title: CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression.
abstract: Whilst studies have consistently identified early symptom reduction as an important predictor of treatment outcome, the impact of early change on common comorbid features has not been investigated. This study of CBT for eating disorders explored patterns of early change in eating pathology and longer-term change in personality pathology, anxiety and depression. It also explored the impact of early change in eating pathology on overall change in personality pathology, anxiety and depression. Participants were 179 adults diagnosed with eating disorders who were offered a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment and following the 6th session. They also completed measures of personality disorder cognitions, anxiety and depression at the start and end of treatment. There were significant changes in eating pathology over the first six sessions of treatment. Significant improvements were also seen in personality disorder pathology, anxiety and depression by the end of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. Early changes in eating pathology were associated with later changes in common comorbid features, with early reduction in restraint being a key predictor. These findings demonstrate that early symptom change can be achieved in CBT for eating disorders when delivered in routine clinical practice. Such change has long-term benefits that go beyond the domain of eating pathology, enhancing change in personality pathology, anxiety and depression.
authors.affiliation: Eating Disorders Service, Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton, SO19 5ES, UK; Clinical Psychology Programme, Psychology Academic Unit, University of Southampton, Shackleton Building (44a), Highfield Campus, Southampton, Hampshire SO17 1BJ, UK. Electronic address: hannahturner0@gmail.com.
authors.forename: Hannah
authors.initials: H
authors.lastname: Turner
authors.affiliation: Eating Disorders Service, Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton, SO19 5ES, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Marshall
authors.affiliation: Eating Disorders Service, Southern Health NHS Foundation Trust, April House, 9 Bath Road, Bitterne, Southampton, SO19 5ES, UK.
authors.forename: Francesca
authors.initials: F
authors.lastname: Wood
authors.affiliation: Clinical Psychology Programme, Psychology Academic Unit, University of Southampton, Shackleton Building (44a), Highfield Campus, Southampton, Hampshire SO17 1BJ, UK.
authors.forename: Lusia
authors.initials: L
authors.lastname: Stopa
authors.affiliation: Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield S10 2NT, UK.
authors.forename: Glenn
authors.initials: G
authors.lastname: Waller
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety; D001008:Anxiety Disorders / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003863:Depression; D003866:Depressive Disorder / Q000628:therapy; D004435:Eating / Q000523:psychology; D001068:Feeding and Eating Disorders / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010551:Personality; D010554:Personality Disorders / Q000628:therapy; D011599:Psychopathology / Q000379:methods; D016896:Treatment Outcome
keywords: Cognitive-behavioural therapy; Comorbidity; Early change; Eating disorders; Personality disorder cognitions