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Anorexia NervosaNCT05812950

Clinical and Cost-effectiveness of Group Schema Therapy for Complex Eating Disorders: the GST-EAT Study

A study testing GST and CBT-E in people with Anorexia Nervosa and Atypical Anorexia Nervosa (Other Specified Eating Disorder), run by Maastricht University at 7 sites in Netherlands.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Amongst psychiatric illnesses, eating disorders (EDs) are notoriously difficult to treat and have a high mortality rate. The average duration of an ED is 6 years and for a majority of ED patients, the disorder will become chronic. Read more about this study

Who is it for?
Ages 16 years and older
What is being tested?
GST and CBT-E
Could I receive a placebo?
No, everyone receives an active treatment
How many people
230 participants
Where
7 sitesNetherlands
Study dates
24 Jul 2023to Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • 1) age > 16 years;
  • 2) a DSM-5 diagnosis of anorexia nervosa, bulimia nervosa, or other specified ED (atypical anorexia nervosa or bulimia nervosa with a low frequency or limited duration).

Who cannot join

  • 1) not being able to speak and read the Dutch language;
  • 2) being in an acute psychotic mental health state at the start of the study;
  • 3) being diagnosed with an autism spectrum disorder;
  • 4) having an IQ below 80, as determined with a validated instrument;
  • 5) showing an early response after phase 1 of CBT-E.

Trial locations and contacts

7 sites in 1 country. Contact the study team or a site near you to ask about taking part.

7 sites in 1 country

Netherlands7 sites, 7 recruiting
  • GGz Breburg

    Breda

    Diede van Limpt, 088-0161600, d.vanlimpt@ggzbreburg.nl

    Recruiting
  • Accare

    Groningen

    Hermien Elgersma, h.j.elgersma@accare.nl

    Recruiting
  • GGZ Friesland

    Leeuwarden

    Jacqueline Oostenbrink, Jacqueline.Oostenbrink@ggzfriesland.nl

    Recruiting
  • GGNet Amarum

    Nijmegen

    suzanne Mares, dr., +31625743442, s.mares@ggnet.nl

    Recruiting
  • GGz Breburg

    Tilburg

    Diede van Limpt, 088-0161600, d.vanlimpt@ggzbreburg.nl

    Recruiting
  • Co-eur

    Utrecht

    Esther Jansen, Esther.Jansen@co-eur.com

    Recruiting
  • GGNet Amarum

    Warnsveld

    Suzanne Mares, dr., +31625743442, s.mares@ggnet.nl

    Recruiting

Other trials in Netherlands

About this study

Amongst psychiatric illnesses, eating disorders (EDs) are notoriously difficult to treat and have a high mortality rate. The average duration of an ED is 6 years and for a majority of ED patients, the disorder will become chronic. Comorbid personality pathology such as negative core beliefs and early maladaptive schemas (EMS) are strongly related to ED severity and chronicity. Enhanced cognitive-behavioural therapy for eating disorders (CBT-E) is used as the first line transdiagnostic treatment for EDs. However, CBT-E is mainly symptom-focused and does not tap into these underlying core beliefs and EMS.

Given the limited treatment effects of existing ED treatments, and the importance of comorbid personality pathology, there is an urgent need to examine more effective treatments for EDs. Group-schematherapy (GST) overcomes the limitations of CBT-E and preliminary results for treatment-resistant EDs are promising. However, robust evidence regarding the clinical and cost-effectiveness of GST for patients that do not benefit from CBT-E is not yet available. The central aim of this project is to investigate the clinical and cost-effectiveness of GST for EDs in patients with comorbid personality pathology, who do not show a clinically significant response in the first phase of CBT-E. This is relevant and important as studies examining the effectiveness of GST for EDs are scarce. This project is a joint research initiative of three academic centers (Dutch Universities), four large nation-wide mental health organizations, and two foundations for client empowerment and participation. Eligible patients will be randomized to either GST or continuation of their CBT-E treatment after failing to show a significant treatment response in the first phase of CBT-E. Based on encouraging findings from previous studies and our own pilot data, a statistically and clinically significant better outcome in terms of ED symptoms, negative core beliefs, EMS, schema modes, and quality of life is expected in the GST group compared to the CBT-E group. GST is also expected to be more cost-effective compared to CBT-E as GST may in the long run prevent chronicity in terms of long treatment trajectories and delayed recovery. Finally, with the proviso of good results for GST, we will disseminate and implement GST in the standard of care for EDs. This project thereby has great potential to improve clinical and cost-effectiveness of treatment for chronic EDs.

