Abstract
BackgroundCognitive-behavioral therapy (CBT) has been recommended for the treatment of eating disorders, and group therapy is known to have certain advantages over individual therapy. The aim of the current study was to compare the 10-year prognosis of patients who completed integrated group CBT with those who dropped out and to examine the effect of completion of group CBT on the prognosis.MethodsThe participants were 65 adult patients with eating disorders. All patients were women and Japanese. The average age (19–37) of the patients was 25.1 ± 3.8 years, and the average body mass index (BMI) was 17.7 ± 2.0. We conducted integrated group CBT with the patients and compared eating disorder symptoms, mood states, coping styles, and self-esteem before and after therapy. Furthermore, we compared clinical features and the 10-year prognosis of patients who completed the treatment and those who dropped out.ResultsAfter 10 sessions of group therapy, Eating Attitudes Test scores, Profile of Mood States depression scores, and Coping Inventory for Stressful Situations emotion-oriented scores decreased, while Rosenberg’s Self-Esteem Scale scores increased. Regarding the results of the 10-year follow up, the completer group had more patients with a good prognosis. In contrast, the dropout group had more patients with a poor prognosis.ConclusionsThose who completed the integrated group CBT had a good prognosis. Group therapy gives the patients an opportunity to form peer relationships, and helps them to develop communication and socialization skills. Furthermore, in the group therapy sessions, the patients develop self-awareness by listening to other members of the group and they also develop interpersonal relationships. This effect may be temporary, but experience of group therapy may provide hope for the patient and increase the chance of the patient continuing treatment.Trial registrationRetrospectively registered in University Hospital Medical Information Network in Japan: No. 000028868 (May 19th, 2017).
Highlights
Cognitive-behavioral therapy (CBT) has been recommended for the treatment of eating disorders, and group therapy is known to have certain advantages over individual therapy
We considered a score of higher than 80 on the Global Assessment of Function (GAF) to be an indicator of good social adaptation
We considered the patients whose eating disorder symptoms improved and who had adapted well to society as having made “good progress,” the patients whose symptoms did not change as having “no change,” and the patients whose symptoms got worse or Intervention The structure of the group therapy was as follows: 1) closed membership, 2) group size limited to no more than eight members, 3) weekly meetings (90 min, 10 sessions), and 4) 2–3 staff members (2 psychiatrists usually participated, sometimes a psychologist joined) present
Summary
Cognitive-behavioral therapy (CBT) has been recommended for the treatment of eating disorders, and group therapy is known to have certain advantages over individual therapy. Many serious problems are associated with eating disorders [2, 3], such as 1) significant mortality rates [4], 2) suicidal behavior [5, 6], 3) high medical costs [7], 4) high rates of comorbidity [8], and 5) high association with childhood trauma, such as abuse. In the National Institute for Health and Clinical Excellence guidelines [9], cognitive behavioral therapy (CBT) is recommended for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Fairburn [10] reported that most eating disorders have a mixed clinical presentation, in which the features of AN, BN, BED, and those of incomplete types overlap in various ways.
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