The British Journal of Psychiatry (2001) 179: 78
© 2001 The Royal College of Psychiatrists
Psychological therapies in anorexia nervosa
M. F. Okhai
Department of Psychological Treatment Services, Addenbrooke's NHS Trust,
Cambridge CB2 2QQ, UK
EDITED BY MATTHEW HOTOPF
The paper by Dare et al
(2001), on a trial of
psychological treatments for anorexia nervosa, has two major shortcomings. The
investigators planned for a year of weekly sessions of 50 minutes of
psychoanalytic therapy; a year of weekly to 3-weekly sessions (60 to 75
minutes) of family therapy; 23 sessions (50 minutes) of
cognitive—analytic therapy (CAT), and an unstated frequency of 30 minute
sessions for 1 year for the ‘routine treatment’ group. The
patients in the psychoanalytic arm ended up receiving a mean of 24.9 sessions
as opposed to 12.9 for the CAT, 13.6 for the family therapy and 10.9 for the
‘routine’ arm. The differences in the numbers of sessions planned
and those actually taking place has not been taken into account in evaluating
the results. A summarised by Bergin & Garfield
(1994), a large number of
different studies show that more sessions are associated with greater
improvements. However, the relationship is not linear and begins to taper off
after 26 sessions: a figure almost reached by the patients in the
psychoanalytic arm but far removed from that of the other three groups.
Not only did the ‘control’ group receive the fewest number of
sessions, with each session lasting only 30 minutes, but as noted and implied
by the authors: therapists assigned to this group had the least commitment to
and experience in treating anorexia nervosa. The paper does not state how many
therapists each patient ‘went through’ during the course of the
study. All these factors would predispose to the formation of poor working
alliances compared with the other groups. Thus, the poor results obtained by
the ‘control’ group could be accounted for by a combination of
fewer sessions of shorter duration and weak therapeutic alliances, rather than
the superiority of specific psychological treatment models.
REFERENCES
Bergin, A. E. & Garfield, S. (1994)
Handbook of Psychotherapy and Behaviour Change (4th
edn), pp. 58-61. New York: John Wiley &
Sons.
Dare, C., Eisler, I., Russell, G., et al
(2001) Psychological therapies for adults with anorexia
nervosa. Randomised controlled trial of out-patient treatments.
British Journal of Psychiatry,
178,
216-221.[Abstract/Free Full Text]
