**9. Conclusion**

*Weight Management*

intensive outpatient, and inpatient) by a multidisciplinary team according to the patient's needs. This intervention focuses on understanding the eating disorder mindset and its function. It is assumed that a change in the ED mindset will lead to symptom reduction. A standard CBT-E is a four-stage model. The first stage of treatment is aimed at creating a therapeutic alliance with assessment and case formulation. Regulation of eating behavior is the primary goal of this stage, through behavioral change. Patients are required to use self-monitoring sheets regarding their eating, and every session starts with a review of these records and in session weighing. The second stage (traditional CBT does not have this stage) is an overview and determination stage for possible barriers to change. Preoccupation with food and body is the main theme of the third stage. In addition, interpersonal problems, body checking behaviors, emotion regulation, ED mindset, and other individual factors related to the symptoms are central areas to work on. The last stage is focused on symptom prevention and possible future problems. Many cognitive and behavioral techniques including cognitive restructuring, exposure, and

Research indicates promising results regarding the efficacy of CBT-based interventions [95], especially on symptom prevention [91]. Thus, it is concluded that CBT-E is a cost-effective alternative to family-based treatments of anorexia [96].

Benefits of family-based interventions for adolescents are evident, and these approaches and CBT also work for adult cases to some degree although not for all. For these reasons the effect of different psychotherapies has gained attention. Research points to the effectiveness of psychodynamic therapy [97], third wave therapies (schema therapy, acceptance-commitment therapy, mindfulness-based interventions) [98], dialectical behavioral therapy [99], and EMDR [100], but no specific approach has shown clear superiority. Adding motivational techniques are also helpful [101], as deficits in treatment motivation are common among patients with AN. These findings suggest that a combination of nutritional therapy and anorexia nervosa-specific psychotherapy is an effective way to treat AN.

As mentioned above, AN is difficult to treat, as treatment might take a long time

with high costs and may still not be possible in some cases. This has highlighted the importance of preventive studies. Prevention of EDs in general rather than AN-specific prevention is more common in research, since interchange between diagnoses and subthreshold EDs is more prevalent. Prevention strategies mainly work on two dimensions: first by reducing risk factors and second by targeting at-risk populations. Risk factors include thin idealization as a sociocultural element; dieting or excessive exercise as behavioral risk factors; and perfectionism, body dissatisfaction, and problems in emotion regulation as cognitive-emotional risk factors. These are more prevalent in high school and college samples as they constitute risky populations. Prevention programs can be school-based, computer-based, CBT-focused, media-literacy-focused, or on a sociopolitical level. A review of the details and effectiveness of these programs is beyond the scope of this chapter. However, longitudinal, structured programs have proven beneficial in reducing body dissatisfaction, disordered eating, and weight management behaviors [102]. Thus, adding preventive strategies to education and health systems can be a promis-

problem-solving training are used during this therapy.

*7.3.3 Other psychotherapy approaches*

**8. Prevention strategies**

ing way of dealing with AN.

**76**

Anorexia nervosa is a complex psychiatric condition that is accompanied with a high morbidity and mortality risk. It is a rare problem and detection of cases with anorexia is hard as clinical presentation may vary; also voluntary admission to treatment facilities is low. Biological, psychological, and social factors intertwine in the etiology. Recent studies provide evidence of advances in understanding the psychobiological mechanisms that contribute to and maintain anorexia nervosa. Predisposing factors include genetic susceptibility and stressful early childhood experiences. On the other hand, psychological and social factors usually play a triggering role in the onset of symptoms. They also maintain the problem with changes in neural networks. Treatment of anorexia is a long and challenging process for patients, caregivers, and health professionals. Symptoms can become chronic when the necessary treatment is not provided. Even with the best treatment options, a full recovery is not possible in all cases. A multidimensional treatment provided by a multidisciplinary team in a specialized unit is fundamental for efficient treatment outcomes. Inpatient treatment can be required in severe cases. Nutritional therapy is an important part of treatment. Psychopharmacotherapy, on the other hand, has only a limited effect. Thus, psychotherapy is the leading factor in treatment. Evidence-based research indicates that adolescent patients with anorexia nervosa benefit from family-based interventions. Adults with anorexia nervosa have a good chance of achieving recovery or at least a substantial improvement in symptoms. CBT is an alternative to family-based interventions. Alongside these, a range of other anorexia-specific psychotherapy approaches is presented, although none of them has shown a clear superiority so far. This brings us to the importance of preventive studies regarding unhealthy eating and weight management behaviors. Future research will continue to focus on enhancing our understanding of the underlying biopsychosocial factors, in order to improve treatment and prevention.
