title: The Intersession Process in Psychotherapy for Anorexia Nervosa: Characteristics and Relation to Outcome.
abstract: The "inter session process" (ISP) is defined as therapy-related conscious thoughts, memories, and emotions that patients and therapists experience between psychotherapy sessions. It indicates how the participants process and use treatment. The main aim of this study is to describe the ISP characteristics of patients in outpatient treatment for anorexia nervosa (AN). An additional aim is to explore the relation between patients' ISP and treatment outcome.
  
  
  
  Patients taking part in a randomized controlled trial on outpatient psychotherapy for AN (ANTOP) filled in the Intersession Experience Questionnaire before each of the 40 psychotherapy sessions. Trajectories of different aspects of the ISP were analyzed with growth curve models based on orthogonal polynomials and tested for differences between 3 outcome categories (recovery, partially recovered, full syndrome AN).
  
  
  
  Data from 108 cases were available for analysis. ISP facets showed diverse, mostly nonlinear, trajectories over the course of treatment. Less favorable outcomes were associated with higher levels of patients' experiencing negative emotions when recalling therapeutic dialogue, thinking about therapy during dreaming/drowsy states, and applying therapeutic learning (in the second half of treatment).
  
  
  
  Findings confirm an overall relation between ISP and treatment outcome. In outpatient treatment in AN, patients with a less successful course seem to be more preoccupied with therapy and therapist between sessions. For the ISP facet "applying therapeutic learning," findings point to an optimal range dependent on treatment phase. Growth curve modeling is required to describe the nonlinear trajectories of ISP facets.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University Freiburg, Germany. armin.hartmann@uniklinik-freiburg.de.
authors.forename: Armin
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University Freiburg, Germany. almut.zeeck@uniklinik-freiburg.de.
authors.forename: Almut
authors.initials: A
authors.lastname: Zeeck
authors.affiliation: Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Wild
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hannover, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: de Zwaan
authors.affiliation: Clinic for Psychosomatic Medicine and Psychotherapy, LWL University Hospital of the Ruhr, University of Bochum, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Herpertz
authors.affiliation: Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Burgmer
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Germany.
authors.forename: Joern
authors.initials: J
authors.lastname: von Wietersheim
authors.affiliation: Clinic for Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: Sefik
authors.initials: S
authors.lastname: Tagay
authors.affiliation: Clinic for Psychosomatic Medicine and Psychotherapy, University of Technology Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Dinkel
authors.affiliation: Institute and Outpatient Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Löwe
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany.
authors.forename: Gaby
authors.initials: G
authors.lastname: Resmark
authors.affiliation: Department of Comparative Human Development, University of Chicago, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Orlinsky
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010045:Outpatients / Q000523:psychology*; D011613:Psychotherapy / Q000379:methods*; D055815:Young Adult
keywords: anorexia nervosa; intersession process; outcome