There was no superiority of a specific approach .
Weight gains were more rapid in adolescents and inpatient treatment .
Background : The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy .
Weight gain was chosen as the primary outcome criterion .
We also aim ed to compare treatment effects according to service level ( inpatient vs. outpatient ) and age group ( adolescents vs. adults ) .
Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial
BACKGROUND Psychotherapy is the treatment of choice for patients with anorexia nervosa , although evidence of efficacy is weak . The Anorexia Nervosa Treatment of Out Patients ( ANTOP ) study aim ed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa -- focal psychodynamic therapy and enhanced cognitive behaviour therapy -- versus optimised treatment as usual . METHODS The ANTOP study is a multicentre , r and omised controlled efficacy trial in adults with anorexia nervosa . We recruited patients from ten university hospitals in Germany . Participants were r and omly allocated to 10 months of treatment with either focal psychodynamic therapy , enhanced cognitive behaviour therapy , or optimised treatment as usual ( including outpatient psychotherapy and structured care from a family doctor ) . The primary outcome was weight gain , measured as increased body-mass index ( BMI ) at the end of treatment . A key secondary outcome was rate of recovery ( based on a combination of weight gain and eating disorder-specific psychopathology ) . Analysis was by intention to treat . This trial is registered at http://is rct n.org , number IS RCT N72809357 . FINDINGS Of 727 adults screened for inclusion , 242 underwent r and omisation : 80 to focal psychodynamic therapy , 80 to enhanced cognitive behaviour therapy , and 82 to optimised treatment as usual . At the end of treatment , 54 patients ( 22 % ) were lost to follow-up , and at 12-month follow-up a total of 73 ( 30 % ) had dropped out . At the end of treatment , BMI had increased in all study groups ( focal psychodynamic therapy 0·73 kg/m(2 ) , enhanced cognitive behaviour therapy 0·93 kg/m(2 ) , optimised treatment as usual 0·69 kg/m(2 ) ) ; no differences were noted between groups ( mean difference between focal psychodynamic therapy and enhanced cognitive behaviour therapy -0·45 , 95 % CI -0·96 to 0·07 ; focal psychodynamic therapy vs optimised treatment as usual -0·14 , -0·68 to 0·39 ; enhanced cognitive behaviour therapy vs optimised treatment as usual -0·30 , -0·22 to 0·83 ) . At 12-month follow-up , the mean gain in BMI had risen further ( 1·64 kg/m(2 ) , 1·30 kg/m(2 ) , and 1·22 kg/m(2 ) , respectively ) , but no differences between groups were recorded ( 0·10 , -0·56 to 0·76 ; 0·25 , -0·45 to 0·95 ; 0·15 , -0·54 to 0·83 , respectively ) . No serious adverse events attributable to weight loss or trial participation were recorded . INTERPRETATION Optimised treatment as usual , combining psychotherapy and structured care from a family doctor , should be regarded as solid baseline treatment for adult out patients with anorexia nervosa .  Focal psychodynamic therapy proved advantageous in terms of recovery at 12-month follow-up , and enhanced cognitive behaviour therapy  was more effective with respect to speed of weight gain and improvements in eating disorder psychopathology . Long-term outcome data will be helpful to further adapt and improve these novel manual-based treatment approaches . FUNDING German Federal Ministry of Education and Research ( Bundesministerium für Bildung und Forschung , BMBF ) , German Eating Disorders Diagnostic and Treatment Network ( EDNET )
There was no superiority of a specific approach .
Weight gains were more rapid in adolescents and inpatient treatment .
Background : The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy .
Weight gain was chosen as the primary outcome criterion .
We also aim ed to compare treatment effects according to service level ( inpatient vs. outpatient ) and age group ( adolescents vs. adults ) .