Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up.
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OBJECTIVE: The aim of this study was to compare two cognitive-behavioral treatments for outpatients with eating disorders, one focusing solely on eating disorder features and the other a more complex treatment that also addresses mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties. METHOD: A total of 154 patients who had a DSM-IV eating disorder but were not markedly underweight (body mass index over 17.5), were enrolled in a two-site randomized controlled trial involving 20 weeks of treatment and a 60-week closed period of follow-up. The control condition was an 8-week waiting list period preceding treatment. Outcomes were measured by independent assessors who were blind to treatment condition. RESULTS: Patients in the waiting list control condition exhibited little change in symptom severity, whereas those in the two treatment conditions exhibited substantial and equivalent change, which was well maintained during follow-up. At the 60-week follow-up assessment, 51.3% of the sample had a level of eating disorder features less than one standard deviation above the community mean. Treatment outcome did not depend on eating disorder diagnosis. Patients with marked mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties appeared to respond better to the more complex treatment, with the reverse pattern evident among the remaining patients. CONCLUSIONS: These two transdiagnostic treatments appear to be suitable for the majority of outpatients with an eating disorder. The simpler treatment may best be viewed as the default version, with the more complex treatment reserved for patients with marked additional psychopathology of the type targeted by the treatment.
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Differences in the correlates and clinical profiles between discrete subtypes in this study provide evidence for the validity of these distinctions.
“Although the frequent crossover of eating disorder subtypes in longitudinal studies of adults37–39 suggests a lack of diagnostic specificity of eating disorder subtypes,40–42 differences in the correlates and clinical profiles between discrete subtypes in our study provide evidence for the validity of these distinctions.”
From Prevalence and Correlates of Eating Disorders in Adolescents: Results From the National Comorbidity Survey Replication Adolescent Supplement (2011) · cites this paper as [39]
The cross-sectional design of this study limits conclusions concerning temporal relationships among comorbid conditions and prevents confirmation of findings from adult samples concerning eating disorder crossovers or transitions from subthreshold to full-threshold conditions.
“However, the cross-sectional design of this study limits conclusions concerning temporal relationships among comorbid conditions and prevents confirmation of findings from adult samples concerning eating disorder crossovers or transitions from subthreshold to full-threshold conditions.37–39”
From Prevalence and Correlates of Eating Disorders in Adolescents: Results From the National Comorbidity Survey Replication Adolescent Supplement (2011) · cites this paper as [39]
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- Authors
- Fairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Bohn, K., Hawker, D. M., Wales, J. A., & Palmer, R. L.
- Affiliations
- University of Oxford (GB)
- University of Leicester (GB)
- Venue
- American Journal of Psychiatry
- Published
- 2009-03
- Volume
- 166
- Issue
- 3
- Pages
- 311-319
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC3035831
- OpenAlex
- W2143116894
- Cited by
- 829
- References
- 22
- Citations by year
- 2026: 25 · 2025: 28 · 2024: 33 · 2023: 30 · 2022: 21 · 2021: 61 · 2020: 86 · 2019: 37 · 2018: 47 · 2017: 63 · 2016: 39 · 2015: 65 · 2014: 54 · 2013: 60 · 2012: 74
- FWCI
- 39.41
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- Wellcome Trust (046386, 079113, 079113/Z/06/Z)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- eating disorders, transdiagnostic cognitive behavioral therapy, clinical perfectionism, low self-esteem, interpersonal problems, treatment response, symptom maintenance, outpatients
- MeSH terms
- Adult, Feeding and Eating Disorders, Demography, Female, Follow-Up Studies, Humans, Interpersonal Relations, Male, Self Concept, Severity of Illness Index, Cognitive Behavioral Therapy, Body Mass Index, Diagnostic and Statistical Manual of Mental Disorders
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