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Relapse is a substantial problem in eating disorders. Until recently, there have been few investigations into maintenance treatments aimed at helping patients maintain improvements made in treatment. This study compared the outcomes of group-based intensive outpatient versus individual cognitive behavioural therapy (CBT)-based maintenance treatments for eating disorders, following inpatient or day treatment. In this sequential cohort study, patients received the type of maintenance treatment (intensive outpatient group or individual CBT) available at the time. A total of 221 patients with eating disorders were included, and data were examined retrospectively. Cox regression was used to determine whether treatment type predicted rate of return to clinically significant symptoms over the 12 months following inpatient or day treatment. Intensive outpatient group versus individual CBT maintenance treatment did not predict differential rate or trajectory of return to clinically significant symptoms in diagnostic subgroups and the overall sample. Maintenance treatment type did not predict changes in weight/shape concerns between end-of-inpatient or day treatment) and 6- or 12-month follow-up (after controlling for diagnosis). Although the treatments appeared similarly effective in helping patients maintain gains made in intensive treatment, individual CBT may be a more time- and cost-efficient approach to delivering maintenance treatment. [ABSTRACT FROM AUTHOR]

Background: Eating disorders (EDs) and posttraumatic stress disorder (PTSD) frequently co-occur and can share a functional relationship. The primary aim of this initial randomized controlled trial was to determine whether integrated cognitive-behavioral therapy (CBT) for co-occurring ED-PTSD was superior to standard CBT for ED in improving PTSD symptoms. Intervention safety and desirability, as well as the relative efficacy of the treatments in improving anxiety, depression, and ED symptomatology, were also examined. Methods: Following a course of intensive ED treatment, individuals with ED-PTSD were recruited to participate and randomized to integrated CBT for ED-PTSD or standard CBT for ED. The sample consisted of 42 individuals with a range of ED diagnoses. Outcomes were assessed at end-of-treatment, 3-, and 6-month follow-up using interview and self-report measures. Results: Mixed models revealed significant interactions of time and therapy condition on clinician-rated and self-reported PTSD symptom severity favoring Integrated CBT for ED-PTSD. Both treatments were associated with statistically significant improvements in PTSD, anxiety, and depression. Improvements were maintained at 3- and 6-month follow-up. There was good safety with both interventions, and satisfaction with both treatments was high. However, there was a stronger preference for integrated treatment. Conclusions: Integrating CBTs for PTSD and ED following intensive ED treatment is safe, desirable, and efficacious for improving PTSD symptoms. Future studies with larger sample sizes are needed to determine whether Integrated CBT for ED-PTSD provides benefits over standard CBT for ED with respect to ED outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine childhood abuse and post‐traumatic stress disorder (PTSD) as predictors and moderators of binge‐eating disorder (BED) treatment outcomes in a randomized controlled trial comparing Integrative Cognitive‐Affective Therapy with cognitive‐behavioural therapy administered using guided self‐help. Method: In 112 adults with BED, childhood abuse was defined as any moderate/severe abuse as assessed by the Childhood Trauma Questionnaire, lifetime PTSD was assessed via the Structured Clinical Interview for DSM‐IV, and outcomes were assessed via the Eating Disorder Examination (EDE). Covariate‐adjusted regression models predicting binge‐eating frequency and EDE global scores at end of treatment and 6‐month follow‐up were conducted. Results: Lifetime PTSD predicted greater binge‐eating frequency at end of treatment (B = 1.32, p = 0.009) and childhood abuse predicted greater binge‐eating frequency at follow‐up (B = 1.00, p = 0.001). Lifetime PTSD moderated the association between childhood abuse and binge‐eating frequency at follow‐up (B = 2.98, p = 0.009), such that childhood abuse predicted greater binge‐eating frequency among participants with a history of PTSD (B = 3.30, p = 0.001) but not among those without a PTSD history (B = 0.31, p = 0.42). No associations with EDE global scores or interactions with treatment group were observed. Conclusions: Results suggest that a traumatic event history may hinder treatment success and that PTSD may be more influential than the trauma exposure itself. Highlights: Lifetime post‐traumatic stress disorder predicted more frequent binge eating at end of treatmentHistory of childhood abuse predicted more frequent binge eating at follow‐up, but only among those with lifetime post‐traumatic stress disorderParticipants with trauma histories responded similarly to Integrative Cognitive‐Affective Therapy and cognitive‐behavioural therapy administered using guided self‐help [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine whether posttraumatic stress disorder (PTSD) predicts non‐completion of CBT‐based day hospital treatment for bulimia nervosa (BN) and other specified feeding and eating disorder (OSFED). Method: Participants were 151 day hospital patients with BN or OSFED. Participants were assessed at pretreatment via interview and self‐report measures. Cox regression was used to model the rate and timing of treatment termination; pretreatment binge and vomit frequencies, eating disorder‐related clinical impairment, depression, and ED psychopathology were entered as covariates. Results: Participants who screened positive for PTSD (n = 64) had more severe ED psychopathology, ED‐related impairment, negative schemas, and depression relative to those who did not screen positive. Cox regression indicated that PTSD significantly predicted premature termination and was associated with a 2.32 times greater risk. Individuals with BN or OSFED and co‐occurring PTSD were particularly likely to terminate in the early phase of treatment compared with later in treatment. Conclusion: PTSD appears to affect some individuals' ability to complete intensive ED treatment. Future research should examine whether PTSD predicts premature termination from less intensive ED treatments, as well as in other intensive treatment settings, and whether PTSD predicts poorer outcomes from ED treatment. [ABSTRACT FROM AUTHOR]

