Inpatient Cognitive Behavior Therapy for Severe Eating Disorders

Enhanced cognitive behaviour therapy (CBT-E) for eating disorders has been developed and evaluated only in outpatient setting. Aim of the paper is to describe a novel model of inpatient treatment, termed inpatient CBT-E, indicated for patients with an eating disorder of clinical severity not manageable in an outpatient setting or that failed outpatient treatment. Inpatient CBT-E is derived by the outpatients CBT-E with some adaptations to rend the treatments suitable for an inpatient setting. The principal adaptations include: 1) multidisciplinary and non-eclectic team composed of physicians, psychologists, dieticians and nurses all trained in CBT; 2) assisted eating; 3) group sessions; and a CBT family module for patients younger than 18 years. The treatment lasts 20 weeks (13 for inpatients followed by seven weeks of residential day treatment) and, as CBT-E, is divided in four stages and can be administered in a focused form (CBT-F) or in a broad form (CBT-B). A randomized control trial is evaluating the effectiveness of the treatment

Inpatient Cognitive Behavior Therapy for Severe Eating Disorders

Enhanced cognitive behaviour therapy (CBT-E) for eating disorders has been developed and evaluated only in outpatient setting. Aim of the paper is to describe a novel model of inpatient treatment, termed inpatient CBT-E, indicated for patients with an eating disorder of clinical severity not manageable in an outpatient setting or that failed outpatient treatment. Inpatient CBT-E is derived by the outpatients CBT-E with some adaptations to rend the treatments suitable for an inpatient setting. The principal adaptations include: 1) multidisciplinary and non-eclectic team composed of physicians, psychologists, dieticians and nurses all trained in CBT; 2) assisted eating; 3) group sessions; and a CBT family module for patients younger than 18 years. The treatment lasts 20 weeks (13 for inpatients followed by seven weeks of residential day treatment) and, as CBT-E, is divided in four stages and can be administered in a focused form (CBT-F) or in a broad form (CBT-B). A randomized control trial is evaluating the effectiveness of the treatment

Intensive Outpatient Cognitive Behaviour Therapy for Eating Disorder

The aim of this paper is to describe a novel model of intensive outpatient cognitive-behaviour therapy (CBT) indicated for eating disorder patients who are having difficulty modifying their eating habits in response to conventional outpatient CBT. Intensive outpatient CBT is a manual based treatment derived by the CBT-Enhanced (CBT-E) for eating disorders. The treatment has four features that distinguish it from the conventional outpatient CBT-E: (1) it is designed to be suitable for both adult and adolescent patients, (2) it is delivered by a multidisciplinary non-eclectic team trained in CBT, (3) there is assistance with eating, (4) there is a family therapy module for patients under the age of 18 years. Preliminary outcome of intensive outpatient CBT-E are encouraging. The treatment has been applied to 20 consecutive underweight eating disorder patients (age 18.2 ± 6.5 years; BMI 14.6 ± 1.5 kg/m2). Thirteen patients (65%) concluded the treatment, five (25%) were admitted at an eating disorder inpatient unit, and two (10%) prematurely interrupted the treatment. Completers obtained significant weight regain and improvement of eating disorder and general psychopathology. Most of the improvements were maintained at six-month follow-up

Versione italiana dello Starvation Symptom Inventory: un questionario per valutare i sintomi da malnutrizione nei disturbi dell'alimentazione

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A Longitudinal Study of Eating Rituals in Patients With Anorexia Nervosa

Background: Eating rituals are any problematic behaviors involving food. They are usually observed in patients with anorexia nervosa, but research into these behaviors and their role in treatment outcomes is lacking.Objective: We set out to assess the presence of eating rituals in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioral therapy (ICBT-E), in addition to their change over time and role as potential predictors of treatment outcome.Materials and Methods: Ninety adult female inpatients with anorexia nervosa were recruited. The Participants’ body mass index (BMI), and scores for Starvation Symptoms Inventory (SSI), Eating Disorder Examination (EDE), and Brief Symptom Inventory (BSI) were recorded, and a purpose-designed 9-item checklist of eating rituals was completed by trained dieticians during assisted eating – an integral part of the ICBT-E. The Structured Clinical Interview for DSM-IV was used at admission to identify the presence of coexisting axis I psychiatric disorders. All other tests were administered at baseline (admission), the end of treatment and 6-month follow-up. BMI, EDE, and BSI were also re-administered after 4 weeks of treatment in order to examine how refeeding affects these variables.Results: We found a correlation at baseline between eating rituals and both general and eating-disorder psychopathology scores. Eating rituals were also associated with the presence of at least one comorbid anxiety disorder. ICBT-E treatment was associated with a significant reduction in eating rituals, as well as a significant increase in BMI and improved eating-disorder and general psychopathology. However, our most relevant finding was that neither baseline eating ritual scores nor their change during treatment was associated with either BMI or general or eating-disorder psychopathology scores taken at either the end of therapy or at 6-month follow-up.Conclusion: Neither the presence of nor change in eating rituals influence treatment outcomes in patients with anorexia nervosa

