Individual cognitive behavioral therapy and combined family/individual therapy for young adults with Anorexia nervosa: A randomized controlled trial

Figures & data

Figure 1. Trial profile.

Table I. Baseline characteristics. Mean (SD) or number of patients (%).

	CBT-YA (n = 37)	FT-YA (n = 37)
Demographic characteristics	N ( %)	N (%)
Born in Sweden	34 (92%)	34 (92%)
Civic status (single)	27 (73%)	26 (70%)
Nationality (Swedish)	35 (92%)	37 (100%)
Familial divorce (yes)	11 (29%)	18 (45%)
Housing (living with parents)	27 (73%)	29 (78%)
Education level
- elementary school	20 (54%)	19 (51%)
- high school	14 (38%)	17 (46%)
- higher education	3 (8%)	0 (0%)
Clinical characteristics	M ( SD)	M ( SD)
Age at entry (years)	19.1 (1.9)	18.7 (2.0)
Duration of illness (months)	31.6 (24.1)	26.8 (24.4)
BMI	16.49 (0.8)	16.54 (0.9)
ED Index	0.769 (0.2)	0.59 (0.2)
EDRC	45.65 (21.5)	42.54 (18.8)
GPMC	103.24 (39.9)	94.45 (28.8)
BDI	24.24 (11.9)	22.51 (8.7)
	N ( %)	N ( %)
Binge–purge subtype	16 (43%)	12 (32%)
Restrictive subtype	21 (57%)	25 (68%)
Former ED contact	24 (65%)	17 (46%)

Eating Disorder Diagnostic Index (ED Index) constructed by a combination of three questions from the Ratings of Anorexia-Bulimia Revised (RAB-R), Composite scales from the Eating Disorder Inventory-3: EDRC = Eating Disorder Risk Composite, GPMC = General Psychological Maladjustment Composite, and BDI = Beck Depression Inventory.

Table II. Changes within groups on the outcome, effect sizes (Cohen’s d) and 95% CI between time points.

Variable (time points 1,2,3)	CBT-YA					FT-YA
	M (SD)	Range	P’	Effect size	95% CI	M (SD)	Range	P’	Effect size	95% CI
BMI (1–2)	16.49 (0.79)^a	14.79–17.71	0.0001	3.97	3.00–4.91	16.54 (0.93)^a	13.97–18.37	0.0001	3.00	2.39–3.61
BMI (2–3)	19.63 (2.08)^b	16.17–24.90	0.8051	0.00	−0.24–0.31	19.33 (1.65)^b	16.58–23.88	0.0049	0.57	0.17–0.90
BMI (1–3)	19.62 (2.44)^c	16.62–26.40	0.0001	3.96	2.93–5.03	20.28 (1.77)^c	16.6–23.80	0.0001	4.02	3.29–4.71
ED Index (1–2)	0.69 (0.17)^a	0.28–0.89	0.0001	2.30	1.86–2.74	0.59 (0.21)^a	0.25–1.00	0.0001	1.58	1.12–2.04
ED Index (2–3)	0.30 (0.23)^b	0–0.81	0.261	0.19	−0.14–0.51	0.25 (0.26)^b	0–1	0.7788	0.04	−0.25–0.33
ED Index (1–3)	0.26 (0.26)^c	0–1	0.0001	2.53	2.04–3.06	0.24 (0.26)^c	0–0.89	0.0001	1.63	1.23–2.04
EDRC (1–2)	45.65 (21.51)^a	2–86	0.0001	0.72	0.39–1.04	42.54 (18.78)^a	12–93	0.0001	0.66	0.39–0.93
EDRC (2–3)	30.19 (20.16)^b	3–72	0.5517	0.10	−0.23–0.42	30.14 (20.57)^b	0–73	0.081	0.16	−0.02–0.34
EDRC (1–3)	28.24 (22.17)^c	1–79	0.0002	0.81	0.42–1.20	26.86 (20.67)^c	0–78	0.0001	0.83	0.55–1.12
GPMC (1–2)	103.24 (39.94)^a	38–227	0.0001	0.82	0.51–1.13	94.46 (28.84)^a	19–148	0.0001	0.82	0.46–1.17
GPMC (2–3)	70.54 (34.29)^b	11–157	0.5349	0.01	−0.17–0.33	70.95 (37.40)^b	3–129	0.1702	0.16	−0.07–0.39
GPMC (1–3)	67.89 (36.81)^c	11–165	0.0001	0.89	0.49–1.28	65.05 (38.84)^c	3–160	0.0001	1.02	0.65–1.40
BDI (1–2)	24.24 (11.97)^a	3–57	0.0001	1.03	0.67–1.38	22.51 (8.66)^a	2–42	0.0001	1.12	0.61–1.62
BDI (2–3)	11.86 (10.79)^b	0–40	1	0.00	−0.31–0.31	12.84 (10.99)^b	0–35	0.62	0.30	0.02–0.62
BDI (1–3)	11.86 (10.82)^c	0–35	0.0001	1.03	0.59–1.47	9.54 (8.86)^c	0–37	0.0001	1.50	1.14–1.86

