title: Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. Targeting habits in anorexia nervosa: a proof-of-concept randomized trial. Confronting fear using exposure and response prevention for anorexia nervosa: A randomized controlled pilot study. Predictors of outcomes in outpatients with anorexia nervosa – Results from the ANTOP study Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments. A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK Randomized Clinical Trial of Parent-Focused Treatment and Family-Based Treatment for Adolescent Anorexia Nervosa. Enhanced cognitive behaviour therapy for adults with anorexia nervosa: A UK–Italy study Inpatient Cognitive Behaviour Therapy for Anorexia Nervosa: A Randomized Controlled Trial Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents Treating severe and enduring anorexia nervosa: a randomized controlled trial. The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Changes in neuronal correlates of body image processing by means of cognitive-behavioural body image therapy for eating disorders: a randomized controlled fMRI study. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Is outpatient cognitive remediation therapy feasible to use in randomized clinical trials for anorexia nervosa? The Effectiveness of Cognitive Remediation Therapy in Patients with a Severe or Enduring Eating Disorder: A Randomized Controlled Trial Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. Can adaptive treatment improve outcomes in family-based therapy for adolescents with anorexia nervosa? Feasibility and treatment effects of a multi-site treatment study. A practical comparison of two types of family intervention: an exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for adults with anorexia nervosa. Three psychotherapies for anorexia nervosa: a randomized, controlled trial. A randomised controlled trial of three psychological treatments for anorexia nervosa. A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa. Clinical effectiveness of treatments for anorexia nervosa in adolescents: randomised controlled trial. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial Training cognitive flexibility in patients with anorexia nervosa: a pilot randomized controlled trial of cognitive remediation therapy. Brief psychotherapy in the treatment of anorexia nervosa. Outcome at one year. An evaluation of the effectiveness and short-term stability of an innovative Australian day patient programme for eating disorders. Effects of providing patient progress feedback and clinical support tools to psychotherapists in an inpatient eating disorders treatment program: A randomized controlled study A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioral therapy for adult anorexia nervosa. Family Therapy versus Individual Therapy for Adolescent Females with Anorexia Nervosa Does internet-based prevention reduce the risk of relapse for anorexia nervosa? Relapse from remission at two- to four-year follow-up in two treatments for adolescent anorexia nervosa. The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up. A randomized clinical trial of an identity intervention programme for women with eating disorders. The Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC): Comparison of the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) with specialist supportive clinical management (SSCM) in outpatients with broadly defined anorexia nervosa: A randomize
abstract: IMPORTANCE Anorexia nervosa ( AN ) is a serious disorder with high rates of morbidity and mortality . Family-based treatment ( FBT ) is an evidence -based therapy for adolescent AN , but less than half of those who receive this approach recover . Hence , it is important to identify other approaches to prevent the development of the chronic form of AN for which there is no known evidence -based treatment . OBJECTIVE To compare FBT with systemic family therapy ( SyFT ) for the treatment of adolescent-onset AN . DESIGN , SETTING , AND PARTICIPANTS Research in Anorexia Nervosa ( RIAN ) is a 2-group  ( FBT and SyFT ) r and omized trial conducted between September 2005 and April 2012 . Interviewers were blinded to the treatment condition . A total of 564 adolescents receiving care at 6 outpatient clinics experienced in the treatment of AN were screened . Of these , 262 adolescents did not meet the inclusion criteria and 138 declined to participate ; hence , 164 adolescents ( aged 12 - 18 years ) of both sexes meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , AN ( except for amenorrhea ) were enrolled . Three participants were withdrawn from FBT and 7 were withdrawn from SyFT after serious adverse events occurred . INTERVENTIONS Two manualized family therapies with 16 one-hour sessions during 9 months . Family-based therapy focuses on the facilitation of weight gain , whereas SyFT addresses general family processes . MAIN OUTCOMES AND MEASURES The primary outcomes were percentage of ideal body weight ( IBW ) and remission ( ≥95 % of IBW ) . The a priori hypothesis was that FBT would result in faster weight gain early in treatment and at the end of treatment ( EOT ) . RESULTS There were no statistically significant differences between treatment groups for the primary outcome , for eating disorder symptoms or comorbid psychiatric disorders at the EOT or follow-up . Remission rates  included FBT , 33.1 % at the EOT and 40.7 % at follow-up and SyFT , 25.3 % and 39.0 % , respectively . Family-based therapy led to significantly faster weight gain early in treatment , significantly fewer days in the hospital , and lower treatment costs per patient in remission at the EOT ( FBT , $ 8963 ; SyFT , $ 18 005 ) . An exploratory moderator analysis found that SyFT led to greater weight gain  than did FBT for participants with more severe obsessive-compulsive symptoms . CONCLUSIONS AND RELEVANCE The findings of this study suggest that FBT is the preferred treatment for adolescent AN because it is not significantly different from SyFT and leads to similar outcomes at a lower cost than SyFT . Adolescents with more severe obsessive-compulsive symptoms may receive more benefits with SyFT . TRIAL REGISTRATION clinical trials.gov Identifier NCT00610753 BACKGROUND Habits are behavioral routines that are automatic and frequent , relatively independent of any desired outcome , and have potent antecedent cues . Among individuals with anorexia nervosa ( AN ) , behaviors that promote the starved state appear habitual , and this is the foundation of a recent neurobiological model of AN . In this proof-of-concept study , we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines . METHODS The primary intervention target was habit strength ; we also measured clinical impact via eating disorder psychopathology and actual eating . Twenty-two hospitalized patients with AN were r and omly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aim ed at cues for maladaptive behavioral routines , Regulating Emotions and Changing Habits ( REaCH ) . RESULTS Covarying for baseline , REaCH was associated with a significantly lower Self-Report Habit Index ( SRHI ) score and significantly lower Eating Disorder Examination- Question naire ( EDE-Q ) global score at the end-of-treatment . The end-of-treatment effect size for SRHI was d = 1.28 , for EDE-Q was d = 0.81 , and for caloric intake was d = 1.16 . CONCLUSIONS REaCH changed habit strength of maladaptive routines more than an active control therapy , and targeting habit strength yielded improvement in clinical ly meaningful measures . These findings support a habit-based model of AN , and suggest habit strength as a mechanism-based target for intervention OBJECTIVE Anorexia nervosa ( AN ) is a severe illness with high rates of relapse . Exposure and Response Prevention for AN ( AN-EXRP ) is a new approach that specifically addresses maladaptive eating behavior by targeting eating-related fear and anxiety . The aim of this study was to evaluate AN-EXRP as an adjunctive strategy to improve eating behavior during weight restoration , at a pivotal moment when treatment goals shift toward relapse prevention . METHOD A r and omized controlled trial was conducted to compare AN-EXRP with a comparison condition , Cognitive Remediation Therapy ( CRT ) .  