Being tested
GST, CBT-E
Keywords
CBT-E, Group Schema Therapy, Eating disorders, Effectiveness
Medical subject headings
Anorexia Nervosa, Bulimia Nervosa, Feeding and Eating Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • GSTBehavioural

    Outpatient eating disorder treatment (5 individual pre-group sessions followed by 26 weekly group sessions + 8 optional individual sessions)

  • CBT-EBehavioural

    Outpatient eating disorder treatment (20-40 weekly individual sessions)

Study groups in NCT05812950
Study groupRoleWhat they receive
Group Schema Therapy for eating disorders (GST)ExperimentalGST starts with 5 individual sessions for introducing the ST model, placing the ED symptoms and behaviors in the context of coping modes, and organizing these in a mode map conceptualization. Thereafter there are 26 weekly group sessions of ST for EDs, supplemented with 8 optional individual ST sessions, and a psycho-education webinar for relatives. The sessions focus on recognizing and changing personal coping modes and underlying early maladaptive schemas, and developing and strengthening the healthy adult mode. GST combines interpersonal, experiential, cognitive and behavioral elements in a unified ST approach (Farrell et al., 2014). Although not at the core of GST, addressing the physiological aspects of the ED (weight care and (restrictive) eating) is necessary and therefore also incorporated in the protocol. Note that the participants in this condition have followed phase 1 and 2 of CBT-E before starting the GST, as following these phases is required to be included in the RCT.
Receives: Behavioral: GST
Cognitive Behavioral Therapy-Enhanced (CBT-E) (TAU)Active comparatorThis transdiagnostic ED treatment (current standard of care/treatment of choice) consists of 20-40 individual therapy sessions, based on the transdiagnostic CBT model of EDs. CBT-E consists of four phases. In phase one, the patient creates a personal case formulation, and the focus is on psycho-education on maintaining factors and at starting well with monitoring eating behaviours and establishing a regular eating pattern. In phase two, the first phase is evaluated and a treatment plan is made. In phase three, the main mechanisms that are thought to maintain the patient's ED (over-evaluation of shape, weight, and eating, dietary restraint or restriction, being underweight, and event- or mood-triggered changes in eating behaviour), are targeted, and a relapse plan is created. Phase four focuses on evaluating the progress so far and maintaining the changes that have been obtained (Fairburn et al., 2009).
Receives: Behavioral: CBT-E

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Eating Disorder Examination Questionnaire (EDE-Q) score

    Eating pathology will be measured with the Eating Disorder Examination Questionnaire (EDE-Q). Fairburn \& Beglin, 2008). This self-report measure is the most commonly used routine outcome measure in ED facilities in the Netherlands to measure the severity of the ED.

    Measured: Baseline (Before start CBT-E), 4 weeks (8 sessions CBT-E), end of treatment (up to 39 weeks after randomization), and 6 and 12 months after end of treatment

Secondary outcomes (10)
  1. Childhood Trauma Questionnaire-Short Form (CTQ-SF)

    This questionnaire consists of 28 questions measuring physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect during childhood.

    Measured: Baseline (Before start CBT-E)

  2. Change in Young Schema Questionnaire Short Form version 3 3 (YSQ-S3) score

    The YSQ-S3 will be used to measure 18 early maladaptive schemas and is a valid instrument for the assessment of early maladaptive schemas in clinical and research settings.

    Measured: Baseline (Before start CBT-E), end of treatment (up to 39 weeks after randomization), and 6 and 12 months after end of treatment

  3. Change in Schema Mode Inventory for Eating Disorders (SMI-ED) score

    The SMI-ED will be used to assess schema modes that are relevant in patients with an eating disorder. It measures 5 maladaptive child modes, 2 maladaptive internalized/introject modes, 7 maladaptive coping modes, and 2 healthy factors.

