Toward Personalized Psychotherapy in Anorexia Nervosa: Evidence from Long-Term Moderator Analyses of the ANTOP Study
Year: 2026
Type: article
Abstract: INTRODUCTION: The Anorexia Nervosa Treatment of Outpatients (ANTOP) randomized controlled trial involved 242 adult patients with anorexia nervosa. Patients from 10 German university hospitals were randomly allocated to 10 months of treatment with focal psychodynamic therapy (FPT), enhanced cognitive behaviour therapy (CBT-E), or optimized treatment as usual (TAU-O). At the end of treatment and follow-up no significant body mass index (BMI) differences between groups were reported. The present study is an explorative, secondary analysis of moderators of weight gain for FPT and CBT-E. METHODS: N = 160 patients - randomized to FPT and CBT-E - were included in the analysis. Moderator analysis was conducted by using a mixed model approach for repeated measures (MMRM). The outcome variable was BMI at the last follow-up T5 (mean time of 5.96 years after the beginning of the study). RESULTS: Low depression severity and high mental quality of life (QoL) at baseline moderated the outcome in favour of CBT-E, whereas high depression severity and low mental QoL was associated with a better outcome in FPT. Sensitivity analyses to predict BMI at earlier time points T1-T4 produced the same results. The direction of the moderator effects was the same for CBT-E and FPT across all time points. Graphical visualization confirms that there is a wide range where both treatments perform similarly, while CBT or FPT perform differently in the extreme ranges of these two variables. CONCLUSION: These findings suggest that baseline psychological burden may inform the selection of psychotherapy modality in anorexia nervosa, supporting a move toward personalized, mechanism-informed treatment allocation.
Source: Psychotherapy and Psychosomatics
DOI: 10.1159/000553469
Authors: Beate Wild, Hans-Christoph Friederich, Katrin Elisabeth Giel, Wolfgang Herzog, Gaby Resmark, Dieter Schellberg, Florian Junne, Martin Teufel, Martina de Zwaan, Andreas Dinkel, Stephan Herpertz, Markus Burgmer, Bernd Löwe, Almut Zeeck, Jörn von Wietersheim, Sefik Tagay, Carmen Schade-Brittinger, Henning Schauenburg, Ulrike Schmidt, Stephan Zipfel
Institutions: Heidelberg University, University Hospital Heidelberg, Deutsches Zentrum für Psychische Gesundheit, University of Tübingen, Essen University Hospital, Medizinische Hochschule Hannover, TUM Klinikum, Technical University of Munich, Ruhr University Bochum, University of Münster, University Hospital Münster, University Medical Center Hamburg-Eppendorf, University of Freiburg, Universität Ulm, University Hospital Ulm, TH Köln - University of Applied Sciences, Philipps University of Marburg, King's College London
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: hybrid
OpenAlex ID: W7203710229