Hospitalized patients with AN ( n = 32 ) who had achieved weight restoration to a BMI > 18.5 kg/m(2 ) received 12 sessions of either AN-EXRP or CRT . Outcome was assessed by change in caloric intake in an objective assessment of eating behavior . RESULTS The average test meal caloric intake of participants who received AN-EXRP increased from 352 ± 263 kcal at baseline to 401 ± 215 kcal post-treatment , while that of participants who received CRT decreased from 501 ± 232 kcal at baseline to 424 ± 221 kcal post-treatment [ t(28 ) = 2.5 , p = .02 ] . Improvement in intake was significantly associated with improvement in eating-related anxiety ( Spearman 's ρ = 0.40 , p = .03 ) . DISCUSSION These data demonstrate that AN-EXRP , compared to a credible comparison intervention , is associated with better caloric intake in a laboratory meal over time in AN . Additional studies are required to determine whether incorporation of these techniques into a longer treatment program leads to enduring and clinical ly significant change This study aim ed to determine predictors of BMI and recovery for out patients with anorexia nervosa ( AN ) . Patients were participants of the ANTOP ( Anorexia Nervosa Treatment of Out- Patients ) trial and r and omized to focal psychodynamic therapy ( FPT ) , enhanced cognitive behavior therapy ( CBT-E ) , or optimized treatment as usual ( TAU-O ) .  N=169 patients participated in the one-year follow-up ( T4 ) . Outcomes were the BMI and global outcome ( recovery/partial syndrome/full syndrome ) at T4 . We examined the following baseline variables as possible predictors : age , BMI , duration of illness , subtype of AN , various axis I diagnoses , quality of life , self-esteem , and psychological characteristics relevant to AN . Linear and logistic regression analyses were conducted to identify the predictors of the BMI and global outcome . The strongest positive predictor for BMI and recovery at T4 was a higher baseline BMI of the patients . Negative predictors for BMI and recovery were a duration of illness > 6 years and a lifetime depression diagnosis at baseline . Additionally , higher bodily pain was significantly associated with a lower BMI and self-esteem was a positive predictor for recovery at T4 . A higher baseline BMI and shorter illness duration led to a better outcome . Further research is necessary to investigate whether or not AN patients with lifetime depression , higher bodily pain , and lower self-esteem may benefit from specific treatment approaches BACKGROUND Very limited evidence is available on how to treat adults with anorexia nervosa and treatment outcomes are poor . Novel treatment approaches are urgently needed . AIMS To evaluate the efficacy and acceptability of a novel psychological therapy for anorexia nervosa ( Maudsley Model of Anorexia Nervosa Treatment for Adults , MANTRA ) compared with specialist supportive clinical management ( SSCM ) in a r and omised controlled trial . METHOD Seventy-two adult out- patients with anorexia nervosa or eating disorder not otherwise specified were recruited from a specialist eating disorder service in the UK . Participants were r and omly allocated to 20 once weekly sessions of MANTRA or SSCM and optional additional sessions depending on severity and clinical need ( trial registration : IS RCT N62920529 ) . The primary outcomes were body mass index , weight and global score on the Eating Disorders Examination at end of treatment ( 6 months ) and follow-up ( 12 months ) . Secondary outcomes included : depression , anxiety and clinical impairment ; neuropsychological outcomes ; recovery rates ; and additional service utilisation . RESULTS At baseline , patients r and omised to MANTRA were significantly less likely to be in a partner relationship than those receiving SSCM ( 3/34 v. 10/36 ; P<0.05 ) . Patients in both treatments improved significantly in terms of eating disorder and other outcomes , with no differences between groups . Strictly defined recovery rates were low . However , MANTRA patients were significantly more likely to require additional in-patient or day-care treatment than those receiving SSCM ( 7/34 v. 0/37 ; P = 0.004 ) . CONCLUSIONS Adults with anorexia nervosa are a difficult to treat group . The imbalance between groups in partner relationships may explain differences in service utilisation favouring SSCM . This study confirms SSCM as a useful treatment for out- patients with anorexia nervosa . The novel treatment , MANTRA , design ed for this patient group may need adaptations to fully exploit its potential BACKGROUND In-patient treatment ( IP ) is the treatment setting of choice for moderately-to-severely ill adolescents with anorexia nervosa , but it is costly , and the risks of relapse and readmissions are high . Day patient treatment ( DP ) is less expensive and might avoid problems of relapse and readmission by easing the transition from hospital to home . We investigated the safety and efficacy of DP after short inpatient care compared with continued IP . METHODS For this multicentre , r and omised , open-label , non-inferiority trial , we enrolled female patients ( aged 11 - 18 years ) with anorexia nervosa from six centres in Germany . Patients were eligible if they had a body-mass index ( BMI ) below the tenth percentile and it was their first admission to hospital for anorexia nervosa . We used a computer-generated r and omisation sequence to r and omly assign patients to continued IP or DP after 3 weeks of inpatient care ( 1:1 ; stratified for age and BMI at admission ) . The treatment programme and treatment intensity in both study groups were identical . The primary outcome was the increase in BMI between the time of admission and a 12-month follow-up adjusted for age and duration of illness ( non-inferiority margin of 0·75 kg/m(2 ) ) . Analysis was done by modified intention to treat . This trial is registered with the International St and ard R and omised Controlled Trial Number Register , number IS RCT N67783402 , and the Deutsches Register Klinischer Studien , number DRKS00000101 . FINDINGS Between Feb 2 , 2007 , to April 27 , 2010 , we screened 660 patients for eligibility , 172 of whom we r and omly allocated to treatment : 85 to IP and 87 to DP . DP was non-inferior to IP with respect to the primary outcome , BMI at the 12-month follow-up ( mean difference 0·46 kg/m(2 ) in favour of DP ( 95 % CI , -0·11 to 1·02 ; pnon-inferiority<0·0001 ) . The number of treatment-related serious adverse events was similar in both study groups ( eight in the IP group , seven in the DP group ) . Three serious adverse events in the IP group and two in the DP group were related to suicidal ideation ; one patient in the DP  attempted suicide 3 months after she was discharged . INTERPRETATION DP after short inpatient care in adolescent patients with non-chronic anorexia nervosa seems no less effective than IP for weight restoration and maintenance during the first year after admission . Thus , DP might be a safe and less costly alternative to IP . Our results justify the broad implementation of this approach . FUNDING German Ministry for Education and Research Background Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa , with a general consensus in the field that eating disorders focussed family therapy ( often referred to as Maudsley Family Therapy or Family Based Treatment ) currently offers the most promising outcomes . Nevertheless , a significant number do not respond well and additional treatment developments are needed to improve outcomes . Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first r and omised controlled trial of multifamily therapy for adolescent anorexia nervosa . Methods The study was a pragmatic multicentre r and omised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy ( MFT-AN ) and single family therapy ( FT-AN ) .  