title: The therapeutic process in psychological treatments for eating disorders: a systematic review.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Leipzig University Medical Center, Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Brauhardt
authors.forename: Martina
authors.initials: M
authors.lastname: de Zwaan
authors.forename: Anja
authors.initials: A
authors.lastname: Hilbert
mesh_terms: D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy; D005196:Family Therapy; D001068:Feeding and Eating Disorders / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D052756:Nutritional Sciences; D011613:Psychotherapy / Q000379:methods*; D011615:Psychotherapy, Group; D016896:Treatment Outcome
keywords: anorexia nervosa; binge-eating disorder; bulimia nervosa; eating disorders; psychotherapeutic process