Moving forward in anorexia nervosa treatment.

The intervention tested is an extended manualised cognitive behaviour therapy.The overarching aim is the promotion of ‘healthy’ (i.e., non-excessive/non-eating disorder related) attitudes, beliefs, and behaviours toward both structured exercise and physical activity in general. It is important to emphasise that the aim of the treatment program is not to make patients stop exercising, but rather to educate them about what constitutes ‘healthy/non-excessive’ exercise and equip them with the knowledge and skills that will enable them to regain control of their exercise behaviour in order to participate in age, goal and health-status appropriate exercise. The program is designed around four core themes of education, guided discovery, cognitive skills, and relapse prevention. Specifically the following are addressed: Education about the cognitive view on the maintenance of excessive exercise Promotion of insight into the factors affecting (maintaining) the patient’s attitudes, beliefs and behaviours toward exercise Education about what constitutes ‘healthy’ exercise Introduction to the cognitive skills and strategies necessary to challenge maladaptive attitudes, beliefs and behaviours toward exercise Introduction to alternative (adaptive) emotion coping strategies Education about relapse prevention We expect reduced driven exercise behaviour and cognitions. The intervention will be administered during day time hours by a trained therapist. The therapy will comprise 8 weekly one hour sessions and is followed by 6-8 months of weekly cognitive behaviour therapy and then 6 months follow-up after that. The cognitive behaviour therapy admistered in the next 6-8 months (or 8-10 months in the control therapy group) is that developed by Pike et al. (Pike KM, Walsh BT, Vitousek K, et al. Cognitive behavior therapy in the post-hospitalization treatment of anorexia nervosa. Am J Psychiatry,2003; 160, 2046-2049.) All therapy is administered on an individual basis.