Development, applicability and effects of a pilot program of group cognitive-behavioral therapy in Brazilian adolescents with anorexia nervosa

Pegado, Paula; Alckmin-Carvalho, Felipe; Leme, Danielle; Carneiro, Francisca; Kypriotis, Patrícia; Camacho, Priscila; Fleitlich-Bilyk, Bacy

doi:10.1590/0101-60830000000158

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Original Article • Arc. Clin. Psychiatr. 45 (3) • 2018 • https://doi.org/10.1590/0101-60830000000158 copy

Development, applicability and effects of a pilot program of group cognitive-behavioral therapy in Brazilian adolescents with anorexia nervosa

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Most of the clinical trials involving cognitive-behavioral therapy (CBT) for the treatment of anorexia nervosa (AN) used the individual therapy format, and few have been dedicated to adapting and assessing the effects of the group format.

Objectives:

To assess the applicability and effects of a group CBT program for Brazilian adolescents with AN.

Methods:

Open clinical trial with 22 patients with AN divided into an intervention group – IG (n = 11; CBT, psychiatry, nutrition and family psychoeducation-6 months) and a control group – CG (n = 11; psychiatry, nutrition and family psychoeducation-6 months). Data collected at baseline, at the end of groups and six months after the completion were: weight, height, body mass index and Eating Disorder Examination Questionnaire (EDE-Q) used to assess the severity of AN symptoms.

Results:

Baseline homogeneous groups, with 91% adherence in the IG vs. 54% in the CG (p = 0.05). Participants in both groups regained weight and decreased symptoms of eating disorders at the end of groups. Comparing the EDE-Q scores IG presented a statistically significant difference in the restraint subscale of the EDE-Q between the end-of-group and the follow-up (p = 0.01).

Discussion:

Group CBT program produced positive effects and was applicable in Brazilian adolescents with AN as an adjuvant to multidisciplinary treatment.

Keywords:
Anorexia nervosa; cognitive therapy; adolescents; group therapy

	Intervention Group (IG) (N = 10)		Control Group (CG) (N = 06)		Mann-Whitney
Variables	Mean	SD	Mean	SD	p-value
Years of age	14.80	1.28	14.00	1.69	0.175
Duration of symptoms (months)	12.30	6.39	6.83	1.47	0.127
Initial weight (kg)	46.40	5.2	44.10	7.61	0.828
Initial height (cm)	162.1	5.6	157.8	4.8	0.158
Initial BMI (kg/m²)	17.62	1.51	17.56	2.22	0.745
Weight loss (kg)	9.10	6.47	10.10	3.46	0.581
EDE-q (Global)	3.25	1.83	4.56	0.75	0.159
EDE-q (Restraint)	3.20	1.94	4.60	0.82	0.230
EDE-q (Weight Concern)	3.48	1.95	4.73	1.00	0.210
EDE-q (Shape Concern)	3.76	1.81	5.12	0.81	0.127
EDE-q (Eating Concern)	2.56	1.92	3.80	1.33	0.276
	N (%)		N (%)	P value Chi-square
Depression	2 (20%)		2 (33.3%)	0.551
Anxiety	3 (30%)		3 (50%)	0.424
Amenorrhea	7 (70%)		5 (83.33%)	0.792

Variables	Intervention Group (IG) (n = 10)			Control Group (CG) (n = 06)			IG	CG	IG	CG	Interaction IG vs. CG	Interaction IG vs. CG
Variables	Baseline (T0)	End (T1)	Follow-up (T2)	Baseline (T0)	End (T1)	Follow-up (T2)	T0-T1		T1-T2		T0-T1	T1-T2
	M (SD)	M (SD)	M (SD)	M (SD)	M (SD)	M (SD)	P^* * Wilcoxon test used to compare the means of each variable between the baseline and the end of the IG and CG and between the end and the follow-up.	P^* * Wilcoxon test used to compare the means of each variable between the baseline and the end of the IG and CG and between the end and the follow-up.	P^* * Wilcoxon test used to compare the means of each variable between the baseline and the end of the IG and CG and between the end and the follow-up.	P^* * Wilcoxon test used to compare the means of each variable between the baseline and the end of the IG and CG and between the end and the follow-up.	P^ Wald test for the effect of interaction, to assess the difference in performance between the intervention and control groups between the baseline and the end, and between the end-of-groups and the follow-up.	P^ Wald test for the effect of interaction, to assess the difference in performance between the intervention and control groups between the baseline and the end, and between the end-of-groups and the follow-up.
Weight (kg)	46.3 (5.2)	52.2 (5.7)	52.9 (7.5)	44.0 (7.6)	51.5 (9.2)	53.5 (10.8)	0.005	0.028	0.575	0.028	0.403	0.280
BMI (kg)	17.62 (1.51)	19.74 (1.27)	19.95 (2.00)	17.56 (2.22)	20.34 (2.59)	20.96 (3.27)	0.005	0.028	0.508	0.028	0.386	0.112
EDE Q Global	3.25 (1.83)	1.14 (1.53)	0.54 (1.38)	4.56 (0.75)	1.74 (1.57)	1.14 (1.67)	0.007	0.046	0.012	0.345	0.561	0.409
Subscales
Restraint	3.20 (1.94)	0.56 (0.94)	0.30 (0.81)	4.60 (0.82)	0.70 (1.04)	0.93 (1.48)	0.007	0.028	0.026	0.414	0.234	0.012
Concern with weight	3.48 (1.95)	1.32 (1.94)	0.70 (1.80)	4.73 (1.00)	2.10 (1.64)	1.30 (1.97)	0.014	0.028	0.072	0.344	0.591	0.573
Concern with eating	2.56 (1.92)	0.86 (1.20)	0.44 (1.06)	3.8 (1.33)	1.46 (1.46)	0.73 (1.11)	0.018	0.074	0.016	0.131	0.585	0.952
Concern with shape	3.76 (1.81)	1.83 (2.21)	0.75 (1.86)	5.12 (0.81)	2.71 (2.60)	1.62 (2.22)	0.036	0.075	0.018	0.345	0.678	0.248

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[1] Address for correspondence: Paula Pegado. Rua Dona Adma Jafet, 74, conjunto 111 – 01308-050 – São Paulo, SP, Brazil. Email: paulapegado@yahoo.com.br