Enhanced Cognitive Behavioral Therapy for Adolescent Anorexia Nervosa: Identifying Predictors of Treatment Response

Objective: This study aimed to identify baseline demographic, clinical, and psychosocial predictors of treatment response in adolescents with anorexia nervosa (AN) undergoing an intensive 20-week enhanced cognitive behavioral therapy (CBT-E) program, which included inpatient and day patient phases. Treatment outcomes were assessed at the end of intensive treatment (EOIT) and at a 20-week follow-up. Method: A prospective cohort of 68 adolescents under the age of 16 consecutively admitted to intensive CBT-E was evaluated. Baseline measures included body mass index (BMI)-for-age percentiles, percentage of expected body weight (%EBW), eating disorder psychopathology (EDE-Q), general psychopathology, and functional impairment. Results: Of those who began treatment, 83.4% completed the program and 70.2% were available for follow-up assessment. Based on intent-to-treat analysis, 94.1% achieved a "good BMI outcome" and 73.5% met criteria for “full response” at EOIT. At follow-up, 64.7% maintained a good BMI and 55.9% sustained a full response. No baseline demographic or clinical variables predicted treatment completion or outcome at either time point. The only significant association was between younger age at admission and higher levels eating disorder psychopathology at follow-up. Conclusions: The lack of reliable predictors of treatment outcome suggests that CBT-E can be potentially effective for all adolescents aged 11–15 with AN. However, the observed association between younger age and elevated psychopathology at follow-up may indicate the need for age-tailored treatment strategies to enhance long-term psychological recovery.