The purpose of this study was to examine differences between eating disordered attitudes and behaviors, depressive symptoms, and anxiety symptoms before and after intensive outpatient treatment at a center for eating disorder treatment. It was predicted based on previous studies and clinical experience that differences would be evident and that eating disordered attitudes and behaviors, depressive symptoms, and anxiety symptoms would all be significantly decreased at post-treatment.
The sample included 127 clients in an intensive outpatient treatment setting for eating disorders. The sample was 88.8% Caucasian, 3.4% African-American, and 3.4% Hispanic/Latino, with 4.3% of the sample identifying an “other” category for race. Data was collected between June of 2011 and October of 2014. The diagnosis at intake (N = 111) was 29.7% anorexia nervosa, 23.4% bulimia nervosa, and 46.8% eating disorder not otherwise specified (EDNOS). The average age of clients at discharge was 23.7 years old (SD= 10.76), with ages ranging from 12 to 68. Clients spent an average of 16.20 total weeks in the program, doing PHP, IOP, or a combination of both. Twenty-five percent of clients did at least one week of PHP. Clients participated in an average of 17.36 (SD = 17.20) individual therapy sessions and an average of 5.29 (SD = 6.23) family therapy sessions during their time in the program.
Mean Differences in Eating Disorder, Depressive & Anxiety Symptoms
Table 1 shows the means (average scores) and sample size for each of these comparisons.
EDI-2 = Eating Disorder Inventory — Second Edition
BDI-II = Beck Depression Inventory — Second Edition
SPRAS = Sheehan Patient Rated Anxiety Scale
Among the sample of clients, the average age was 21.4 years (SD = 6.7), and ranged from 14-49 years old. Of the participants, 11.7% participated in the partial hospitalization program (PHP) only, while 55.8% participated in the intensive outpatient program (IOP) only. Another 31.2% of the sample participated in a combination of PHP and IOP treatment.
Paired sample t-tests were used to compare mean scores on pre-treatment and post-treatment measures. Eighty-eight of the 127 clients provided both pre- and post- treatment data on eating disordered thoughts, attitudes, and behaviors as measured by the EDI-2 (Garner, 1991). The analysis indicated that there was a statistically significant difference, t (87) = 10.77, p < .001, between eating disordered thoughts, attitudes, and behaviors as measured by the EDI-2 (Eating Disorder Inventory 2, Garner, 1991). Clients reported a significantly lower number of eating disordered attitudes, personality features, and symptoms at post-treatment than they did at pre-treatment.
Secondly, the analysis indicated that there was a significant difference, t (94) = 10.74, p < .001, between depressive symptoms as measured by the BDI-II (Beck Depression Inventory II, Beck, Steer, & Brown, 1996), indicating a significant reduction in depressive symptoms reported by patients at post-treatment versus pre-treatment.
Finally, results showed a significant difference, t (104) = 9.17, p < .001, in state anxiety as measured by the STAI (State-Trait Anxiety Inventory, Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). Results also showed a significant difference, t (98) = 8.38, p < .001, in trait anxiety, also measured by the STAI. Clients reported a significant reduction of anxiety symptoms at post-treatment in both state and trait anxiety. Table 1 shows the means, standard deviations, and sample size for each of these comparisons.
Table 2 displays the comparisons of binge eating and purging behaviors before and after treatment. Clients were asked to report the number of symptoms they engaged in on a weekly basis during their time in the program. Binge eating behaviors decreased significantly between pre and post treatment, t (116)= 4.57, p < .001, and so did purging behaviors, t (116) = 5.30, p < .001.
After looking at overall findings, the cases were sorted by diagnosis. The data for patients diagnosed at intake with anorexia nervosa were examined for weight change between intake and discharge from the program. It was predicted that this subgroup of patients gained a significant amount of weight over the course of treatment. For this subgroup of 32 patients, there was a significant increase in weight between intake and discharge (p < .001). The mean weight at intake among this sample was 103.4 lbs. and the mean weight at discharge was 113.5 lbs. The mean difference in weight for patients with anorexia nervosa between intake and discharge was 10.1 lbs with a standard deviation of 9.34.
The findings support the effectiveness of the multi-disciplinary, multi-modal treatment program at ACE, focused on both psychodynamic underlying issues and cognitive-behavioral skill development in making significant progress in eating disordered symptoms, anxiety and depression over an average of sixteen weeks, a relatively short time frame for outpatient therapy.