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Dalle Grave R.,Villa Garda Hospital | Calugi S.,Villa Garda Hospital | Doll H.A.,University of East Anglia | Fairburn C.G.,University of Oxford
Behaviour Research and Therapy | Year: 2013

A specific form of family therapy (family-based treatment) is the leading treatment for adolescents with anorexia nervosa. As this treatment has certain limitations, alternative approaches are needed. " Enhanced" cognitive behaviour therapy (CBT-E) is a potential candidate given its utility as a treatment for adults with eating disorder psychopathology. The aim of the present study was to establish, in a representative cohort of patients with marked anorexia nervosa, the immediate and longer term outcome following CBT-E. Forty-nine adolescent patients were recruited from consecutive referrals to a community-based eating disorder clinic. Each was offered 40 sessions of CBT-E over 40 weeks from a single therapist. Two-thirds completed the full treatment with no additional input. In these patients there was a substantial increase in weight together with a marked decrease in eating disorder psychopathology. Over the 60-week post-treatment follow-up period there was little change despite minimal subsequent treatment. These findings suggest that CBT-E may prove to be a cost-effective alternative to family-based treatment. © 2012 Elsevier Ltd.

Fairburn C.G.,University of Oxford | Cooper Z.,University of Oxford | Doll H.A.,University of East Anglia | O'Connor M.E.,University of Oxford | And 2 more authors.
Behaviour Research and Therapy | Year: 2013

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 randomized 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 randomized 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. © 2012 Elsevier Ltd.

Dalle Grave R.,Villa Garda Hospital | Calugi S.,Villa Garda Hospital | Conti M.,Villa Garda Hospital | Doll H.,University of Leicester | Fairburn C.G.,University of Oxford
Psychotherapy and Psychosomatics | Year: 2013

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 randomized 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 assessments 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. Copyright © 2013 S. Karger AG, Basel.

Dalle Grave R.,Villa Garda Hospital
European Journal of Internal Medicine | Year: 2011

Background: Eating disorders are common health problems afflicting mainly female adolescents and young women. They are associated with important physical health and psychosocial morbidity, and carry increased risk of death. Their cause is not yet completely understood and their management is complex, with some patients resisting all available treatments. Aims of this review: To provide the readers with an update regarding our knowledge and understanding of eating disorders. Methods: Medline database has been used for searching articles on eating disorders published since 1980. The key words used were eating disorders, anorexia nervosa, bulimia nervosa, bulimia, and binge eating. Professional books published during this period has been also reviewed. Conclusions: In the last 30 years a substantial improvement has been achieved both in the understanding and management of eating disorders, but many problems still need to be resolved. Three principal priorities should be addressed. First, the actual classification of eating disorders should be revised, since about half the cases seen in clinical practice receive a diagnosis of eating disorder not otherwise specified, and it is common to observe a migration between eating disorder diagnoses. Second, the research on pathogenesis should better clarify the exact role of genetic and environmental risk factors, and how they interact and vary across the development and maintenance of eating disorders. Third, there is an urgent need both to disseminate the few evidence-based treatments available, and to develop more potent treatments for all the eating disorder diagnostic categories. © 2010 European Federation of Internal Medicine.

Dalle Grave R.,Villa Garda Hospital
European Psychiatric Review | Year: 2011

Cognitive behavioural therapy (CBT) is the most effective treatment for adults with bulimia nervosa (BN), but it is not effective enough; at best, only half of patients make a full remission and it has not been designed for treating patients with anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS). To address some of these limitations, an enhanced form of CBT for BN, named CBT-E, has been developed. CBT-E adopts modern procedures to address eating disorder psychopathology, and it is suitable for treating all forms of clinical eating disorders. The treatment was originally designed for adults in standard outpatient settings, but was then adapted for intense levels of care (e.g. intensive outpatient, day-hospital, and inpatient). In this article intensive CBT-E for treating eating disorders will be described. A brief summary of the data supporting this novel form of treatment will also be provided. © Touch Briefings 2011.

Dalle Grave R.,Villa Garda Hospital | Calugi S.,Villa Garda Hospital | Marchesini G.,University of Bologna
International Journal of Eating Disorders | Year: 2012

Objective: To define the utility of the DSM-IV-TR definition of binge eating, as it applies to anorexia nervosa (AN) and underweight eating disorder not otherwise specified (ED-NOS). Method: We investigated the psychopathological features associated with bulimic episodes in 105 underweight individuals with eating disorders who reported regular objective bulimic episodes with or without subjective bulimic episodes (OBE group, n = 33), regular subjective bulimic episodes only (SBE group, n = 36) and neither objective nor subjective bulimic episodes (n = 36, no-RBE group). The Eating Disorder Examination (EDE), anxiety, depression, and personality tests were administered before and upon completion of inpatient cognitive behavior therapy (CBT) treatment 6 months later. Results: Compared with the SBE group, OBE subjects had higher body mass index, and more frequent self-induced vomiting, while both OBE and SBE groups had more severe eating disorder psychopathology and lower self-directness than the no-RBE group. Dropout rates and outcomes in response to inpatient CBT were similar in the three groups. Discussion: Despite a few significant differences at baseline, the similar outcome in response to CBT indicates that categorizing patients with underweight eating disorder on the basis of the type or frequency of bulimic episodes is of limited clinical utility. © 2012 Wiley Periodicals, Inc.

