Moderators of weight gain in the early stages of outpatient cognitive behavioral therapy for adults with anorexia nervosa

Abstract

Treatments for anorexia nervosa have relatively low levels of effectiveness. This prospective study examines the impact of patients' characteristics on their early responses to cognitive behavioral therapy (CBT) for anorexia nervosa. Patients' eating attitudes, body mass index, and comorbid characteristics at the outset of treatment were used to predict drop-out and changes in weight across the first 10 sessions of CBT. Forty anorexic patients (28 full syndrome and 12 atypical cases--body mass index range = 12.8-18.4) entered CBT for anorexia nervosa. Early drop-outs (N = 6) had relatively low levels of anxiety at the beginning of therapy, but there were no other moderators. Weight gain was slower in the 6th to 10th sessions among patients with relatively unhealthy eating attitudes (restraint and shape concerns). Higher levels of anxiety at the start of treatment were associated with poorer weight gain across these first 10 sessions. Early anxiety levels should be attended to closely in CBT for anorexia nervosa, with low levels indicating a high risk of drop-out and a greater need for engagement and motivational work, and high levels, indicating that clinicians should work explicitly with the patient on anxiety reduction techniques in order to enhance their level of early weight gain.