The Efficacy of Therapeutic Treatments in Chronic Anorexia Nervosa

This study will compare the established therapy, Cognitive Behaviour Therapy (CBT), with the most promising therapy to emerge in the recent anorexia nervosa (AN) literature, Non-specific Supportive Clinical Management (NSCM), in a chronic anorexia nervosa (C-AN) sample. To accomplish these aims, 90 females over the age of 18, meeting the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM IV) criteria for AN for more than seven years will be randomly assigned to one of two manualised treatment conditions, CBT or NSCM. Both treatments will involve 30 individual treatment sessions over 6 months. All patients will be monitored for six months after the end of treatment. Assessments will occur at baseline, 15 weeks into treatment, end of treatment, and six months post-treatment. The primary outcome will be the change in measures assessing chronicity, i.e., Quality of Life (QoL), depression and social isolation. The secondary outcomes will include change in core eating disorder (ED) pathology, motivation for change and use of medical services (the number of hospital days, GP and specialist visits). NSCM fosters a therapeutic relationship that promotes adherence to treatment, without imposing assumptions about change; it includes education, care and support for change, without necessitating it. The treatment does not aim to restore weight, but supports patients in making any changes that will improve QoL and physical well-being, including, but not exclusively, weight change. CBT actively targets food and weight increases by having the patient challenge Eating Disorder (ED) behaviours and underlying maladaptive cognitions around food, body, weight and shape. CBT is an active treatment aimed at acheiving some weight gain and the reumption of normal eating habits by challenging underlying beliefs and thoughts through cognitive restructuring and behaviour change. This trial will involve two treatments sites and one data management site. Treatment Site 1: University of Sydney, School of Psychology Treatment Site 2: University of London, St George's School of Medicine Data Management Site: University of Chicago, Pritzker School of Medicine This innovative project will provide the world's first information about potentially effective treatments for this highly debilitated group who have proved very difficult for professionals to treat thus far. It will be the largest study ever conducted on C-AN anywhere in the world.