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Cited by 78Eating Disorders and BehaviorsPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Early response to psychological treatment for eating disorders: a systematic review and meta-analysis

Chang, Peter G.R.Y., Delgadillo, Jaime, Waller, Glenn·2021·Clinical Psychology Review
DOI 10.1016/j.cpr.2021.102032
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Abstract

Early response is a well-established predictor of positive outcomes at the end of psychological treatments for common mental disorders. There is some prior evidence that this conclusion also applies to eating disorders, including three meta-analyses, but no moderators of that relationship have been identified. However, a number of further papers have been published since, which might influence the size of the effect of early response or the potential role of moderating factors. This pre-registered systematic review presents a comprehensive examination of this literature. Three databases were searched (Scopus, PsycInfo, PubMed). In total, 33 eligible studies were included in a narrative synthesis, and 25 studies were included in random-effects meta-analysis. The majority (91%) of studies were rated as having low or moderate risk of bias. Approximately half of patients across clinical samples showed early response to psychological therapy, which was most often defined as reliable symptomatic improvement during the first four sessions. A significant and moderate association was found between early response and post-treatment outcomes (r = 0.41 [95% CI: 0.32-0.481], p < .0001). Significant evidence of heterogeneity (Q[28] = 136.42, p < .0001; I 2 = 80.2%) was evident. The review was limited by the exclusion of grey literature and only 76% of studies provided sufficient statistical information for meta-analytic synthesis, although we found no significant evidence of publication bias, χ 2(1) = 0.001, p = .97. Overall, evidence accumulated over twenty years establishes early response as the most robust predictor of treatment outcomes in the field of eating disorders. However, only half of patients show early change in this way. Further research is needed to determine whether there are patient or clinician characteristics that predict early response to psychological treatment for eating disorders.

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  • Brief SSH-BEeT predominantly encompasses behavioural interventions commonly employed in early CBT sessions for BED, and it was suggested that these behavioural components may drive early and substantial symptom change often seen in the first 4 weeks of CBT treatment for BED.

    “Given Brief SSH-BEeT predominantly encompasses behavioural interventions (i.e., establishing regular eating patterns, self-monitoring of food-intake, etc.) that are commonly employed in the early sessions of a CBT program for BED, it was suggested that these behavioural components may drive the early and substantial symptom change often seen in the first 4 weeks of CBT treatment for BED (33, 34).”

    From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [33]

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  • Improvements early in eating disorder treatment indicate better prognosis.

    “Because improvements early in ED treatment indicate better prognosis (Brown et al., 2018; Chang et al., 2021)”

    From Early reduction in anxiety sensitivity predicts greater reduction in disordered eating and trait anxiety during treatment for bulimia nervosa. (2024) · cites this paper as Chang et al., 2021

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Authors
Chang, P. G. R. Y., Delgadillo, J., & Waller, G.
Affiliations
University of Sheffield (GB)
Corresponding author
Waller, Glenn
ORCID
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2021-06
Volume
86
Pages
102032
ISSN
0272-7358 (ISSN-L)
DOI
10.1016/j.cpr.2021.102032
OpenAlex
W3153606049
Cited by
78
References
54
Citations by year
2026: 13 · 2025: 22 · 2024: 19 · 2023: 12 · 2022: 6 · 2021: 6
FWCI
1.43
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Clinical Psychology Review (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Research Portal (King's College London) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
eating disorders, early response, psychological intervention, predictors of treatment outcome, symptomatic improvement, treatment outcome prediction, treatment moderators
MeSH terms
Feeding and Eating Disorders, Humans, Treatment Outcome

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