Grave R.D.,Villa Garda Hospital | Calugi S.,Villa Garda Hospital | El Ghoch M.,Villa Garda Hospital | Conti M.,Villa Garda Hospital | Fairburn C.G.,University of Oxford
Frontiers in Psychiatry | Year: 2014

Introduction: Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. Method: Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based on the enhanced cognitive behavior therapy (CBT-E). The patients were assessed before and after hospitalization, and 6 and 12 months later. Results: Twenty-six patients (96%) completed the program. In these patients, there was a substantial improvement in weight, eating disorder features, and general psychopathology that was well maintained at 12-month follow-up. Conclusion: These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa. © 2014 Dalle Grave, Calugi, El Ghoch, Conti and Fairburn.

El Ghoch M.,Villa Garda Hospital | Milanese C.,University of Verona | Calugi S.,Villa Garda Hospital | Pellegrini M.,University of Modena and Reggio Emilia | And 2 more authors.
American Journal of Clinical Nutrition | Year: 2014

Background: Although the effect of immediate weight restoration on body composition and body fat distribution has previously been studied in anorexia nervosa (AN), its influence in women with AN on eating disorder psychopathology and psychological distress has not previously been investigated to our knowledge. Objectives: We assessed body composition and fat mass distribution before and after body weight restoration and investigated any relation between changes in body fat patterns of patients with AN treated in a specialist inpatient unit and their eating disorder and psychological distress features. Design: Body composition was measured by using dual-energy X-ray absorptiometry in 50 female, adult patients with AN before and after complete weight restoration [body mass index (BMI; in kg/m2) ≥18.5] and 100 healthy control subjects matched by age and post-treatment BMI of study group participants. Eating disorder psychopathology and psychological distress were assessed in the AN group before and after weight restoration by using the Eating Disorder Examination interview and the Global Severity Index of the Brief Symptom Inventory (BSI-GSI), respectively. Results: After the achievement of complete weight restoration, patients with AN had higher trunk (P < 0.001), android (P < 0.001), and gynoid ( P < 0.001) fat masses and lower arm (P < 0.001) and leg (P = 0.001) fat masses with respect to control subjects. No relation was shown between body-composition variables and eating disorder psychopathology in the AN group, and the only significant predictor of change in BSI-GSI was the baseline BSI-GSI score. Conclusion: The normalization of body weight in patients with AN is associated with a preferential distribution of body fat in central regions, which does not, however, seem to influence either eating disorder psychopathology or psychological distress scores. This trial was registered at as ISRCTN92626057. © 2014 American Society for Nutrition.

Dalle Grave R.,Villa Garda Hospital | Calugi S.,Villa Garda Hospital | Marchesini G.,University of Bologna
Behaviour Research and Therapy | Year: 2014

Weight-loss maintenance remains a problematic issue in lifestyle modification programmes, but a small percentage of individuals are able to maintain a significant long-term weight loss. This means cognitive mechanisms may effectively contrast the biological pressures to regain weight arising from an obesiogenic environment. Aims of this review were to summarizes and synthesizes the data on the cognitive factors associated with program attrition, weight loss and weight maintenance derived from the QUOVADIS (QUality of life in Obesity: eVAluation and DIsease Surveillance), an observational study on quality of life in 1944 obese patients seeking treatment in 25 medical centres in Italy, and discuss its results in light of other literature. The data obtained suggest that some cognitive factors are associated with treatment discontinuation (namely higher weight-loss expectations, appearance-based primary motivation for weight loss, and unsatisfactory progress), while others with the amount of weight lost (i.e., increased dietary restraint and reduced disinhibition) or with long-term weight loss maintenance in patients who interrupted the treatment (i.e., satisfaction with results achieved, confidence in being able to lose weight without professional help). All these findings have important clinical implications. © 2014 Elsevier Ltd.

Dalle Grave R.,Villa Garda Hospital | Calugi S.,Villa Garda Hospital | Ruocco A.,Villa Garda Hospital | Marchesini G.,University of Bologna
International Journal of Eating Disorders | Year: 2011

Objective: The clinical significance of diagnosing the night eating syndrome (NES) in obese individuals has not been clearly demonstrated. We aimed to test the effect of NES on weight loss outcome in obesity. Method: In an observational case-control study, we measured weight loss outcome in obese individuals with NES (32 cases) and 68 non-NES matched participants entering a weight-loss program. The diagnosis of NES was generated by a two-stage assessment, including the Night Eating Questionnaire (screening test) and the Night Eating Syndrome History and Inventory. The program included a 21-day inpatient treatment based on a low-calorie diet, exercise, and psycho-educational groups, followed by a 6-month outpatient follow-up. Body weight, metabolic parameters, and questionnaires of psychopathology were assessed at baseline, at the end of the inpatient period and at the end of follow-up. Results: NES participants were only characterized by significantly higher scores of the Beck Depression Inventory and the Night Eating Questionnaire. The time course of weight loss did not differ between groups throughout the study period. Only eight NES participants were still classified as NES at study end. Discussion: The presence of NES does not affect weight loss outcome of an obesity treatment based on lifestyle modification. Copyright © 2009 Wiley Periodicals, Inc.

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