A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified ( restricting type ) were r and omised to the two treatments using computer generated blocks of r and om sizes to ensure balanced numbers in the trial arms . Independent assessors , blind to the allocation , completed evaluations at baseline , 3 months , 12 months ( end of treatment ) and 18 months . Results Both treatment groups showed clinical ly significant improvements with just under 60 % achieving a good or intermediate outcome ( on the Morgan-Russell scales ) at the end of treatment in the FT-AN group and more than 75 % in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention ( OR = 2.55 95 % ; CI 1.17 , 5.52 ; p = 0.019 ) . At follow-up ( 18 months post baseline ) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant . Clinical ly significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology . Approximately half the patients in FT-AN and nearly 60 % of those in MFT-AN had started menstruating . Conclusions This study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family re sources and mutual support leading to improved outcomes .Trial Registration Current Controlled Trials IS RCT N11275465 ; Registered 29 January 2007 ( retrospectively registered BACKGROUND Currently , without systematic evidence , psychotherapy for anorexia nervosa in adults draws on psychodynamic , cognitive and systemic theories . AIMS To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa . METHOD Eighty-four patients were r and omised to four treatments : three specific psychotherapies - ( a ) a year of focal psychoanalytic psychotherapy ; ( b ) 7 months of cognitive-analytic therapy ( CAT ) ; ( c ) family therapy for 1 year - and ( d ) low contact , ' routine ' treatment for 1 year ( control ) . RESULTS At 1 year , there was symptomatic improvement in the whole group of patients . This improvement was modest , several patients being significantly undernourished at follow-up . Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment ; CAT tended to show benefits . CONCLUSIONS Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia Background Individual , family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa ( AN ) . Potential predictors of treatment outcome are explored . Method Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years ( adult units N = 12 ; adolescent N = 2 ) ( patients N = 177 ) . Results One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study . Following inpatient care , physical improvement was moderate/good with a large increase in BMI , although most patients continued to have a clinical level of eating disorder symptoms at discharge . The potentially modifiable predictors of outcome included confidence to change , social functioning and carer expressed emotion and control . Conclusions Overall , the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness . Adolescents had a better response . Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms . As predicted by the carer interpersonal maintenance model , carer behaviour may influence the response to inpatient care , as may improved social functioning and confidence to change OBJECTIVE There have been few r and omized clinical trials ( RCTs ) for adolescents with anorexia nervosa ( AN ) . Most of these posit that involving all family members in treatment supports favorable outcomes . However , at least 2 RCTs suggest that separate parent and adolescent sessions may be just as effective as conjoint treatment . This study compared the relative efficacy of family-based treatment ( FBT ) and parent-focused treatment ( PFT ) . In PFT , the therapist meets with the parents only , while a nurse monitors the patient . METHOD Participants ( N = 107 ) aged 12 to 18 years and meeting DSM 4(th)Edition criteria for AN or partial AN were r and omized to either FBT or PFT .  Participants were assessed at baseline , end of treatment ( EOT ) , and at 6 and 12 months posttreatment . Treatments comprised 18 outpatient sessions over 6 months . The primary outcome was remission , defined as ≥95 % of median body mass index and Eating Disorder Examination Global Score within 1 SD of community norms . RESULTS Remission was higher in PFT than in FBT at EOT ( 43 % versus 22 % ; p = .016 , odds ratio [ OR ] = 3.03 , 95 % CI = 1.23 - 7.46 ) , but did not differ statistically at 6-month ( PFT 39 % versus FBT 22 % ; p = .053 , OR = 2.48 , CI = 0.989 - 6.22 ) , or 12-month ( PFT 37 % versus FBT 29 % ; p = .444 , OR = 1.39 , 95 % CI = 0.60 - 3.21 ) follow-up . Several treatment effect moderators of primary outcome were identified . CONCLUSION At EOT , PFT was more efficacious than FBT in bringing about remission in adolescents with AN . However , differences in remission rates  between PFT and FBT at follow-up were not statistically significant . CLINICAL TRIAL REGISTRATION INFORMATION A R and omised Controlled Trial of Two Forms of Family-Based Treatment and the Effect on Percent Ideal Body Weight and Eating Disorders Symptoms in Adolescent Anorexia Nervosa ; http://www.anzctr.org.au/ ; ACTRN12610000216011 Anorexia nervosa is difficult to treat and no treatment is supported by robust evidence . As it is uncommon , it has been recommended that new treatments should undergo extensive preliminary testing before being evaluated in r and omized controlled trials . The aim of the present study was to establish the immediate and longer-term outcome following “ enhanced ” cognitive behaviour therapy ( CBT-E ) .  Ninety-nine adult patients with marked anorexia nervosa ( body mass index ≤ 17.5 ) were recruited from consecutive referrals to clinics in the UK and Italy . Each was offered 40 sessions of CBT-E over 40 weeks with no concurrent treatment . Sixty-four percent of the patients were able to complete this outpatient treatment and in these patients there was a substantial increase in weight ( 7.47 kg , SD 4.93 ) and BMI ( 2.77 , SD 1.81 ) . Eating disorder features also improved markedly . Over the 60-week follow-up period there was little deterioration despite minimal additional treatment . These findings provide strong preliminary support for this use of CBT-E and justify its further evaluation in r and omized controlled trials . As CBT-E has already been established as a treatment for bulimia nervosa and eating disorder not otherwise specified , the findings also confirm that CBT-E is transdiagnostic in its scope Background : The aim of this study was to compare the immediate and longer-term effects of two cognitive behaviour therapy programmes for hospitalized patients with anorexia nervosa , one focused exclusively on the patients ' eating disorder features and the other focused also on mood intolerance , clinical perfectionism , core low self-esteem or interpersonal difficulties . Both programmes were derived from enhanced cognitive behaviour therapy ( CBT-E ) for eating disorders . Methods : Eighty consecutive patients with severe anorexia nervosa were r and omized to the two inpatient CBT-E programmes , both of which involved 20 weeks of treatment ( 13 weeks as an inpatient and 7 as a day patient ) . The patients were then followed up over 12 months . The assessment s were made blind to treatment condition . Results : Eighty-one percent of the eligible patients accepted inpatient CBT-E , of whom 90 % completed the 20 weeks of treatment . The patients in both programmes showed significant improvements in weight , eating disorder and general psychopathology . Deterioration after discharge did occur but it was not marked and it was restricted to the first 6 months . There were no statistically significant differences between the effects of the two programmes . Conclusions : These findings suggest that both versions of inpatient CBT-E are well accepted by these severely ill patients and might be a viable and promising treatment for severe anorexia nervosa . There appears to be no benefit from using the more complex form of the treatment Background Families express a need for information to support people with severe anorexia nervosa . Aims To examine the impact of the addition of a skills training intervention for caregivers ( Experienced Caregivers Helping Others , ECHO ) to st and ard care . Method Patients over the age of 12 ( mean age 26 years , duration 72 months illness ) with a primary diagnosis of anorexia nervosa and their caregivers were recruited from 15 in-patient services in the UK . Families were r and omised to ECHO ( a book , DVDs and five coaching sessions per caregiver ) or treatment as usual .  