Specialist supportive clinical management for anorexia nervosa: Analysis of therapy content and relation to outcome.

OBJECTIVE: Psychotherapy for anorexia nervosa (AN) is complex and multifaceted, with little known about likely effective components of treatments. The current study explored the spoken content of specialist supportive clinical management (SSCM) for AN, a treatment with evidence of effectiveness in several randomized clinical trials. METHOD: One hundred seventy-eight therapy sessions constituting all ten therapist-patient dyads of those who completed SSCM treatment in the original clinical trial of SSCM, were transcribed verbatim. Themes were developed and content analyzed using qualitative content analysis of complete therapy sessions by four analysts, with 10% of sessions cocoded for interrater agreement. RESULTS: Over three quarters of session content was within the clinical management theme, the largest subtheme relating to normalizing eating, followed by weight, mechanics of SSCM, and encouragement of self-care. Approximately 20% of total content was in the supportive psychotherapy theme, half about relationships. The relative proportion of clinical management content remained high, decreasing during the last five sessions. Those achieving good outcome did not have a lower ratio of clinical management to supportive psychotherapy content. DISCUSSION: The current study revealed strong clinical management focus on core symptoms of AN-normalization of eating and weight gain-throughout SSCM for AN. PUBLIC SIGNIFICANCE: Six clinical trials have found SSCM to be effective in treating AN. Content of SSCM sessions in the original trial was classified using qualitative content analysis. Study findings revealed strong clinical management focus on core AN symptoms-normalization of eating and weight gain-throughout SSCM, with the ratio of clinical management to supportive psychotherapy greater for those with a good outcome.

Evidence-based treatments remain the best intervention for good long-term outcome of severe and enduring anorexia nervosa.

More research is needed about response to specialist treatments for severe and enduring anorexia nervosa. Current evidence suggests those with severe and enduring anorexia nervosa respond to evidence-based treatments and continue to recover over decades. In the absence of clear guidelines to the contrary and given our understanding of the superior efficacy of specialist treatments over more eclectic treatment choices, it is our responsibility to continue to train and supervise clinicians to deliver evidence-based treatments, irrespective of the variant of anorexia nervosa.