Day treatment programme for patients with eating disorders: randomized controlled trial

Aim. This paper reports a randomized controlled trial to compare the effects of day treatment programmes for patients with eating disorders with those of traditional outpatient treatment. Background. Eating disorders are common, especially in adolescents, and their worldwide prevalence is increasing. Treatment interventions for patients with eating disorders have traditionally been offered on an outpatient or inpatient basis, but the recent introduction of day hospital programmes offers the possibility of greater cost-effectiveness and relapse-prevention for this population. Methods. Volunteers from an outpatient clinic for eating disorders were randomly assigned either to a treatment group (n = 21), participating in a modified day treatment programme based on the Toronto Day Hospital Program, or to a control group (n = 22) receiving a traditional outpatient programme of interpersonal psychotherapy, cognitive behaviour therapy and pharmacotherapy. Data were collected from January to December 2002 using the Eating Disorder Examination, Eating Disorder Inventory-2, Beck Depression Inventory, and Rosenberg Self-Esteem Scale. Results. Participants in the day treatment programme showed significantly greater improvements on most psychological symptoms of the Eating Disorder Inventory-2, frequency of binging and purging, body mass index, depression and self-esteem scores than the control group. They also showed significant improvement in perfectionism, but the group difference was not significant. Conclusion. Nurses in day treatment programmes can play various and important roles establishing a therapeutic alliance between patient and carer in the initial period of treatment. In addition, the cognitive and behavioural work that is vital to a patient's recovery, that is, dealing with food issues, weight issues and self-esteem, is most effectively provided by a nurse therapist who maintains an empathic involvement with the patient.