treatment programs (DTPs), for families who need additional support. Little is known about the factors that predict weight restoration for DTPs intended to support FBT. The current study examined the ability of specific adolescent and caregiver variables to predict weight restoration at discharge for adolescents with anorexia nervosa (AN) enrolled in a skills-based DTP that supports FBT. Participants were 87 adolescents diagnosed with AN and their caregivers (N = 74). Body Mass Index (BMI) at baseline, percentage of Expected Body Weight (%EBW) gain within the first 4 weeks, and caregiver empowerment level at baseline were found to significantly predict weight restoration. Higher BMI at baseline and higher %EBW gained in the first 4 weeks of treatment were predictive of weight restoration, whereas lower caregiver empowerment at baseline was predictive of weight restoration. Additionally, the rate of weight gain is reported for this DTP grounded in FBT philosophy.

Effectiveness and feasibility of a cognitive-behavioral group intervention for body image disturbance in women with eating disorders.

OBJECTIVE: The present study investigated the effectiveness and feasibility of a cognitive-behavioral group intervention for the treatment of body image disturbance in women with eating disorders. METHOD: The study used a multiple-baseline design and enrolled 38 participants with a range of eating disorders. The intervention targeted attitudinal and behavioral components of body image disturbance using psychoeducation, self-monitoring, systematic desensitization, and cognitive restructuring. Primary outcomes included multidimensional body image assessment (effectiveness) and treatment adherence and satisfaction (feasibility). RESULTS: Participants undergoing manualized group treatment reported significantly less body image disturbance than participants randomized to a waitlist control condition. However, differences disappeared after both groups had been through intervention. Participants also reported less depression and eating disorder pathology from baseline to posttreatment, however this difference was not considered statistically significant. Feasibility outcomes suggest the intervention was well received and highly acceptable to participants. CONCLUSIONS: Findings emphasize the importance of adding an evidence-based body image component to standard eating disorder treatment.

Cognitive set-shifting in anorexia nervosa.

OBJECTIVE: Adult anorexia nervosa (AN) is associated with inefficient cognitive flexibility and set-shifting. Whether such inefficiencies also characterize adolescent AN is an important area of research. METHOD: Adolescents with AN and matched controls were administered a computerized task that required initial learning of an explicit rule using corrective feedback and learning of a new rule after a set number of trials. Adult patients with AN and controls were also examined. RESULTS: Adolescents with AN did not differ from matched controls with respect to set-shifting cost (decrease in performance after rule change), whereas adults with AN had significantly greater set-shifting cost compared with controls. DISCUSSION: This study suggests that set-shifting inefficiencies may not be a vulnerability factor for AN development in adolescents with AN, but might become an important aspect of the disorder at later age, and could point towards developmental neurobiologic brain changes that could affect AN at different ages.