Predictors of Intensive Enhanced Cognitive Behavioral Therapy for Anorexia Nervosa. Prospective Cohort Study.

OBJECTIVE

This study investigates baseline predictors of treatment response in patients with anorexia nervosa (AN) who received an intensive 20-week program of enhanced cognitive behavioral therapy (CBT-E). The aim was to identify demographic, clinical, and psychosocial variables that predict treatment outcomes at the end of intensive treatment-inpatient followed by day patient (EOIT) and 20-week follow-up.

METHOD: A prospective cohort study was conducted with 421 patients aged 16-63 years (mean age = 25.4 years) consecutively admitted for intensive CBT-E. Baseline assessments included body mass index (BMI), eating disorder psychopathology (EDE-Q), general psychopathology, and functional impairment.

RESULTS

Of the 421 patients, 82.7% completed the treatment, and 70.6% attended the 20-week follow-up. Considering the intent-to-treat analysis, 83.2% of patients had a "good BMI outcome" and 63.3% had a "full response" and "full recovery" at EOIT. At the 20-week follow-up, 58.7% maintained a "good BMI outcome" and 51.5% remained in "full response" and "full recovery." A higher baseline BMI was a significant predictor of achieving a good BMI outcome at EOIT and follow-up. Full response at EOIT was associated with lower baseline EDE-Q scores, while at follow-up, it was predicted by higher baseline BMI, lower EDE-Q, and larger BMI and EDE-Q changes during treatment.

CONCLUSIONS

BMI and eating-disorder psychopathology are key predictors of treatment outcomes in patients with AN undergoing intensive CBT-E. These findings emphasize the importance of early weight gain and reductions in eating disorder psychopathology as treatment targets to enhance outcomes in this population.