Patient ( n=178 ) and caregiver ( n=268 ) outcomes were measured at discharge and 6 and 12 months after discharge . Results Patients with caregivers in the  ECHO group had reduced eating disorder psychopathology ( EDE-Q ) and improved quality of life ( WHO-Quol ; both effects small ) and reduced in-patient bed days ( 7–12 months post-discharge ) . Caregivers in the ECHO group had reduced burden ( Eating Disorder Symptom Impact Scale , EDSIS ) , expressed emotion ( Family Question naire , FQ ) and time spent caregiving at 6 months but these effects were diminished at 12 months . Conclusions Small but sustained improvements in symptoms and bed use are seen in the intervention group . Moreover , caregivers were less burdened and spent less time providing care . Caregivers had most benefit at 6 months suggesting that booster sessions , perhaps jointly with the patients , may be needed to maintain the effect . Sharing skills and information with caregivers may be an effective way to improve outcomes . This r and omised controlled trial ( RCT ) was registered with Current Controlled Trials IS RCT N06149665 . Declaration of interest J.T. is a co-author of the book used in the ECHO intervention and receives royalties . Copyright and usage © The Royal College of Psychiatrists 2015 . This is an open access article distributed under the terms of the Creative Commons Non-Commercial , No Derivatives ( CC BY-NC-ND ) licence Research on treatments in anorexia nervosa ( AN ) is scarce . Although most of the therapeutic programs used in ‘ real world practice ’ in AN treatment resort to multidisciplinary approaches , they have rarely been evaluated . Objective To compare two multidimensional post-hospitalization out patients treatment programs for adolescents with severe AN :  Treatment as Usual ( TAU ) versus this treatment plus family therapy ( TAU+FT ) . Method Sixty female AN adolescents , aged 13 to 19 years , were included in a r and omized parallel controlled trial conducted from 1999 to 2002 for the recruitment , and until 2004 for the 18 months follow-up . Allocation to one of the two treatment groups ( 30 in each arm ) was r and omised . The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents . The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics , but not eating disorder symptoms . The main Outcome Measure was the Morgan and Russell outcome category ( Good or Intermediate versus Poor outcome ) . Secondary outcome indicators included AN symptoms or their consequences ( eating symptoms , body mass index , amenorrhea , number of hospitalizations in the course of follow-up , social adjustment ) . The evaluators , but not participants , were blind to r and omization . Results At 18 months follow-up , we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy ( Intention-to-treat : TAU+FT : 12/30 ( 40 % ) ; TAU : 5/29 ( 17.2 % ) p = 0.05 ; Per Protocol analysis : respectively 12/26 ( 46.2 % ) ; 4/27 ( 14.8 % ) , p = 0.01 ) . Similar group effects were observed in terms of achievement of a healthy weight ( i.e. , BMI ≥10th percentile ) and menstrual status . Conclusions Adding family therapy sessions , focusing on intra-familial dynamics rather than eating symptomatology , to a multidimensional program improves treatment effectiveness in girls with severe AN . Trial Registration Controlled-trials.com IS RCT BACKGROUND There are no evidence -based treatments for severe and enduring anorexia nervosa ( SE-AN ) . This study evaluated the relative efficacy of cognitive behavioral therapy ( CBT-AN ) and specialist supportive clinical management ( SSCM ) for adults with SE-AN . METHOD Sixty-three participants with a diagnosis of AN , who had at least a 7-year illness history , were treated in a multi-site r and omized controlled trial ( RCT ) . During 30 out-patient visits spread over 8 months , they received either CBT-AN or SSCM , both modified for SE-AN . Participants were assessed at baseline , end of treatment ( EOT ) , and at 6- and 12-month post-treatment follow-ups . The main outcome measures were quality of life , mood disorder symptoms and social adjustment . Weight , eating disorder ( ED ) psychopathology , motivation for change and health-care burden were secondary outcomes . RESULTS Thirty-one participants were r and omized to CBT-AN and 32 to SSCM with a retention rate of 85 % achieved at the end of the study . At EOT and follow-up , both groups showed significant improvement . There were no differences between treatment groups at EOT . At the 6-month follow-up , CBT-AN participants had higher scores on the Weissman Social Adjustment Scale ( WSAS ; p = 0.038 ) and at 12 months they had lower Eating Disorder Examination ( EDE ) global scores ( p = 0.004 ) and higher readiness for recovery ( p = 0.013 ) compared to SSCM . CONCLUSIONS Patients with SE-AN can make meaningful improvements with both therapies . Both treatments were acceptable and high retention rates at follow-up were achieved . Between-group differences at follow-up were consistent with the nature of the treatments given BACKGROUND Previous research has found that many patients with anorexia nervosa ( AN ) are unable to maintain normal weight after weight restoration . The objective of this study was to identify variables that predicted successful weight maintenance among weight-restored AN patients . METHOD Ninety-three patients with AN treated at two sites ( Toronto and New York ) through in-patient or partial hospitalization achieved a minimally normal weight and were then r and omly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy ( CBT ) for 1 year . Clinical , demographic and psychometric variables were assessed after weight restoration prior to r and omization and putative predictors of successful weight maintenance at 6 and 12 months were examined . RESULTS The most powerful predictors of weight maintenance at 6 and 12 months following weight restoration were pre-r and omization body mass index ( BMI ) and the rate of weight loss in the first 28 days following r and omization . Higher BMI and lower rate of weight loss were associated with greater likelihood of maintaining a normal BMI at 6 and 12 months . An additional predictor of weight maintenance was site ; patients in Toronto fared better than those in New York . CONCLUSIONS This study found that the best predictors of weight maintenance in weight-restored AN patients over 6 and 12 months were the level of weight restoration at the conclusion of acute treatment and the avoidance of weight loss immediately following intensive treatment . These results suggest that outcome might be improved by achieving a higher BMI during structured treatment programs and on preventing weight loss immediately following discharge from such programs BACKGROUND Previous neuroimaging studies have demonstrated abnormalities in visual body image processing in anorexia and bulimia nervosa , possibly underlying body image disturbance in these disorders . Although cognitive behavioural interventions have been shown to be successful in improving body image disturbance in eating disorders , no r and omized controlled study has yet analysed treatment-induced changes in neuronal correlates of visual body image processing . METHOD Altogether , 32 females with eating disorders were r and omly assigned either to a manualized cognitive behavioural body image therapy consisting of 10 group sessions , or to a waiting list control condition . Using functional magnetic resonance imaging , brain responses to viewing photographs of one 's own and another female 's body taken from 16 st and ardized perspectives while participants were wearing a uniform bikini were acquired before and after the intervention and the waiting time , respectively . RESULTS Data indicate a general blood oxygen level dependent signal enhancement in response to looking at photographs of one 's own body from pre- to post-treatment , whereas exclusively in the control group activation decreases from pre- to post-waiting time were observed . Focused activation increases from pre- to post-treatment were found in the left middle temporal gyrus covering the coordinates of the extrastriate body area and in bilateral frontal structures including the middle frontal gyrus . CONCLUSIONS Results point to a more intense neuronal processing of one 's own body after the cognitive behavioural body image therapy in cortical regions that are responsible for the visual processing of the human body and for self-awareness CONTEXT Evidence -based treatment trials for adolescents with anorexia nervosa are few . OBJECTIVE To evaluate the relative efficacy of family-based treatment ( FBT ) and adolescent-focused individual therapy ( AFT ) for adolescents with anorexia nervosa in full remission . DESIGN R and omized controlled trial . SETTING Stanford University and The University of Chicago ( April 2005 until March 2009 ) . PARTICIPANTS One hundred twenty-one participants , aged 12 through 18 years , with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement . Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT . Participants were assessed at baseline , end of treatment ( EOT ) , and 6 months ' and 12 months ' follow-up posttreatment . MAIN OUTCOME MEASURES Full remission from anorexia nervosa defined as normal weight ( ≥95 % of expected for sex , age , and height ) and mean global Eating Disorder Examination score within 1 SD of published means . Secondary outcome measures included partial remission rates ( > 85 % of expected weight for height plus those who were in full remission ) and changes in body mass index percentile and eating-related psychopathology . RESULTS There were no differences in full remission between treatments at EOT . However , at both the 6- and 12-month follow-up , FBT was significantly superior to AFT on this measure . Family-based treatment was significantly superior for partial remission at EOT but not at follow-up . In addition , body mass index percentile at EOT was significantly superior for FBT , but this effect was not found at follow-up . Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT , but there were no differences at follow-up . CONCLUSION Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT , FBT was more effective in facilitating full remission at both follow-up points . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00149786 OBJECTIVE There are limited data supporting specific treatments for adults with anorexia nervosa ( AN ) . R and omized clinical trials ( RCTs ) for adults with AN are characterized by high attrition limiting the feasibility of conducting and interpreting existing studies . High dropout rates may be related to the inflexible and obsessional cognitive style of patients with AN . This study evaluated the feasibility of using cognitive remediation therapy ( CRT ) to reduce attrition in RCTs for AN . METHOD Forty-six participants ( mean age of 22.7 years and mean duration of AN of 6.4 years ) were r and omized to receive eight sessions of either CRT or cognitive behavioral therapy ( CBT ) over 2 months followed by 16 sessions of CBT for 4 months . RESULTS During the 2-month CRT vs. CBT  treatment , rates of attrition were lower in CRT ( 13 % ) compared with that of CBT ( 33 % ) . There were greater improvements in cognitive inefficiencies in the CRT compared with that of the CBT group at the end of 2 months . There were no differences in other outcomes . DISCUSSION These results suggest that CRT is acceptable and feasible for use in RCTs for outpatient treatment of AN . CRT may reduce attrition in the short term . Adequately powered future studies are needed to examine CRT as an outpatient treatment for AN Background : Individuals with eating disorders show deficits in neuropsychological functioning which might preexist and underlie the etiology of the eating disorders and influence relapse . Deficits in cognitive flexibility , i.e. set-shifting and central coherence , might perpetuate the symptoms . Cognitive remediation therapy ( CRT ) was developed to improve cognitive flexibility , thereby increasing the likelihood of improved outcome . The focus of CRT is on how patients think , rather than on what patients think . The present study investigated the effectiveness of  CRT  for patients with a severe or enduring eating disorder by means of a r and omized controlled trial comparing intensive treatment as usual ( TAU ) to CRT plus TAU . Methods : Eighty-two patients were r and omly assigned to CRT plus TAU ( n = 41 ) or TAU alone ( n = 41 ) . Outcome measures were set-shifting , central coherence , eating disorder and general psychopathology , motivation , quality of life and self-esteem . Assessment s were performed at baseline ( n = 82 ) and after 6 weeks ( T1 ; n = 75 ) and 6 months ( T2 ; n = 67 ) . Data were analyzed by means of linear mixed model analyses . Results : Patients who received CRT in addition to TAU improved significantly more with regard to eating disorder-related quality of life at the end of treatment ( T1 ) and eating disorder psychopathology at follow-up ( T2 ) , compared to those who received TAU only . Moreover , moderator analyses revealed that patients with poor baseline set-shifting abilities benefited more from CRT than patients with no deficits in set-shifting abilities at baseline ; the quality of life of the former group was higher than that of the latter at follow-up . Conclusions : CRT seems to be promising in enhancing the effectiveness of concurrent treatment This paper reports the results of a r and omised treatment trial of two forms of outpatient family intervention for anorexia nervosa . Forty adolescent patients with anorexia nervosa were r and omly assigned to " conjoint family therapy " ( CFT ) or to " separated family therapy " ( SFT ) using a stratified design controlling for levels of critical comments using the Expressed Emotion index . The design required therapists to undertake both forms of treatment and the distinctiveness of the two therapies was ensured by separate supervisors conducting live supervision of the treatments . Measures were undertaken on admission to the study , at 3 months , at 6 months and at the end of treatment . Considerable improvement in nutritional and psychological state occurred across both treatment groups . On global measure of outcome , the two forms of therapy were associated with equivalent end of treatment results . However , for those patients with high levels of maternal criticism towards the patient , the SFT was shown to be superior to the CFT . When individual status measures were explored , there were further differences between the treatments . Symptomatic change was more marked in the SFT whereas there was considerably more psychological change in the CFT group . There were significant changes in family measures of Expressed Emotion . Critical comments between parents and patient were significantly reduced and that between parents was also diminished . Warmth between parents increased OBJECTIVE Adolescents with Anorexia Nervosa ( AN ) , treated with family-based treatment ( FBT )  who fail to gain 2.3 kg by the fourth week of treatment have a 40 - 50 % lower chance of recovery than those who do . Because of the high risk of developing enduring AN , improving outcomes in this group of poor responders is essential . This study examines the feasibility and effects of a novel adaptive treatment ( i.e. , Intensive Parental Coaching-IPC ) aim ed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT . METHOD 45 adolescents ( 12 - 18 years of age ) meeting DSM TR IV criteria for AN were r and omized in an unbalanced design ( 10 to st and ard FBT ; 35 to the adaptive arm ) . Attrition , suitability , expectancy rates , weight change , and psychopathology were compared between groups . OUTCOMES There were no differences in rates of attrition , suitability , expectancy ratings , or most clinical outcomes between r and omized groups . However , the group of poor early responders that received IPC achieved full weight restoration ( > 95 % of expected mean BMI ) by EOT at similar rates as those who had responded early . CONCLUSIONS The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT . The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early . A sufficiently powered study is needed to confirm these promising findings BACKGROUND Little is known about the outcome of involving families in the treatment of adults with anorexia nervosa . Carers of people with anorexia nervosa experience significant levels of distress . This may contribute to unhelpful behaviours which maintain the illness . AIMS To evaluate the effectiveness and acceptability of family workshops with educational and skills-based components as compared to individual family work . METHOD An exploratory r and omised controlled trial of two forms of family intervention was conducted for in patients with anorexia nervosa ( n = 48 ) and their family members on a specialised unit for adults . RESULTS In both groups , there was an improvement in patients ' BMI and a reduction in carers ' distress . There were no differences between groups . CONCLUSION Preliminary findings suggest that workshop-based intervention with two families might be as effective as an individually focused family intervention . This may offer a more cost-effective intervention for this treatment-resistant group OBJECTIVE Few r and omized , controlled trials have examined the efficacy of treatments for anorexia nervosa .  Cognitive behavior therapy and interpersonal psychotherapy are effective in a related disorder , bulimia nervosa . There are theoretical and treatment indications for these therapies in anorexia nervosa . METHOD Fifty-six women with anorexia nervosa diagnosed by using strict and lenient weight criteria were r and omly assigned to three treatments . Two were specialized psychotherapies ( cognitive behavior therapy and interpersonal psychotherapy ) , and one was a control treatment combining clinical management and supportive psychotherapy ( nonspecific supportive clinical management ) . Therapy consisted of 20 sessions over a minimum of 20 weeks . RESULTS For the total study group ( intent-to-treat group ) , there were significant differences among therapies in the primary global outcome measure . Nonspecific supportive clinical management was superior to interpersonal psychotherapy , while cognitive behavior therapy was intermediate , neither worse than nonspecific supportive clinical management nor better than interpersonal psychotherapy . For the women completing therapy , nonspecific supportive clinical management was superior to the two specialized therapies . CONCLUSIONS The finding that nonspecific supportive clinical management was superior to more specialized psychotherapies was opposite to the primary hypothesis and challenges assumptions about the effective ingredients of successful treatments for anorexia nervosa BACKGROUND There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa ( AN ) . The aim of this study was to compare three psychological treatments for AN : Specialist Supportive Clinical Management , Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy . METHOD A multi-centre r and omised controlled trial was conducted with outcomes assessed at pre- , mid- and post-treatment , and 6- and 12-month follow-up by research ers blind to treatment allocation . All analyses were intention-to-treat . One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment setting s in three Australian cities and offered 25 - 40 sessions over a 10-month period . Primary outcomes were body mass index ( BMI ) and eating disorder psychopathology . Secondary outcomes included depression , anxiety , stress and psychosocial impairment . RESULTS Treatment was completed by 60 % of participants and 52.5 % of the total sample completed 12-month follow-up . Completion rates did not differ between treatments . There were no significant differences between treatments on continuous outcomes ; all result ed in clinical ly significant improvements in BMI , eating disorder psychopathology , general psychopathology and psychosocial impairment that were maintained over follow-up . There were no significant differences between treatments with regard to the achievement of a healthy weight ( mean = 50 % ) or remission ( mean = 28.3 % ) at 12-month follow-up . CONCLUSION The findings add to the evidence base for these three psychological treatments for adults with AN , but the results underscore the need for continued efforts to improve outpatient treatments for this disorder . Trial Registration Australian New Zeal and Clinical Trials Registry ( ACTRN 12611000725965 ) Ninety patients with severe anorexia nervosa fulfilling DSM-III-R criteria were assessed in depth in terms of their family developmental psychopathology and then r and omly allocated to either one of three treatment groups or to no treatment . In three treatment regimes , a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems . All three treatment regimes were highly significantly effective at one year in terms of weight gain , return of menstruation , and aspects of social and sexual adjustment . Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group BACKGROUND Treatment guidelines identify few adequately powered trials to guide recommendations for anorexia nervosa . AIMS To evaluate the effectiveness of three readily available National Health Service treatments for adolescents ( aged 12 - 18 years ) with anorexia nervosa . METHOD Multicentre r and omised controlled trial of 167 young people comparing in-patient , specialist out-patient and general child and adolescent mental health service ( CAMHS ) treatment .  RESULTS Each group made considerable progress at 1 year , with further improvement by 2 years . Full recovery rates were poor ( 33 % at 2 years , 27 % still with anorexia nervosa ) . Adherence to in-patient treatment was only 50 % . Neither in-patient nor specialist out-patient therapy demonstrated advantages over general CAMHS treatment by intention to treat , although some CAMHS out- patients were subsequently admitted on clinical grounds . In-patient treatment ( r and omised or after out-patient transfer ) predicted poor outcomes . CONCLUSIONS First-line in-patient psychiatric treatment does not provide advantages over out-patient management . Out-patient treatment failures do very poorly on transfer to in-patient facilities BACKGROUND Psychotherapy is the treatment of choice for patients with anorexia nervosa , although evidence of efficacy is weak . The Anorexia Nervosa Treatment of Out Patients ( ANTOP ) study aim ed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa -- focal psychodynamic therapy and enhanced cognitive behaviour therapy -- versus optimised treatment as usual . METHODS The ANTOP study is a multicentre , r and omised controlled efficacy trial in adults with anorexia nervosa . We recruited patients from ten university hospitals in Germany . Participants were r and omly allocated to 10 months of treatment with either focal psychodynamic therapy , enhanced cognitive behaviour therapy , or optimised treatment as usual ( including outpatient psychotherapy and structured care from a family doctor ) . The primary outcome was weight gain , measured as increased body-mass index ( BMI ) at the end of treatment . A key secondary outcome was rate of recovery ( based on a combination of weight gain and eating disorder-specific psychopathology ) . Analysis was by intention to treat . This trial is registered at http://is rct n.org , number IS RCT N72809357 . FINDINGS Of 727 adults screened for inclusion , 242 underwent r and omisation : 80 to focal psychodynamic therapy , 80 to enhanced cognitive behaviour therapy , and 82 to optimised treatment as usual . At the end of treatment , 54 patients ( 22 % ) were lost to follow-up , and at 12-month follow-up a total of 73 ( 30 % ) had dropped out . At the end of treatment , BMI had increased in all study groups ( focal psychodynamic therapy 0·73 kg/m(2 ) , enhanced cognitive behaviour therapy 0·93 kg/m(2 ) , optimised treatment as usual 0·69 kg/m(2 ) ) ; no differences were noted between groups ( mean difference between focal psychodynamic therapy and enhanced cognitive behaviour therapy -0·45 , 95 % CI -0·96 to 0·07 ; focal psychodynamic therapy vs optimised treatment as usual -0·14 , -0·68 to 0·39 ; enhanced cognitive behaviour therapy vs optimised treatment as usual -0·30 , -0·22 to 0·83 ) . At 12-month follow-up , the mean gain in BMI had risen further ( 1·64 kg/m(2 ) , 1·30 kg/m(2 ) , and 1·22 kg/m(2 ) , respectively ) , but no differences between groups were recorded ( 0·10 , -0·56 to 0·76 ; 0·25 , -0·45 to 0·95 ; 0·15 , -0·54 to 0·83 , respectively ) . No serious adverse events attributable to weight loss or trial participation were recorded . INTERPRETATION Optimised treatment as usual , combining psychotherapy and structured care from a family doctor , should be regarded as solid baseline treatment for adult out patients with anorexia nervosa .  