What works for adolescents with AN? A systematic review of psychosocial interventions

Mapping the evidence for the prevention and treatment of eating disorders in young people

ABSTRACT

Eating disorders often develop during adolescence and young adulthood, and are associated with significant psychological and physical burden. Identifying evidence-based interventions is critical and there is need to take stock of the extant literature, to inform clinical practice regarding well-researched interventions and to direct future research agendas by identifying gaps in the evidence base.

AIM

To investigate and quantify the nature and distribution of existing high-quality research on the prevention and treatment of eating disorders in young people using evidence mapping methodology.

METHOD

A systematic search for prevention and treatment intervention studies in adolescents and young adults (12-25 years) was conducted using EMBASE, PSYCINFO and MEDLINE. Studies were screened and mapped according to disorder, intervention modality, stage of eating disorder and study design. Included studies were restricted to controlled trials and systematic reviews published since 1980.

RESULTS

The eating disorders evidence map included 197 trials and 22 systematic reviews. Prevention research was dominated by trials of psychoeducation (PE). Bulimia nervosa (BN) received the most attention in the treatment literature, with cognitive behavioural therapy (CBT) and antidepressants the most common interventions. For anorexia nervosa (AN), family based therapy (FBT) was the most studied. Lacking were trials exploring treatments for binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS). Relapse prevention strategies were notably absent across the eating disorders.

CONCLUSIONS

Despite substantial literature devoted to the prevention and treatment of eating disorders in young people, the evidence base is not well established and significant gaps remain. For those identified as being at-risk, there is need for prevention research exploring strategies other than passive PE. Treatment interventions targeting BED and EDNOS are required, as are systematic reviews synthesising BN treatment trials (e.g., CBT, antidepressants). FBTs for AN require investigation against other validated psychological interventions, and the development of relapse prevention strategies is urgently required. By systematically identifying existing interventions for young people with eating disorders and exposing gaps in the current literature, the evidence map can inform researchers, funding bodies and policy makers as to the opportunities for future research.

The effectiveness of a day program for the treatment of adolescent anorexia nervosa

OBJECTIVE

The risks of anorexia nervosa (AN) are well established. Despite its severity, little certainty exists for practitioners, with ethical and financial limitations yielding few controlled studies establishing effective treatments. Thus, other methods of establishing treatment effectiveness are necessary. This study presents preliminary results of an open clinical trial of a day program for adolescents with AN.

METHOD

Participants were 26 anorectic females, 12-18 years, who completed the "Transition Program."

RESULTS

Significant change emerged on measures of weight gain, and behavioral and attitudinal measures of eating pathology. Large effect sizes were evident for weight gain at 6 month follow-up. Preliminary trends suggest that treatment gains on these and other measures of eating pathology were maintained at 6 month follow-up.

DISCUSSION

Preliminary results support day program treatment for adolescents with mild-moderately severe eating disorders. Present outcomes are discussed with respect to the dearth of efficacious treatment options for adolescents.

The Individual Within a Condition: A Qualitative Study of Young People's Reflections on Being Treated for Anorexia Nervosa

BACKGROUND

Anorexia nervosa is a mental health problem that can seriously impede the physical, social, and psychological functioning of those who develop it. Unfortunately, outcome for this patient group, even after treatment, is not necessarily promising.

OBJECTIVE

To explore the views of young people about being treated for anorexia.

DESIGN

Qualitative interviews were conducted with 10 adolescents. All interviews were recorded with participants' written consent and transcribed verbatim. A thematic analysis was applied to these data.

RESULTS

Five themes were derived from the analysis: a) accessing appropriate care, b) balancing the physical and psychological, c) qualities required in professionals, d) help from nonprofessional routes, and e) perceived progress.

CONCLUSIONS

Participants were clear about needing to be motivated to change. Practitioners can help by challenging patients in a nonconfrontational manner, treating them as individuals rather than cases of anorexia, and considering their psychosocial and physical functioning. J Am Psychiatr Nurses Assoc, 2008; 13(6), 368.-375. DOI: 10.1177/1078390307309215.