A Cochrane review [Abstract]1 included 10 trials with a total of 599 anorexia nervosa participants. Two of the 10 trials included children, 86-98% of patients were females. Five trials evaluated a form of cognitive and/or behaviour therapy, 4 trials evaluated an integrative therapy and 3 trials evaluated a form of psychodynamic therapy. The results suggest that treatment as usual (TAU) when delivered by a non-eating-disorder specialist or similar may be less efficacious than focal psychodynamic therapy. This was suggested for a primary outcome of recovery by achievement of a good or intermediate outcome on the Morgan and Russell Scale (RR 0.70, 95% CI 0.51 to 0.97; 1 RCT, n=40). However there were no differences between cognitive analytic therapy and TAU for this outcome (RR 0.78, 95% CI 0.61 to 1.00; 2 RCTs, n=71), nor for body mass index (BMI). There were no differences in overall dropout rates between individual psychological therapies and TAU.Two trials (n=197) found a non-specific specialist therapy (Specialist Supportive Clinical Management) or an Optimised TAU delivered by therapists with eating disorder expertise was similar in outcomes to cognitive behaviour therapy (BMI MD -0.00, 95% CI -0.91 to 0.91). When comparing individual psychological therapies with each other, no specific treatment was consistently superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial (n=35). None of the trials identified any adverse effects.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients and treatments) and imprecise results (few studies and few patients in each comparison).
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