Focal psychodynamic therapy proved advantageous in terms of recovery at 12-month follow-up , and enhanced cognitive behaviour therapy  was more effective with respect to speed of weight gain and improvements in eating disorder psychopathology . Long-term outcome data will be helpful to further adapt and improve these novel manual-based treatment approaches . FUNDING German Federal Ministry of Education and Research ( Bundesministerium für Bildung und Forschung , BMBF ) , German Eating Disorders Diagnostic and Treatment Network ( EDNET ) OBJECTIVE Inefficient cognitive flexibility is considered a neurocognitive trait marker involved in the development and maintenance of anorexia nervosa ( AN ) .  Cognitive Remediation Therapy ( CRT ) is a specific treatment targeting this cognitive style . The aim of this study was to investigate the feasibility and efficacy ( by estimating the effect size ) of specifically tailored CRT for AN , compared to non-specific cognitive training . METHOD A prospect i ve , r and omized controlled , superiority pilot trial was conducted . Forty women with AN receiving treatment as usual ( TAU ) were r and omized to receive either CRT or non-specific neurocognitive therapy ( NNT ) as an add-on . Both conditions comprised 30 sessions of computer-assisted ( 21 sessions ) and face-to-face ( 9 sessions ) training over a 3-week period . CRT focused specifically on cognitive flexibility . NNT was comprised of tasks design ed to improve attention and memory . The primary outcome was performance on a neuropsychological post-treatment assessment of cognitive set-shifting . RESULTS Data available from 25 treatment completers were analyzed . Participants in the CRT condition outperformed participants in the NNT condition in cognitive set-shifting at the end of the treatment ( p = 0.027 ; between-groups effect size d = 0.62 ) . Participants in both conditions showed high treatment acceptance . DISCUSSION This study confirms the feasibility of CRT for AN , and provides a first estimate of the effect size that can be achieved using CRT for AN . Furthermore , the present findings corroborate that neurocognitive training for AN should be tailored to the specific cognitive inefficiencies of this patient group Thirty out- patients with severe anorexia nervosa were r and omly allocated to either 12 sessions of dietary advice or 12 sessions of combined individual and family psychotherapy . At one-year follow-up both groups showed significant overall improvement , and the dietary advice group showed significant weight gain . A similar mean weight gain for the psychotherapy patients did not reach statistical significance , but this group made significant improvements in sexual and social adjustment There is a dearth of literature evaluating day patient treatment for  eating disorders  based upon the targeted goals of treatment , to conclude that day patient programmes are effective . This study aim ed to explore the effectiveness of an innovative day patient programme by examining whether the seven key treatment goals improved across treatment and were maintained 3 months after discharge . Of the 58 participants who completed measures assessing BMI , eating disorder cognitions , behaviours , core beliefs , readiness to change , quality of life and perpetuating factors at admission , discharge and follow-up , 44 completed the day programme with 14 non-completers . The results demonstrated that all seven treatment goals improved across treatment and the improvements were maintained or further improved at 3 month follow-up . The results are discussed in context of the published day patient programme literature with implication s for future research to maximise optimal treatment outcomes from day patient treatment Abstract Research on the effects of progress feedback and clinician problem-solving tools on patient outcome has been limited to a few clinical problems and setting s ( Shimokawa , Lambert , & Smart , 2010 ) . Although these interventions work well in outpatient setting s their effects so far have not been investigated with eating-disordered patients or in inpatient care . In this study , the effect of providing feedback interventions was investigated in a r and omized clinical trial involving 133 females diagnosed with anorexia nervosa , bulimia nervosa , or eating disorders not otherwise specified . Comparisons were made between the outcomes of patients r and omly assigned to either treatment-as-usual ( TAU ) or an experimental condition ( Fb ) within therapists ( the same therapists provided both treatments ) . Patients in the Fb condition more frequently experienced clinical ly significant change than those who had TAU ( 52.95 % vs. 28.6 % ) . Similar trends were noted within diagnostic groups . In terms of pre to post change in mental health functioning , large effect sizes favored Fb over TAU . Patients '  BMI improved substantially in both TAU and the feedback condition . The effects of feedback were consistent with past research on these approaches although the effect size was smaller in this study . Suggestions for further research are delineated The aim of this study was to compare two forms of outpatient treatment , educational behavioural treatment and cognitive analytical therapy for adult anorexia nervosa . Thirty patients were r and omly allocated to the two treatments . At one year , the group had gained 6.8 kg , 19/30 ( 63 % ) had a good or intermediate recovery in terms of nutritional outcome . The group given cognitive analytical treatment reported significantly greater subjective improvement but there were no differences in other outcome parameters . In conclusion outpatient treatment of adult onset anorexia nervosa leads to an improvement in two thirds of cases . Larger studies will be needed to determine the most effective form of treatment in this group Behavioral family systems therapy ( BFST ) was compared with ego-oriented individual therapy ( EOIT ) in a controlled , r and om-assignment investigation involving 22 young adolescents with anorexia nervosa . Each adolescent and her parents received approximately 16 months of outpatient therapy along with a common medical and dietary regimen . BFST emphasized parental control over eating and weight gain , coupled with cognitive restructuring and problem-solving communication training . EOIT emphasized building ego strength , adolescent autonomy , and insight into the emotional blocks to eating . BFST produced greater change on body-mass index than did EOIT , but both treatments produced comparable improvements on eating attitudes , body shape dissatisfaction , interoceptive awareness , depression/internalizing psychopathology , and eating-related family conflict . The implication s of these results for the clinician who treats adolescents with anorexia nervosa are discussed . J Dev Behav Pediatr 15:111–116 , 1994 . Index terms : anorexia nervosa , adolescents , family therapy , individual therapy Technological advancements allow new approaches to psychotherapy via electronic media . The eating disorder literature currently contains no studies on internet intervention in anorexia nervosa ( AN ) . This study presents a RCT on an internet-based relapse prevention program ( RP ) over nine months after inpatient treatment for AN . The sample comprised 258 women , r and omized to the RP or treatment as usual ( TAU ) .  