Subscales from the Eating Disorder Inventory-3: EDRC = Eating Disorder Risk Composite, GPMC = General Psychological Maladjustment Composite, and BDI = Beck Depression Inventory. ^a time point 1, ^b time point 2, ^c time point 3

*Critical p was set at <0.003 after Bonferroni correction

Table III. Adjusted mean scores (LS-mean) post-treatment and at follow-up after 18 months for ED psychopathology, by treatment group. Estimated least square mean difference (Ls-Mean Diff) and confidence interval (CI) per group and estimated coefficient of the interaction effect of treatment by time with CI.

	CBT-YA		FT-YA		CBT-YA VS. FT-YA
	Ls-Mean (SE)	95% CI	Ls-Mean (SE)	95% CI	Ls-Mean Diff	95% CI	P*	Coeff.	95% CI
Body Mass Index
Post-treatment	19·61 (0.·28)	19·00–20·20	19·33 (0·28)	18·80–19·90	0.28	−0·51–1·06	0.49	−0.32	−1.22–0.58
Follow-up	19·62 (0·29)	19·10–20·20	20·26 (0·28)	19·70–20·80	−0.64	−1·43–0·15	0.11	0.59	−0.31–1.50
Eating Disorder Index
Post-treatment	0.30 (0.04)	0.23–0.38	0.25 (0.04)	0.18–0.33	0.05	−0.06–0.16	0.36	0.06	−0.05–0.17
Follow-up	0.26 (0.04)	0.19–0.34	0.24 (0.04)	0.17–0.32	0.05	−0.09–0.13	0.74	0.09	−0.02–0.20
EDRC
Post-treatment	30.20 (3.40)	23.50–36.90	30.10 (3.40)	23.40–36.90	0.10	−9.46–9.56	0.99	3.05	−5.44–1.55
Follow-up	28.20 (3.40)	21.50–35.00	26.90 (3.40)	20.10–33.60	1.40	−8.13–10.89	0.78	1.73	−6.77–10.23
GPMC
Post-treatment	70.54 (5.95)	58.80–82.30	70.95 (5.95)	59.20–82.70	−0.40	−17.06–16.20	0.96	9.19	−6.25–24.63
Follow-up	67.89 (5.95)	56.10–79.70	65.05 (5.95)	53.30–76.80	2.80	−13.81–19.50	0.74	5.95	−9.49–21.39
BDI
Post-treatment	11.86 (1.77)	8.49–15.20	12.84 (1.71)	9.46–16.20	−1.00	−5.75–3.81	0.70	2.59	−2.93–8.12
Follow-up	11.86 (1.78)	8.49–15.20	9.54 (1.71)	6.16–12.90	2.30	−2.46–7.10	0.30	−0.70	−6.23–4.83

Subscales from the Eating Disorder Inventory-3: EDRC = Eating Disorder Risk Composite, GPMC = General Psychological Maladjustment Composite, and BDI = Beck Depression Inventory * Critical p was set at < 0.003 after Bonferroni correction

Table IV. Diagnostic change during treatment and follow-up, by treatment group.

	Post-assessment					Follow-up
	No diagnosis	AN	BN	EDNOS	Total	No diagnosis	AN	BN	EDNOS	Total
CBT-YA	28 (75.7%)	3 (8.1%)	1 (2.7%)	5 (13.5%)	37	33 (89.2%)	2 (5.4%)	0 (0%)	2 (5.4%)	37
FT-YA	28 (75.7%)	3 (8.1%)	0 (0%)	6 (16.2%)	37	30 (81.1%)	0 (0%)	2 (5.4%)	5 (13.5%)	37
Total	56 (75.7%)	6 (8.1%)	1 (1.3%)	11 (14.9%)	74	63 (85.1%)	2 (2.7%)	2 (2.7%)	7 (9.5%)	74