title: Treating severe and enduring anorexia nervosa: a randomized controlled trial.
abstract: BACKGROUND
  There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-AN). This study evaluated the relative efficacy of cognitive behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM) for adults with SE-AN.
  
  
  METHODS
  Sixty-three participants with a diagnosis of AN, who had at least a 7-year illness history, were treated in a multi-site randomized controlled trial (RCT). During 30 out-patient visits spread over 8 months, they received either CBT-AN or SSCM, both modified for SE-AN. Participants were assessed at baseline, end of treatment (EOT), and at 6- and 12-month post-treatment follow-ups. The main outcome measures were quality of life, mood disorder symptoms and social adjustment. Weight, eating disorder (ED) psychopathology, motivation for change and health-care burden were secondary outcomes.
  
  
  RESULTS
  Thirty-one participants were randomized to CBT-AN and 32 to SSCM with a retention rate of 85% achieved at the end of the study. At EOT and follow-up, both groups showed significant improvement. There were no differences between treatment groups at EOT. At the 6-month follow-up, CBT-AN participants had higher scores on the Weissman Social Adjustment Scale (WSAS; p = 0.038) and at 12 months they had lower Eating Disorder Examination (EDE) global scores (p = 0.004) and higher readiness for recovery (p = 0.013) compared to SSCM.
  
  
  CONCLUSIONS
  Patients with SE-AN can make meaningful improvements with both therapies. Both treatments were acceptable and high retention rates at follow-up were achieved. Between-group differences at follow-up were consistent with the nature of the treatments given.
authors: School of Psychology and Centre for Eating and Dieting Disorders (Boden Institute), School of Psychology, University of Sydney, NSW, Australia.
authors: S
authors: S
authors: Touyz
authors: D
authors: D
authors: Le Grange
authors: H
authors: H
authors: Lacey
authors: P
authors: P
authors: Hay
authors: R
authors: R
authors: Smith
authors: S
authors: S
authors: Maguire
authors: B
authors: B
authors: Bamford
authors: K M
authors: KM
authors: Pike
authors: R D
authors: RD
authors: Crosby
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D017281:Cost of Illness; D003863:Depression / Q000175:diagnosis; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009042:Motivation / Q000502:physiology; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D012917:Social Adjustment; D012944:Social Support; D016896:Treatment Outcome; D055815:Young Adult