A psychological intervention to reduce exercise in anorexia

A paper published in the current issue of Psychotherapy and Psychosomatics explores the effects of an improved program for reducing exercise, which is frequently associated with anorexia nervosa.

Treatment of compulsive exercise is recognized as a key unmet challenge in the treatment of anorexia nervosa (AN). A manualized group intervention "healthy exercise behavior" (HEB) was develop to address specifically this challenge. This study evaluates the efficacy of HEB in reducing compulsive exercise as add-on to routine inpatient treatment (treatment as usual [TAU]) in a randomized controlled trial.

Two hundred and seven adolescent and adult female inpatients with (atypical) AN were randomly allocated to receive treatment as usual or treatment as usual with additional HEB. HEB integrates elements of exercise-based therapy into a cognitive-behavioral approach. The goal was to reduce the severity of compulsive exercise between pre- and post-intervention along with additional aspects of compulsive exercise, weight gain, eating disorder and general psychopathology, and emotion regulation.

The treatment as usual + HEB group showed significantly stronger reductions in the severity of compulsive exercise compared to the group receiving only treatment as usual. A stronger reductions from admission to discharge and from admission to follow-up was also found. Significant group differences between pre- and post-intervention emerged in additional aspects of compulsive exercise. Despite successfully reducing compulsive exercise, HEB did not lead to weight gain or improvement in other aspects of eating disorder, general psychopathology, and emotion regulation.

These findings showed that the healthy exercise behavior (HEB) proved effective in reducing compulsive exercise in inpatients with (atypical) AN and represents an important add-on to current treatment.