Expert- and self-ratings were evaluated by intent-to-treat analyses . Concerning age , age at onset and comorbidity , both groups were comparable at r and omization . During the RP , the intervention group gained weight while the TAU group had minimal weight loss .  RP completers gained significantly more body weight than patients in the TAU condition . Group-by-time comparisons for eating-related cognitions and behaviors and general psychopathology showed a significantly more favorable course in the RP program for " sexual anxieties " and " bulimic symptoms " ( interview ) , and " maturity fears " and " social insecurity " ( EDI-2 ) . General psychopathology showed no significant group-by-time interaction . Important factors for successful relapse prevention were adherence to the intervention protocol and increased spontaneity . Considering the unfavorable course and chronicity of anorexia nervosa ( AN ) , internet-based relapse prevention in AN following inpatient treatment appears a promising approach . Future internet-based programs may be further improved and enhanced OBJECTIVE Long-term follow-up studies documenting maintenance of treatment effects are few in adolescent anorexia nervosa ( AN ) . This exploratory study reports relapse from full remission and attainment of remission during a 4-year open follow-up period using a convenience sample of a subgroup of 65 % ( n = 79 ) from an original cohort of 121 participants who completed a r and omized clinical trial comparing family-based therapy ( FBT ) and adolescent-focused individual therapy ( AFT ) .  METHOD Follow-up assessment s were completed up to 4 years posttreatment ( average , 3.26 years ) . Available participants completed the Eating Disorder Examination as well as self-report measures of self-esteem and depression at 2 to 4 years posttreatment . RESULTS Two participants ( 6.1 % ) relapsed ( FBT : n = 1 , 4.5 % ; AFT : n = 1 , 9.1 % ) , on average 1.98 years ( SD = 0.14 years ) after remission was achieved at 1-year follow-up . Ten new participants ( 22.7 % ) achieved remission ( FBT : n = 1 , 5.9 % ; AFT : n = 9 , 33.3 % ) . Mean time to remission for this group was 2.01 years ( SD = 0.82 years ) from 1-year follow-up . There were no differences based on treatment group assignment in either relapse from full remission or new remission during long-term follow-up . Other psychopathology was stable over time . CONCLUSION There were few changes in the clinical presentation of participants who were assessed at long-term follow-up . These data suggest that outcomes are generally stable posttreatment regardless of treatment type once remission is achieved . Clinical trial registration information-Effectiveness of Family-Based Versus Individual Psychotherapy in Treating Adolescents With Anorexia Nervosa ; http://www . clinical trials.gov/ ; NCT00149786 BACKGROUND This study aims to assess changes in core eating disorder psychopathology ( Eating Attitudes Test , EAT ; Eating Disorders Inventory-2 , EDI-2 ) , depression ( Hamilton Rating Scale , HRSD ; Beck Depression Inventory , BDI ) and general psychopathology ( MMPI-2 ) after inpatient treatment and one-year follow-up among patients diagnosed with anorexia . METHODS Thirty-two patients were treated for anorexia nervosa on an inpatient unit , and were assessed before and after treatment . The inpatient milieu was design ed to use cognitive therapy as the primary therapeutic intervention , along with weight restoration . RESULTS At discharge , all patients displayed significant change in core eating disorder psychopathology in their depressive symptoms , as well as in general aspects of psychopathology . At one-year follow-up , changes in some areas of core eating disorder psychopathology and depressive symptoms continued to be significantly different than from admissions . CONCLUSIONS The combination of CBT and weight restoration can significantly reduce eating disorder symptoms , depression , and general psychopathology during hospitalization , with some sustained benefit over a one year period . Future research is needed to identify the effect of CBT on anorexia nervosa during a wide variety of treatment setting s. Also , research must focus on the influence of outpatient treatment in the outcome of anorexia nervosa OBJECTIVE Findings of a r and omized trial of an identity intervention programme ( IIP ) design ed to build new positive self-schemas that are separate from other conceptions of the self in memory as the means to promote improved health in women diagnosed with eating disorders are reported . METHOD After baseline data collection , women with anorexia nervosa or bulimia nervosa were r and omly assigned to IIP ( n = 34 ) or supportive psychotherapy ( SPI ) ( n = 35 ) and followed at 1 , 6 , and 12 months post-intervention . RESULTS The IIP and supportive psychotherapy were equally effective in reducing eating disorder symptoms at 1 month post-intervention , and changes were stable through the 12-month follow-up period . The IIP tended to be more effective in fostering development of positive self-schemas , and the increase was stable over time . Regardless of baseline level , an increase in the number of positive self-schemas between pre-intervention and 1-month post-intervention predicted a decrease in desire for thinness and an increase in psychological well-being and functional health over the same period . DISCUSSION A cognitive behavioural intervention that focuses on increasing the number of positive self-schemas may be central to improving emotional health in women with anorexia nervosa and bulimia nervosa OBJECTIVE Anorexia nervosa ( AN ) in adults has poor outcomes , and treatment evidence is limited . This study evaluated the efficacy and acceptability of a novel , targeted psychological therapy for AN ( Maudsley Model of Anorexia Nervosa Treatment for Adults ; MANTRA ) compared with Specialist Supportive Clinical Management ( SSCM ) . METHOD One hundred forty-two out patients with broadly defined AN ( body mass index [ BMI ] ≤ 18.5 kg/m² ) were r and omly allocated to receive 20 to 30 weekly sessions ( depending on clinical severity ) plus add-ons ( 4 follow-up sessions , optional sessions with dietician and with carers ) of MANTRA ( n = 72 ) or SSCM ( n = 70 ) . Assessment s were administered blind to treatment condition at baseline , 6 months , and 12 months after r and omization . The primary outcome was BMI at 12 months . Secondary outcomes included eating disorders symptomatology , other psychopathology , neuro-cognitive and social cognition , and acceptability . Additional service utilization was also assessed . Outcomes were analyzed using linear mixed models . RESULTS Both treatments result ed in significant improvements in BMI and reductions in eating disorders symptomatology , distress levels , and clinical impairment over time , with no statistically significant difference between groups at either 6 or 12 months . Improvements in neuro-cognitive and social-cognitive measures over time were less consistent . One SSCM patient died . Compared with SSCM , MANTRA patients rated their treatment as significantly more acceptable and credible at 12 months . There was no significant difference between groups in additional service consumption . CONCLUSIONS Both treatments appear to have value as first-line outpatient interventions for patients with broadly defined AN . Longer term outcomes remain to be evaluated
target: There was no superiority of a specific approach .
  Weight gains were more rapid in adolescents and inpatient treatment .
background: Background : The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy .
  Weight gain was chosen as the primary outcome criterion .
  We also aim ed to compare treatment effects according to service level ( inpatient vs. outpatient ) and age group ( adolescents vs. adults ) .