Resting Energy Expenditure in Anorexia Nervosa: Measured versus Estimated

Introduction. Aim of this study was to compare the resting energy expenditure (REE) measured by the Douglas bag method with the REE estimated with the FitMate method, the Harris-Benedict equation, and the Müller et al. equation for individuals with BMI < 18.5 kg/m2 in a severe group of underweight patients with anorexia nervosa (AN). Methods. 15 subjects with AN participated in the study. The Douglas bag method and the FitMate method were used to measure REE and the dual energy X-ray absorptiometry to assess body composition after one day of refeeding. Results. FitMate method and the Müller et al. equation gave an accurate REE estimation, while the Harris-Benedict equation overestimated the REE when compared with the Douglas bag method. Conclusion. The data support the use of the FitMate method and the Müller et al. equation, but not the Harris-Benedict equation, to estimate REE in AN patients after short-term refeeding

Cognitive-Behavioral Strategies to Increase the Adherence to Exercise in the Management of Obesity

Physical activity plays a major role in the development and management of obesity. High levels of physical activity provide an advantage in maintaining energy balance at a healthy weight, but the amount of exercise needed to produce weight loss and weight loss maintenance may be difficult to achieve in obese subjects. Barriers to physical activity may hardly be overcome in individual cases, and group support may make the difference. The key role of cognitive processes in the failure/success of weight management suggests that new cognitive procedures and strategies should be included in the traditional behavioral treatment of obesity, in order to help patients build a mindset of long-term weight control. We reviewed the role of physical activity in the management of obesity, and the principal cognitive-behavioral strategies to increase adherence to exercise. Also in this area, we need to move from the traditional prescriptive approach towards a multidisciplinary intervention

Personality dimensions and treatment drop-outs among eating disorder patients treated with cognitive behavior therapy

Abstract Premature, unilateral interruption of inpatient treatment of eating disorders (ED) is a key factor limiting success. We evaluated the role of personality dimensions (temperament and character) in predicting drop-out in 145 consecutive ED inpatients (133 females) who entered cognitive behavior therapy. Baseline assessment included anthropometry, the Eating Disorder Examination, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Temperament and Character Inventory (TCI). Treatment was based on the new transdiagnostic cognitive behavior theory of ED, adapted for an inpatient setting; it was manual-based and lasted 20 weeks (13, inpatients; 7, residential day hospital). Thirty-four patients (23.4%) discontinued treatment. Drop-outs had a lower level of education, a higher prevalence of separation or divorce in the family, and lower scores on the TCI Persistence scale. After correction for age, gender and bodymass index, scores on the Persistence scale continued to be significantly related to drop-out, and the association was confirmed by KaplanMeier analysis. Eating disorder patients with low Persistence scores are significantly less likely to complete inpatient treatment

Lifestyle modification in the management of the metabolic syndrome: achievements and challenges

Lifestyle modification based on behavior therapy is the most important and effective strategy to manage the metabolic syndrome. Modern lifestyle modification therapy combines specific recommendations on diet and exercise with behavioral and cognitive strategies. The intervention may be delivered face-to-face or in groups, or in groups combined with individual sessions. The main challenge of treatment is helping patients maintain healthy behavior changes in the long term. In the last few years, several strategies have been evaluated to improve the long-term effect of lifestyle modification. Promising results have been achieved by combining lifestyle modification with pharmacotherapy, using meals replacement, setting higher physical activity goals, and long-term care. The key role of cognitive processes in the success/failure of weight loss and maintenance suggests that new cognitive procedures and strategies should be included in the traditional lifestyle modification interventions, in order to help patients build a mind-set favoring long-term lifestyle changes. These new strategies raise optimistic expectations for an effective treatment of metabolic syndrome with lifestyle modifications, provided public health programs to change the environment where patients live support them

Long-term weight loss maintenance for obesity: a multidisciplinary approach

The long-term weight management of obesity remains a very difficult task, associated with a high risk of failure and weight regain. However, many people report that they have successfully managed weight loss maintenance in the long term. Several factors have been associated with better weight loss maintenance in long-term observational and randomized studies. A few pertain to the behavioral area (eg, high levels of physical activity, eating a low-calorie, low-fat diet; frequent self-monitoring of weight), a few to the cognitive component (eg, reduced disinhibition, satisfaction with results achieved, confidence in being able to lose weight without professional help), and a few to personality traits (eg, low novelty seeking) and patient–therapist interaction. Trials based on the most recent protocols of lifestyle modification, with a prolonged extended treatment after the weight loss phase, have also shown promising long-term weight loss results. These data should stimulate the adoption of a lifestyle modification-based approach for the management of obesity, featuring a nonphysician lifestyle counselor (also called “lifestyle trainer” or “healthy lifestyle practitioner”) as a pivotal component of the multidisciplinary team. The obesity physicians maintain a primary role in engaging patients, in team coordination and supervision, in managing the complications associated with obesity and, in selected cases, in the decision for drug treatment or bariatric surgery, as possible more intensive, add-on interventions to lifestyle treatment