The change process in adult anorexia nervosa inpatient treatment: a path model
Knowledge on the change process in the treatment of anorexia nervosa (AN) is an important starting point for the improvement of treatment, yet very little evidence exists. In an exploratory analysis, we aimed to investigate the interdependencies between higher-rank change process factors, BMI and AN-specific cognitions and behaviours over the course of inpatient treatment.
We included 176 female adult AN inpatients from three specialized centres. The temporal interdependencies between the change factors and the outcome variables over the course of treatment (t0: beginning, t1: mid-treatment, t2: end) were investigated using a path model.
The sample had a mean age of 27.1 years (SD = 8.9 years) and a mean BMI at admission of 15.0 kg/m2 (SD = 1.6 kg/m2). A greater basic need satisfaction and a greater emotional involvement and commitment to treatment at t0 positively influenced the BMI at t1. Furthermore, greater basic need satisfaction at t0 led to less AN-specific cognitions and behaviours at t2.
The results are discussed with respect to the self-determination theory and the consistency theory. Further research on the change process in AN treatment is recommended.
KeywordsChange process Anorexia nervosa Inpatient treatment Basic need satisfaction
We would like to thank Prof. M. Rose and Dr. B. Meyer for their valuable contributions to the study design and Alexandra Murray for her constructive and important comments on the manuscript. We gratefully acknowledge the support of all physicians and psychotherapists in the three study centres and all patients who participated in our study.
Compliance with ethical standards
This study was funded by a “Swiss Anorexia Nervosa Foundation” grant awarded to Professor B. Löwe and Dr. B. Meyer.
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by all local research ethic committees (Medical Chamber Hamburg MC-419/10, Medical Association Schleswig-Holstein: AZ 030/10; University Medical Center Munich: 246-10). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants included in the study.
- 1.Treasure J, Schmidt U (2013) The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord 1:13. doi: 10.1186/2050-2974-1-13 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.NICE (2004) Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. The British Psychological Society and the Royal College of Psychiatrists, Leicester and LondonGoogle Scholar
- 6.Goddard E, Hibbs R, Raenker S, Salerno L, Arcelus J, Boughton N, Connan F, Goss K, Laszlo B, Morgan J, Moore K, Robertson D, S S, Schreiber-Kounine C, Sharma S, Whitehead L, Schmidt U, Treasure J (2013) A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK. BMC Psychiatry 13:287. doi: 10.1186/1471-244X-13-287 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Schmidt U, Renwick B, Lose A, Kenyon M, Dejong H, Broadbent H, Loomes R, Watson C, Ghelani S, Serpell L, Richards L, Johnson-Sabine E, Boughton N, Whitehead L, Beecham J, Treasure J, Landau S (2013) The MOSAIC study—comparison of the maudsley model of treatment for adults with anorexia nervosa (MANTRA) with specialist supportive clinical management (SSCM) in outpatients with anorexia nervosa or eating disorder not otherwise specified, anorexia nervosa type: study protocol for a randomized controlled trial. Trials 14:160. doi: 10.1186/1745-6215-14-160 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Zipfel S, Wild B, Gross G, Friederich HC, Teufel M, Schellberg D, Giel KE, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Lowe B, Tagay S, von Wietersheim J, Zeeck A, Schade-Brittinger C, Schauenburg H, Herzog W, As group (2014) Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet 383(9912):127–137. doi: 10.1016/S0140-6736(13)61746-8 CrossRefPubMedGoogle Scholar
- 15.LoTempio E, Forsberg S, Bryson SW, Fitzpatrick KK, Le Grange D, Lock J (2013) Patients’ characteristics and the quality of the therapeutic alliance in family-based treatment and individual therapy for adolescents with anorexia nervosa. J Fam Ther 35:29–52. doi: 10.1111/1467-6427.12011 CrossRefGoogle Scholar
- 28.Grawe K (2007) Neuropsychotherapy: how the neurosciences inform effective psychotherapy. Lawrence Erlbaum Associate Publishers, MahwahGoogle Scholar
- 29.First MB, Spitzer RL, Gibbon M, Williams JBW (2004) Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edn. New York Sate Psychiatric Institute, New YorkGoogle Scholar
- 32.Kline RB (2005) Principles and practice of structural equation modeling. Methodology in the social sciences, 2nd edn. Guilford, New YorkGoogle Scholar
- 33.Quaschning K, Korner M, Wirtz M (2013) Analyzing the effects of shared decision-making, empathy and team interaction on patient satisfaction and treatment acceptance in medical rehabilitation using a structural equation modeling approach. Patient Educ Couns 91(2):167–175. doi: 10.1016/j.pec.2012.12.007 CrossRefPubMedGoogle Scholar
- 37.Accurso EC, Ciao AC, Fitzsimmons-Craft EE, Lock JD, Le Grange D (2014) Is weight gain really a catalyst for broader recovery? The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa. Behav Res Ther 56:1–6. doi: 10.1016/j.brat.2014.02.006 CrossRefPubMedPubMedCentralGoogle Scholar