Transdiagnostic Predictors of Treatment Outcome in Patients With Anorexia Nervosa Receiving Intensive Enhanced Cognitive Behavioral Therapy (CBT-E).

OBJECTIVE

This study examined the role of maintenance mechanisms not specific to eating disorders, as conceptualized in enhanced cognitive behavioral therapy (CBT-E)-namely clinical perfectionism, low core self-esteem, mood intolerance, and interpersonal problems-in patients with anorexia nervosa receiving intensive focused CBT-E. The aim was to assess changes in these mechanisms during treatment and their predictive value for outcomes.

METHOD: In this prospective cohort study, 113 patients aged 16-65 years were admitted for intensive CBT-E. Body mass index (BMI), eating disorder psychopathology, general psychopathology, and functional impairment were assessed at baseline, end of intensive treatment (EOIT), and 20-week follow-up. Non-eating disorder-specific variables were evaluated at baseline and EOIT.

RESULTS

Ninety-nine patients (87.6%) completed treatment, and 75 (75.8%) attended follow-up. All non-eating disorder-specific mechanisms showed significant improvement during treatment. No variable predicted the dropout rate. In intention-to-treat analyses, lower self-esteem at baseline predicted increased eating disorder psychopathology at EOIT, while lower self-esteem at EOIT predicted increased psychopathology at follow-up. Additionally, lower baseline sociability and interpersonal ambivalence at EOIT-features of interpersonal problems-predicted decreased BMI at EOIT and follow-up, respectively.

CONCLUSIONS

The focused form of intensive CBT-E is associated with significant improvements in non-eating disorder specific mechanisms in patients with anorexia nervosa. However, when low self-esteem or specific interpersonal difficulties are present, these factors significantly predict poorer outcomes in eating-disorder psychopathology and weight restoration. This suggests that, for a subset of patients, addressing these non-eating disorder specific mechanisms more directly may be necessary to optimize treatment response and sustain improvements over time.