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March 30, 2017

The Importance of Early Improvement in Treatment

The Importance of Early Improvement in Treatment

Previous research suggests an early response to eating disorder treatment predicts better outcomes, both at the end of treatment and at follow-up appointments. What do we mean by “early response”? The definition varies, but a recent research study exploring the time-sensitivity of eating disorder treatment response defines early response as “a clinically meaningful improvement in behavioral symptoms within the first weeks of treatment.”

That research study comprised a systematic literature review and meta-analysis to further explore the relationship between response time during treatment and eating disorder remission status. The goal was to look at how accurately the end of treatment remission status could be predicted based on early response to treatment for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).

The study showed that early response was predictive of remission for the participants with AN and BED. The effect was not observed in participants with BN. Here’s a breakdown of the results:

Anorexia nervosa

  • Early weight gain at different time points during the first 6 weeks of treatment increased the likelihood of remission (irrespective of treatment modality)
  • For adolescents treated in the family behavior treatment, early weight gain during the first 4 weeks of treatment was predictive of later improvements and attainment of healthy body weight.
  • Interventions focusing on reducing shame and improving self-compassion early in treatment promoted better outcomes

Binge Eating Disorder

  • For both cognitive behavior therapy (CBT) and behavioral weight loss (BWL) interventions, it was found that early reduction in binge episode frequency predicted remission at the end of treatment
  • A reduction of at least 65% in binge eating frequency at the 4th week of treatment predicted binge-eating abstinence at the end of treatment
  • Studies examining medication use with psychotherapy found that remission was more likely when binge episodes were reduced by week 4

Bulimia Nervosa

Early response to treatment does not appear to have the same overall predictive utility as with AN and BED.

  • Results showed that early reductions in the frequency of binge/purge episodes were associated with the end of treatment remission in adult BN clients receiving day hospital treatment
  • Early reductions in symptoms were found to be indicative of later (follow-up) remission, but the early response did not strongly predict the immediate outcome
  • Reductions in depressive symptoms early in treatment were predictive of treatment outcomes

So it seems that early treatment response is highly relevant, particularly for AN and BED. Given this evidence, clients in treatment should be properly monitored for early response to ensure targets are met within an established timeframe. It may be appropriate to consider a change in approach or shift to a higher level of care if there is a lack of early response. Results also suggest that early treatment interventions should focus on reducing shame and promoting self-compassion.

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