Abstract
ContextThird-wave therapies have demonstrated efficacy as a treatment option for EDs in adulthood. Data on the suitability for EDs in adolescence are lacking.ObjectiveTo estimate the efficacy of third-wave interventions to reduce ED symptoms in adolescents in randomized controlled trials (RCTs) and uncontrolled studies.Data sourcesWe systematically reviewed the databases PubMed (1976-January 2021), PsycINFO (1943-January 2021), and the Cochrane database (1995-January 2021) for English-language articles on third-wave therapies. References were screened for further publications of interest.Study selectionRCTs and pre-post studies without control group, comprising patients aged 11–21 years (mean age = 15.6 years) with an ED diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified) investigating the efficacy of third-wave psychological interventions were included. Efficacy had to be evaluated according to the Eating Disorder Examination or Eating Disorder Examination-Questionnaire, the Eating Disorder Inventory-2, the Eating Disorder Inventory-3, or the Structured Interview for Anorexic and Bulimic Disorders for DSM-IV and ICD-10. The outcome assessed in the meta-analysis was the EDE total score.Data extractionIndependent extraction of data by two authors according to a pre-specified data extraction sheet and quality indicators.Data synthesisWe identified 1000 studies after removal of duplicates, assessed the full texts of 48 articles for eligibility, and included 12 studies with a total of 487 participants (female 97.3%/male 2.6%) in the qualitative synthesis and seven studies in the meta-analysis. Articles predominantly reported uncontrolled pre-post trials of low quality, with only two published RCTs. Treatments focused strongly on dialectical behaviour therapy (n = 11). We found moderate effects of third-wave therapies on EDE total score interview/questionnaire for all EDs (d = − 0.67; z = − 5.53; CI95% = − 0.83 to − 0.59). Descriptively, the effects appeared to be stronger in patients with BN and BED.ConclusionAt this stage, it is not feasible to draw conclusions regarding the efficacy of third-wave interventions for the treatment of EDs in adolescence due to the low quality of the empirical evidence. Since almost all of the identified studies used DBT, it is unfortunately not possible to assess other third-wave treatments’ efficacy.
Highlights
Eating disorders (ED) such as anorexia nervosa (AN) and bulimia nervosa (BN) come with comorbid psychiatric disorders, serious physical complications and a high risk of chronicity and mortality [1, 2]
(2021) 8:20 (Continued from previous page). At this stage, it is not feasible to draw conclusions regarding the efficacy of third-wave interventions for the treatment of EDs in adolescence due to the low quality of the empirical evidence
Risk of bias assessment We evaluated the risk of bias in individual studies according to the Effective Public Health Practice Project (EPHPP) [36] recommendations on the domains selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts
Summary
Eating disorders (ED) such as anorexia nervosa (AN) and bulimia nervosa (BN) come with comorbid psychiatric disorders, serious physical complications and a high risk of chronicity and mortality [1, 2]. The Global Burden of Disease study found EDs in adolescence to be the 12th leading cause of disability-adjusted life years in 15–19-yearold girls in high-income countries [3, 4]. According to our current understanding of the disease mechanisms, EDs share characteristics of emotion dysregulation disorders such as borderline personality disorder (BPD). Patients with EDs often suffer from high levels of aversive tension, especially in social situations and in situations where they are confronted with their body, body weight, or food intake [6]. Similar to patients with BPD, EDs are characterized by high-risk behaviours (e.g. life-threatening weight loss, vomiting, laxative abuse). Regulation of unpleasant emotions appears to be behind both restrictive and bulimic eating behaviour [7]
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