    Measured: 4 weeks (8 sessions CBT-E), end of treatment (up to 39 weeks after randomization), and 6 and 12 months after end of treatment

  4. Change in Brief Symptom Inventory (BSI) score

    The BSI will be used to assess general psychological and physical symptoms

    Measured: 4 weeks (8 sessions CBT-E), end of treatment (up to 39 weeks after randomization), and 6 and 12 months after end of treatment

  5. Change in Eating Disorder Quality of Life (EDQoL) score

    Quality of life will be assessed using the EDQoL

    Measured: 4 weeks (8 sessions CBT-E), end of treatment (up to 39 weeks after randomization), and 6 and 12 months after end of treatment

  6. Clinical Perfectionism Questionnaire (CPQ)

    The CPQ will be used to assess clinical perfectionism. This questionnaire consists of 12 items that measure the level of self-evaluation based on striving towards extremely high personal standards despite adverse consequences.

    Measured: Baseline (Before start CBT-E)

  7. Session Rating Scale (SRS)

    Therapeutic alliance will be evaluated in each session using the patient-rated SRS, which is a short (four items) measure.

    Measured: up to 39 weeks

  8. Quality of life and achievement personalized treatment goals

    A qualitative interview (to be developed)

    Measured: End of treatment (up to 39 weeks after randomization)

  9. Treatment Inventory of Costs in Patients with psychiatric disorders (TiC-P)

    Patient-reported productivity losses and multiple dimensions of healthcare resource consumption will be measured, using the validated TIC-P questionnaire. This questionnaire has been tested extensively for patients with a psychiatric disorder, using a recall period of three months. Using various unit prices in healthcare, both productivity losses and healthcare resource consumption will be valued monetarily in order to estimate the actual costs for the CBT-E arm and the GST arm within a closed time frame (Bouwmans et al., 2013).

    Measured: 4 weeks (8 sessions CBT-E), end of treatment (up to 39 weeks after randomization), and 6 and 12 months after end of treatment

  10. Change in Quality-adjusted life years score

    Five dimensions of quality of life will be measured, using the EQ-5D-5L questionnaire: mobility, self-care, usual activities, pain / discomfort, and anxiety / depression. Participants will be asked to rank the extent to which they feel satisfied about these five dimensions on a 5-point Likert scale. Then they will be asked to rank their current health state, using a 0-100 VAS analog scale. Final utility scores from both the CBT-E arm and the GST arm on all dimensions of this questionnaire will be converted into a single health utility measure: Quality-adjusted life years or QALYs (Feng et al., 2021).

    Measured: 4 weeks (8 sessions CBT-E), end of treatment (up to 39 weeks after randomization), and 6 and 12 months after end of treatment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Apr 2023
  2. Study start24 Jul 2023
  3. Primary completionDec 2026 (estimated)
  4. Study completionDec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
All participants start with CBT-E phase 1 and 2. If not improved enough with regard to eating disorder symptoms (following EDE-Q pre- and post measure comparison) in the first phase, they will be included in the RCT. When included they will be randomly assigned to either the CBT-E continuation condition or the GST condition.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
230 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05812950
Sponsor's protocol ID
NL80491.068.22
Other IDs
60-63600-98-1131
Status last verified
Nov 2023
First submitted
4 Mar 2023
Last updated
30 Nov 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Mares SHW, Roelofs J, Zinzen J, Beatse M, Elgersma HJ, Drost RMWA, Evers SMAA, Elburg AAV. Clinical effectiveness, cost-effectiveness and process evaluation of group schema therapy for eating disorders: study protocol for a multicenter randomized controlled trial. BMC Psychol. 2024 Mar 4;12(1):123. doi: 10.1186/s40359-024-01624-w.

    PubMed 38439092

Questions about this trial

What is this clinical trial studying?

A study testing GST and CBT-E in people with Anorexia Nervosa and Atypical Anorexia Nervosa (Other Specified Eating Disorder), run by Maastricht University at 7 sites in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 30 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Jeffrey Roelofs, Dr. (+31433881607, j . roelofs @ maastricht university . nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Eating Disorder Examination Questionnaire (EDE-Q) score (time frame: Baseline (Before start CBT-E), 4 weeks (8 sessions CBT-E), end of treatment (up to 39 weeks after randomization), and 6 and 12 months after end of treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05812950, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Nov 2023.

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