Early Change and Favorable Outcomes in Eating Disorder Treatment

Does it matter how quickly your eating disorder symptoms decrease once you start treatment?

Yes, yes, and yes!

An abundance of evidence accumulated over the last 20 years reinforces that early change to treatment is a “robust” predictor of a good outcome. In other words, those who experience symptomatic improvement within the early weeks of treatment, fare better overall. So, for example, if we see a reduction in binge eating or purging–or in the case of anorexia nervosa, an increase in weight over the first four to eight weeks of treatment–chances are, the patient will do well both at treatment end and well into the future.

This is HUGE

This is a big deal. To think that you can actually have a sense in the first few weeks of treatment, that you’re achieving a leg up in terms of potential for full recovery. Consider how this knowledge might motivate you to push hard at the start and tolerate some of the early challenges, helping you feel all the more confident that, if you can get some traction in these early weeks, there is a much brighter future ahead.  

Let’s break this concept down a bit further.

So what time frame is considered “early” for change in treatment?

There is some debate in the field. Many studies consider the first month of treatment as the critical period, while others define “early treatment” as soon as one week or as late as ten weeks in.3,4,5 At Columbus Park, we view the first eight sessions as the “early change window.”  In our first-line outpatient treatment, Enhanced Cognitive Behavioral Therapy (CBT-E), we expect to complete all of phase one within the first four weeks. As per the treatment protocol, sessions are twice weekly, which is intentionally intensive, so we can “start well” and build momentum.

What kind of symptom reduction would be considered “rapid response” to treatment?

There are different approaches to defining the amount of symptom reduction that represents “early change.” Many providers consider a percentage of reduction of symptoms from the baseline. For example, if someone is binge-eating seven days per week when they start treatment, and by week eight, they’ve dropped down by 60 percent or more–to, let’s say, two to three times per week (very doable in outpatient CBT-E)–we would consider that a nice response to treatment and good early change.  In the case of anorexia nervosa, weight gain at the start of treatment is associated with a better prognosis longer term. A notable study in 2017, looking at adolescents receiving Family Based Treatment (FBT), found that the most robust predictor of remission at end of treatment was gaining at least 11.2 pounds by the eighth session. Of note, children and adolescents engaging in FBT have the benefit of significant parental involvement and control, which results in faster weight gain than typically seen in adult outpatients.  

Is early response to treatment directly associated with outcome? 

As the 2021 meta-analysis confirms, yes, early response is a potent predictor of treatment outcome.  Patients who experience early change: 

• need significantly fewer treatment sessions.

• show lower scores on symptom measures after treatment ends. 

• are twice as likely to achieve full recovery.

• are more likely to sustain recovery over time.

Additionally, as the meta-analysis supports, early response leads to positive treatment outcomes for the full range of eating conditions, including anorexia nervosa, bulimia nervosa, and binge eating disorder. Early response was associated with positive outcomes regardless of outcome measures (i.e. number of binge eating episodes or measurement of weight-based results). Two studies compared rates of early response across various psychotherapy modalities; they found greater remission in patients who received Cognitive Behavioral Therapy (CBT)— the main treatment we use at Columbus Park—versus those who did not.3,4

Early change front and center

In conclusion, the achievement of early change should be front and center in any eating disorder treatment. It’s essential for providers to keep a close eye on progress from the start. If there is inadequate change by session four, there should be immediate discussion about the barriers to change and how treatment can be adjusted to propel the patient forward.   

Columbus Park’s Early Change Model

We’ve seen the correlation between early change and good outcomes firsthand at Columbus Park. Our Early Change Model is designed with rapid response to our interventions as the primary goal for the first four to eight weeks of treatment. 

If you or a loved one is struggling with an eating disorder, please reach out to our team at info@columbuspark.com to discuss treatment options.

References

1. Vall, E., & Wade, T. D. (2015). Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 48, 946–971. https://doi.org/10.1002/eat.22411 

2. Beard, J. I., & Delgadillo, J. (2019). Early response to psychological therapy as a predictor of depression and anxiety treatment outcomes: A systematic review and meta-analysis. Depression and Anxiety, 36, 866–878. https://doi.org/10.1002/da.22931 

3. Hilbert, A., Herpertz, S., Zipfel, S., Tuschen-Caffier, B., Friederich, H. C., Mayr, A., ... de Zwaan, M. (2019). Early change trajectories in cognitive-behavioral therapy for binge-eating disorder. Behavior Therapy, 50, 115–125. https://doi.org/10.1016/j.beth.2018.03.013

4. MacDonald, D. E., McFarlane, T. L., Dionne, M. M., David, L., & Olmsted, M. P. (2017). Rapid response to intensive treatment for bulimia nervosa and purging disorder: A randomized controlled trial of a CBT intervention to facilitate early behavior change. Journal of Consulting and Clinical Psychology, 85, 896–908. https://doi.org/10.1037/ccp0000221 

5. Lock, J., Couturier, J., Bryson, S., & Agras, S. (2006). Predictors of dropout and remission in family therapy for adolescent anorexia nervosa in a randomized clinical trial. International Journal of Eating Disorders, 39, 639–647. https://doi.org/10.1002/eat.20328

6. Le Grange, D., Accurso, E. C., Lock, J., Agras, S., & Bryson, S. W. (2014). Early weight gain predicts outcome in two treatments for adolescent anorexia nervosa. The International journal of eating disorders, 47(2), 124–129. https://doi.org/10.1002/eat.22221