title: The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa--a randomized controlled trial.
abstract: BACKGROUND
  Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide. The seriousness of the disorder requires extensive knowledge of effective treatment options. However, evidence for treatment efficacy in this area is remarkably weak. A recent Cochrane review states that there is an urgent need for large, well-designed treatment studies for patients with anorexia nervosa. The aim of this particular multi-centre study is to evaluate the efficacy of two standardized outpatient treatments for patients with anorexia nervosa: focal psychodynamic (FPT) and cognitive behavioural therapy (CBT). Each therapeutic approach is compared to a "treatment-as-usual" control group.
  
  
  METHODS
  237 patients meeting eligibility criteria are randomly and evenly assigned to the three groups - two intervention groups (CBT and FPT) and one control group. The treatment period for each intervention group is 10 months, consisting of 40 sessions respectively. Body weight, eating disorder related symptoms, and variables of therapeutic alliance are measured during the course of treatment. Psychotherapy sessions are audiotaped for adherence monitoring. The treatment in the control group, both the dosage and type of therapy, is not regulated in the study protocol, but rather reflects the current practice of established outpatient care. The primary outcome measure is the body mass index (BMI) at the end of the treatment (10 months after randomization).
  
  
  CONCLUSIONS
  The study design surmounts the disadvantages of previous studies in that it provides a randomized controlled design, a large sample size, adequate inclusion criteria, an adequate treatment protocol, and a clear separation of the treatment conditions in order to avoid contamination. Nevertheless, the study has to deal with difficulties specific to the psychopathology of anorexia nervosa. The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol. However, because patients are difficult to recruit and often ambivalent about treatment, a drop-out rate of 30% is assumed for sample size calculation. Due to the ethical problem of denying active treatment to patients with anorexia nervosa, the control group is defined as "treatment-as-usual".
authors.affiliation: Department of Psychosomatic and General Internal Medicine, Medical University Hospital, Heidelberg, Germany. beate.wild@med.uni-heidelberg.de
authors.forename: Beate
authors.initials: B
authors.lastname: Wild
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Friederich
authors.forename: Gaby
authors.initials: G
authors.lastname: Gross
authors.forename: Martin
authors.initials: M
authors.lastname: Teufel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.forename: Katrin E
authors.initials: KE
authors.lastname: Giel
authors.forename: Martina
authors.initials: M
authors.lastname: de Zwaan
authors.forename: Henning
authors.initials: H
authors.lastname: Schauenburg
authors.forename: Carmen
authors.initials: C
authors.lastname: Schade-Brittinger
authors.forename: Helmut
authors.initials: H
authors.lastname: Schäfer
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D005260:Female; D005858:Germany; D006801:Humans; D010352:Patient Dropouts; D018579:Patient Selection; D011613:Psychotherapy / Q000379:methods*; D012107:Research Design; D018401:Sample Size; D016896:Treatment Outcome