As well as a focus on nutrition to help people gain weight, I-CBTE tackles thought processes using psychology.
23 February 2022
An “exciting” approach to treating people with anorexia has led to a dramatic increase in the number who recover, UK experts have found.
Some 70% of patients on the treatment plan got back to a good weight and did not binge or purge, compared to less than 5% of those receiving standard NHS-led care.
Dr Agnes Ayton, author of a new study and chair of the eating disorders faculty at the Royal College of Psychiatrists, is so impressed with the results that she and other experts are now calling for the NHS to adopt the model.
Integrated enhanced cognitive behavioural (I-CBTE) therapy originated in Italy and involves a planned 13-week admission to hospital followed by seven weeks of day treatment plus further outpatient treatment. In total, patients undergo treatment for 40 weeks.
As well as a focus on nutrition to help people gain weight, I-CBTE tackles thought processes using psychology.
Sessions may examine what processes are maintaining a person’s eating problem, such as addressing shape and eating, and can look at improving the ability to deal with stress and mood changes, as well as creating a plan for future setbacks.
NHS data shows there were 5,941 admissions (among all ages) from April to October 2021 for anorexia, but there are additional long waits for treatment.
For the new study, covering admissions to 15 UK eating disorders units from 2017 and 2020, data was collected for 212 patients with severe anorexia.
Patients were typically aged 29 and were very underweight, with a typical body mass index of 14.4.
At discharge, the 34 patients receiving I-CBTE typically had a BMI of 19 (within the healthy range) compared to an underweight BMI of 16 for those who had a short inpatient admission and 17 given other standard care.
After one year, 70% of patients receiving I-CBTE had maintained their weight and were not bingeing or purging, compared with less than 5% receiving usual care or who had had a short admission.
Only 14% of those in the I-CBTE group needed to be readmitted, compared to 62% receiving standard care commissioned by the NHS.
The research, by psychiatrists at Oxford Health NHS Foundation Trust, has yet to be peer-reviewed but builds on 20 years of experience from Oxford and Italy.
Dr Ayton told the PA news agency that, at present, people can be discharged before they reach a healthy weight and they often relapse.
“This translates into quite an unplanned care pathway, where people are admitted in a crisis and then they get discharged before they they are well enough to be discharged,” she said.
“With I-CBTE, the idea is that we a work as a multidisciplinary team, everyone is trained in the model.
“The patient knows what is going to happen and how much time they will need to spend in hospital. And I think that reduces the anxiety of the patient.”
She said her team had been surprised by their findings, adding: “Obviously we were hoping that we would have good results but when we saw them we were actually very excited.”
She added: “The positive results were beyond our expectations.
“This treatment model offers hope to those who have suffered with anorexia nervosa for many years.
“This important replication of previous work in Italy in real life NHS settings shows that the treatment model is robust and could potentially transform the lives of people with severe anorexia nervosa.”
Former patient Lorna Collins, aged 40, developed anorexia following a traumatic brain injury.
“I was admitted to hospital multiple times. Each time, I was discharged underweight and without proper follow-up care,” she said.
“After relocating to Buckinghamshire, I was referred to the Oxford team. The treatment I received was unlike anything I had experienced before. It saved my life. An eating disorder is no longer part of my identity. I am in full recovery. I am living proof that this approach can work.”
