A benchmark study of a combined individual and group anorexia nervosa therapy program

Abstract

Objective

Anorexia nervosa (AN) is a treatment-resistant illness. Up to half of the patients show limited or no significant treatment response. First, we aimed to describe a new stepped-care outpatient treatment combining group and individual therapy (CIGAN) with a strong focus on normalizing eating and weight and in vivo meal support for adults with moderate to severe AN. Second, we aimed to compare CIGAN with specialized treatments of Specialized Supportive Clinical Management (SSCM) and the Maudsley model of AN (MANTRA).

Method

The study includes 137 adults with moderate to severe AN and the primary outcome (BMI) at six and twelve months was compared with the outcomes published for SSCM and MANTRA using the Chi-squared test and Student’s t-test. The paired t-test and Cohen’s d were used to compare the within-group follow-up data with the baseline data.

Results

CIGAN patients changed significantly on all outcome measures at 6 and 12 months, with effect sizes on BMI of 1.37 and 1.51 and on the weight of 1.36 and 1.60, respectively. Except for the 12-month comparison with MANTRA, patients had a higher BMI and larger BMI increase at both 6 and 12 months than SSCM (BMI p = 0.002 and 0.023, BMI increase p < 0.001 and 0.003) and MANTRA (BMI p = 0.031 and 0.168, BMI increase p < 0.001 and 0.037).

Discussion

CIGAN, including a stepped care approach, is a promising treatment, and further research on the effective elements is warranted.

Keywords:

• Anorexia nervosa
• treatment outcome
• psychotherapy
• group psychotherapy
• benchmark study

Author contributions

Bo Skytte Kaa did the first draft of the manuscript and involved in the conceptualization, data management, and analysis. Johanne Mathilde Nymark Bünemann was involved in the data management and revisions of the manuscript. Loa Clausen was involved in the conceptualization, data analysis, and revisions of the manuscript. All authors accepted the final version of the manuscript.

Disclosure statement

The authors declare that the present paper was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Dr. Clausen reports Hans Reitzels Forlag and Dansk Psykologisk Forlag (author, royalty recipient).

Notes on contributors

Bo S Kaa is a clinical psychologist who have worked with persons with eating disorders for 16 years.

Johanne MN Bünemann is a clinical psychologist who have worked with persons with eating disorders for 6 years.

Loa Clausen is a senior researcher and clinical psychologist and have worked within the eating disorder field for more than 20 years.

Data availability statement

Data and codes are not publicly available due to Danish legislation.