Objective: We previously demonstrated that early improvements in access to emotion regulation strategies during the first 4 weeks of intensive cognitive behavior therapy (CBT)‐based eating disorder (ED) treatment predicted a range of post‐treatment outcomes. This follow‐up article examines whether early improvements in access to emotion regulation strategies continue to predict good treatment outcomes at 6 months post‐treatment. Method: Participants were 76 patients with bulimia nervosa or purging disorder who participated in the original study and the 6‐month follow‐up assessment. Hierarchical regression models were used to examine whether early improvements in emotion regulation strategies predicted 6‐month follow‐up outcomes. Results: After controlling relevant covariates and rapid and substantial behavior change, greater early improvements in access to emotion regulation strategies during the first 4 weeks of intensive treatment predicted lower overall ED psychopathology and ED‐related functional impairment 6 months after treatment. They did not predict abstinence from binge, vomit, and laxative use behaviors during the follow‐up period. Discussion: Individuals who learn early in treatment that they can use skills to more effectively regulate emotions have better treatment outcomes on some variables 6 months after treatment. Teaching emotion regulation skills in the first phase of CBT for ED may be beneficial, particularly for individuals with baseline difficulties. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Graded body image exposure is a key component of CBT for eating disorders (EDs). However, despite being a highly anxiety-provoking intervention, its specific effectiveness is unknown. The aims of this initial study were to investigate the feasibility and preliminary effectiveness of individualized graded body image exposure to a range of feared/avoided body image-related situations in a sample of partially remitted ED patients. Method Forty-five female adult participants were randomly assigned to maintenance treatment as usual (MTAU) only or MTAU plus five sessions of graded body image exposure. Results The graded body image exposure intervention led to large improvements in body avoidance as measured by two different methods. In addition, there was evidence of a significant impact of body image exposure on the overvaluation of shape, but not weight, 5 months after treatment. Discussion Taken together, the current results provide evidence of the feasibility of adjunctive individualized graded body image exposure within a clinical treatment program and suggest that graded body image exposure reduces body avoidance behaviors in partially remitted ED patients. Our findings suggest that individualized graded body image exposure shows promise as an intervention targeting the overvaluation of shape in EDs. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:494-504) [ABSTRACT FROM AUTHOR]

The traditional group format of day hospital treatment for eating disorders restricts individual tailoring of treatment, which is challenging when complex cases are referred. In 2007 we introduced a new program that included individual sessions. Patients referred to this program were older, had longer illness duration, and more pre-treatment symptoms than the original group program. These clients also had more psychopathology, and were more likely to have a diagnosis of anorexia nervosa binge/purge subtype. Weight gain and abstinence from symptoms were less likely for patients in this new program. However, premature discharge, rapid response, symptom frequencies, and relapse rates did not differ. [ABSTRACT FROM PUBLISHER]

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