Abstract
Standardised treatment manuals facilitate therapy planning and enhance comparability for research purposes. Within the Anorexia Nervosa Treatment of Out Patients (ANTOP) study, the largest multisite outpatient intervention trial in anorexia nervosa (AN) to date, manualised enhanced cognitive-behavioural therapy (CBT-E) was offered as one treatment modality. The manual consisted of 9 modules, of which Motivation, Nutrition, Formulation and Relapse Prevention were compulsory. Homework worksheets were provided, to ensure the transfer of therapeutic improvements to daily life. This study investigated the use of modules and worksheets in order to explore practice styles of trained therapists in the treatment of AN. This secondary analysis was based on log-sheets (n = 2604) CBT-E therapists completed after each session. Frequencies of modules and worksheets used across all sessions were calculated. Relationships, such as that between use of module and duration of illness, were examined. The most commonly used module was Motivation. In patients with longer illness duration, the module Self Esteem seemed to be particularly important. The worksheet Scales, balancing the pros and cons of AN, was prioritised by therapists. The results underline the importance of motivational work in the treatment of AN, including validating the ambivalence experienced by most AN patients. With increasing duration of illness, resource-oriented elements, such as self esteem stabilisation, should be of focus.
Highlights
Treatment manuals for psychotherapeutic interventions guarantee that the path of treatment remains relatively focused, ensuring a standardised quality of therapy [1]
The use of worksheets was recorded 888 times across all session logs. 590 additional records of worksheet use were excluded from analysis, as they did not refer to any of the 55 worksheets made available to the therapists
Analysing individual outpatient therapy administered by experienced therapists involved in the Anorexia Nervosa Treatment of Out Patients (ANTOP) study, this paper provides other therapists with practical recommendations regarding the use of modules and corresponding worksheets within manualised cognitive behaviour therapy (CBT-E) for anorexia nervosa (AN)
Summary
Treatment manuals for psychotherapeutic interventions guarantee that the path of treatment remains relatively focused, ensuring a standardised quality of therapy [1]. Manuals exist for a vast array of treatments, including cognitive behaviour therapy (CBT) [3,4,5]. A convincing bank of evidence suggests that manualised CBT is effective in treating eating disorders [6,7,8]. A recently developed modified version of CBT, called enhanced cognitive behaviour therapy (CBT-E) [3], employs a transdiagnostic approach addressing all eating disorders. CBT-E has been shown to produce lasting improvements in body-mass index and eating disorder pathology in AN patients [11], and to be as effective as other “standard” treatment options [11,12]
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