The Importance of Early Change

The importance of early change in eating disorder treatment cannot be over-emphasized.  When we say “early change” we mean a significant reduction in ED symptoms like restriction, binge-eating and purging – within the first 6-8 weeks of treatment.  Extensive research shows that early change is associated with a significantly improved treatment outcome. In other words, those patients who show a drop in ED symptoms early on in treatment, fare better overall.

A recent research study conducted a unique evaluation of rapid response in Enhanced Cognitive Behavioral Therapy “CBT-E” (the main treatment we use at Columbus Park).  The study aimed to identify one specific, single behavioral symptom (such as purging episodes in BN, binge eating episodes in BED, or weight regain in AN) that could be used to assess early response across multiple diagnostic categories. Researchers evaluated a transdiagnostic population of Anorexia, Bulimia and Eating Disorder Not Otherwise Specified “EDNOS,” in a community-based setting using the EDE-Q,16 (a widely used measure of eating disorder pathology) to identify this baseline criterion. Results suggested that baseline differences such as sociodemographic variables, personality factors, eating disorder pathology, related psychopathology nor eating disorder severity were found to distinguish rapid and non-rapid responders. The only clear predictor of a rapid responder was whether or not reliable change was noted on the EDE-Q in the early stages of treatment (on average, 4.6 weeks after commencing treatment).

Despite these inconclusive results, the success rates of rapid responders was reinforced. The International Journal Eating Disorders states, “on average, rapid responders required significantly fewer treatment sessions than non-rapid responders and showed significantly lower scores on EDE-Q post-treatment.” Study participants labeled as rapid responders demonstrated “superior treatment outcomes”, had “lower scores on the EDE-Q global post-treatment” and were “twice as likely to achieve full remission.” Results demonstrated that 53% of rapid responders were labeled as in full remission post treatment as opposed to the non-rapid responders who lagged behind at 23% remission at post-treatment.  

Since the research has so consistently supported that early change results in remission and long-term recovery, we at Columbus Park take specific steps to ensure a successful initiation of treatment.  First, we are sure to deliver the treatments with accuracy and fidelity to the treatment models; in other words, we deliver the treatments well so that our clients have the best chance of a good treatment response.  We also make sure that our clients initiate treatment at a time when they can be consistent and get the proper “dose” of the treatment; we make sure to start at a time when clients don’t have a planned vacation, work trips etc.  Consistency helps our clients build momentum which consequently improves patient engagement and bolsters confidence.

At Columbus Park, we use objective measures – specifically our client’s decrease in global distress along with weight (in AN) or binge/purge frequency (in BED/BN) – to assess how our clients are responding to treatment.   We track the treatment response closely and make sure that our clients are on track. If they are not, we swiftly make necessary adjustments to the treatment. We’re proud to say that Columbus Park’s outcomes represent our success in helping our clients experience early change and the consequent overall positive treatment response.  Please read more about Columbus Park outcomes here and here