The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa

Timo Brockmeyer; Marieke Titzmann; Stephan Zipfel; Beate Wild; Gaby Resmark; Martin Teufel; Katrin Giel; Martina de Zwaan; Andreas Dinkel; Stephan Herpertz; Markus Burgmer; Bernd Löwe; Sefik Tagay; Eva Rothermund; Almut Zeeck; Wolfgang Herzog; Hans Christoph Friederich

doi:10.1016/j.brat.2023.104285

The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa

Timo Brockmeyer
, Marieke Titzmann
, Stephan Zipfel
, Beate Wild
, Gaby Resmark
, Martin Teufel
, Katrin Giel
, Martina de Zwaan
, Andreas Dinkel
, Stephan Herpertz
, Markus Burgmer
, Bernd Löwe
, Sefik Tagay
, Eva Rothermund
, Almut Zeeck
, Wolfgang Herzog
, Hans Christoph Friederich

Department of Psychosomatic Medicine and Psychotherapy

Georg-August-Universität Göttingen
Universitätsklinikum Heidelberg
Universitätsklinikum Tübingen
University of Duisburg-Essen
Medizinische Hochschule Hannover
LWL-University Hospital
Universitätsklinikum Münster
Universitätsklinikum Hamburg-Eppendorf
University of Applied Sciences Cologne
University Medical Center Ulm and Center of Excellence 'Metabolic Disorders'
University Medical Center

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms ‘clarification’ (insight), ‘mastery’ (coping), and ‘therapeutic relationship’ were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.

Original language	English
Article number	104285
Journal	Behaviour Research and Therapy
Volume	163
DOIs	https://doi.org/10.1016/j.brat.2023.104285
State	Published - Apr 2023

Keywords

Action mechanisms
Common factors
Eating disorders
Mechanisms of change
Psychotherapy

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10.1016/j.brat.2023.104285

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Brockmeyer, T., Titzmann, M., Zipfel, S., Wild, B., Resmark, G., Teufel, M., Giel, K., de Zwaan, M., Dinkel, A., Herpertz, S., Burgmer, M., Löwe, B., Tagay, S., Rothermund, E., Zeeck, A., Herzog, W., & Friederich, H. C. (2023). The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa. Behaviour Research and Therapy, 163, Article 104285. https://doi.org/10.1016/j.brat.2023.104285

@article{6939d18d85a84c3899cc496a15b98cb8,

title = "The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa",

abstract = "Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms {\textquoteleft}clarification{\textquoteright} (insight), {\textquoteleft}mastery{\textquoteright} (coping), and {\textquoteleft}therapeutic relationship{\textquoteright} were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.",

keywords = "Action mechanisms, Common factors, Eating disorders, Mechanisms of change, Psychotherapy",

author = "Timo Brockmeyer and Marieke Titzmann and Stephan Zipfel and Beate Wild and Gaby Resmark and Martin Teufel and Katrin Giel and \{de Zwaan\}, Martina and Andreas Dinkel and Stephan Herpertz and Markus Burgmer and Bernd L{\"o}we and Sefik Tagay and Eva Rothermund and Almut Zeeck and Wolfgang Herzog and Friederich, \{Hans Christoph\}",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier Ltd",

year = "2023",

month = apr,

doi = "10.1016/j.brat.2023.104285",

language = "English",

volume = "163",

journal = "Behaviour Research and Therapy",

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Brockmeyer, T, Titzmann, M, Zipfel, S, Wild, B, Resmark, G, Teufel, M, Giel, K, de Zwaan, M, Dinkel, A, Herpertz, S, Burgmer, M, Löwe, B, Tagay, S, Rothermund, E, Zeeck, A, Herzog, W & Friederich, HC 2023, 'The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa', Behaviour Research and Therapy, vol. 163, 104285. https://doi.org/10.1016/j.brat.2023.104285

TY - JOUR

T1 - The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa

AU - Brockmeyer, Timo

AU - Titzmann, Marieke

AU - Zipfel, Stephan

AU - Wild, Beate

AU - Resmark, Gaby

AU - Teufel, Martin

AU - Giel, Katrin

AU - de Zwaan, Martina

AU - Dinkel, Andreas

AU - Herpertz, Stephan

AU - Burgmer, Markus

AU - Löwe, Bernd

AU - Tagay, Sefik

AU - Rothermund, Eva

AU - Zeeck, Almut

AU - Herzog, Wolfgang

AU - Friederich, Hans Christoph

PY - 2023/4

Y1 - 2023/4

N2 - Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms ‘clarification’ (insight), ‘mastery’ (coping), and ‘therapeutic relationship’ were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.

AB - Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms ‘clarification’ (insight), ‘mastery’ (coping), and ‘therapeutic relationship’ were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.

KW - Action mechanisms

KW - Common factors

KW - Eating disorders

KW - Mechanisms of change

KW - Psychotherapy

UR - https://www.scopus.com/pages/publications/85149930173

U2 - 10.1016/j.brat.2023.104285

DO - 10.1016/j.brat.2023.104285

M3 - Article

AN - SCOPUS:85149930173

SN - 0005-7967

VL - 163

JO - Behaviour Research and Therapy

JF - Behaviour Research and Therapy

M1 - 104285

ER -

The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa

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Keywords

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