An experimental analysis of alliance focused treatment for anorexia nervosa.

摘要

INTRODUCTION: Evidence supporting outpatient treatments for anorexia nervosa (AN) is severely lacking, due to low retention rates and poor outcome in treatment studies. One explanation for patient drop-out is weak treatment alliances, which are also associated with poor outcome. This study investigates a novel treatment for AN, Alliance Focused Treatment (AFT), which attends to ruptures in the alliance as well as interpersonal difficulties and emotional avoidance commonly associated with AN. Group analyses are presented along with one detailed case. METHOD: Seven women with AN-spectrum illnesses were randomized to receive both AFT and Behavioral Change Treatment (BCT) using a replicated single case A-B-C-B design. Participants began with a Baseline Phase (A) and then received the experimental treatment (AFT) and the comparison treatment (BCT) in alternating fashion. This design allowed each participant to provide comparison (control) data for each treatment. "Time" (session number) was used as a covariate in analyses. Each treatment phase was four weeks long, with twice-weekly sessions. Participants recorded daily kilocalorie intake and post-session treatment alliance. Generalized Estimating Equations were used to examine differences in kilocalorie intake and treatment alliance between phases and within participants. Graphs of slopes of kilocalorie and alliance change for each participant, in each phase, facilitated observation of treatment effects. RESULTS: Six participants completed treatment. Significant overall increases in kilocalorie intake were observed only in BCT relative to a baseline period when controlling for time, however, both AFT and BCT showed interactions with time indicating kilocalorie intake increased in both conditions. No significant differences between active treatments in kilocalorie intake were observed. Participants rated global working alliance significantly higher in BCT, while they rated the task dimension of alliance significantly higher in AFT. Global patient-rated treatment alliance was significantly associated with kilocalorie intake, and the relationship between global alliance and kilocalorie intake became stronger over time. Participants rated ruptures in 39% of sessions and frequently reported discussion of the rupture as a component of its resolution. DISCUSSION: This study provides preliminary support for the feasibility and effect of AFT and BCT, and highlights the importance of the alliance in treating adults with AN.