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The therapeutic process in psychological treatments for eating disorders: A systematic review

Authors

  • Anne Brauhardt MSc,

    Corresponding author
    1. Leipzig University Medical Center, Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, Leipzig, Germany
    • Correspondence to: Anne Brauhardt, MSc, Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, Medical Psychology and Medical Sociology, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany. E-mail: anne.brauhardt@medizin.uni-leipzig.de

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  • Martina de Zwaan MD,

    1. Hannover Medical School, Department of Psychosomatic Medicine and Psychotherapy, Hannover, Germany
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  • Anja Hilbert PhD

    1. Leipzig University Medical Center, Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, Leipzig, Germany
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  • Supported by 01GV0601, 01EO1001 from Federal Ministry of Education and Research (BMBF), Germany.

ABSTRACT

Objective

For eating disorders, a vast number of investigations have demonstrated the efficacy of psychological treatments. However, evidence supporting the impact of therapeutic process aspects on outcome (i.e., process-outcome research) has not been disentangled.

Method

Using the Generic Model of Psychotherapy (GMP) to organize various process aspects, a systematic literature search was conducted on psychological treatment studies for anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders not otherwise specified.

Results

Improved outcomes resulted for family-based treatment compared to individual treatment, for individual compared to group treatment, booster sessions, and positive patient expectations (GMP contract aspect); for nutritional counseling and exercising but not exposure with response prevention as adjunct interventions (therapeutic operations); for highly motivated patients and, to a lesser extent, for therapeutic alliance (therapeutic bond); as well as for rapid response and longer overall treatment duration (temporal patterns). Regarding other GMP aspects, studies on self-relatedness were completely lacking and in-session impacts were rarely investigated.

Discussion

As most studies assessed only a limited number of process aspects, the ability to draw conclusions about their overall impact regarding outcome is rather limited. Therefore, future process-outcome research is needed beyond investigations of treatment efficacy for eating disorders. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:565–584)

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