***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE A subset of individuals with bulimia nervosa ( BN ) have borderline personality disorder ( BPD ) symptoms , including chronic negative affect and interpersonal problems . These symptoms predict poor BN treatment outcome in some studies . The broad version of Enhanced Cognitive Behavior Therapy ( CBT-E ) was developed to address co-occurring problems that interfere with treatment response . The current study investigated the relative effects , predictors , and moderators of CBT-E for BN with BPD and co-occurring mood/anxiety disorders . METHOD Fifty patients with BN and threshold or sub-threshold BPD and current or recent Axis I mood or anxiety disorders were r and omly assigned to receive focused CBT-E ( CBT-Ef ) or broad CBT-E ( CBT-Eb ) specifically including an interpersonal module and additional attention to mood intolerance . RESULTS Forty-two percent of the sample reported remission from binge eating and purging at termination . Significant changes across symptom domains were observed at termination and at 6-month follow-up . Though CBT-Ef predicted good outcomes in multivariate models , the severity of affective/interpersonal problems moderated treatment effects : participants with higher severity showed better ED outcomes in CBT-Eb , whereas those with lower severity showed better outcomes in CBT-Ef .  Severity of affective/interpersonal BPD symptoms at baseline predicted negative outcomes overall . Follow-up BPD affective/interpersonal problems were predicted by baseline affective/interpersonal problems and by termination EDE score . DISCUSSION This study supports the utility of CBT-E for patients with BN and complex comorbidity .  CBT-Ef appears to be more efficacious for patients with relatively less severe BPD symptoms , whereas CBT-Eb appears to be more efficacious for patients with more severe BPD symptoms Eating disorders may be viewed from a transdiagnostic perspective and there is evidence supporting a transdiagnostic form of cognitive behaviour therapy ( CBT-E ) . The aim of the present study was to compare CBT-E with interpersonal psychotherapy ( IPT ) , a leading alternative treatment for adults with an eating disorder . One hundred and thirty patients with any form of eating disorder ( body mass index > 17.5 to < 40.0 ) were r and omized to either CBT-E or IPT .  Both treatments involved 20 sessions over 20 weeks followed by a 60-week closed follow-up period . Outcome was measured by independent blinded assessors . Twenty-nine participants ( 22.3 % ) did not complete treatment or were withdrawn . At post-treatment 65.5 % of the CBT-E participants met criteria for remission compared with 33.3 % of the IPT participants ( p < 0.001 ) . Over follow-up the proportion of participants meeting criteria for remission increased , particularly in the IPT condition , but the  CBT-E remission rate remained higher ( CBT-E 69.4 % , IPT 49.0 % ; p = 0.028 ) . The response to CBT-E was very similar to that observed in an earlier study . The findings indicate that CBT-E is potent treatment for the majority of out patients with an eating disorder .  IPT remains an alternative to CBT-E , but the response is less pronounced and slower to be expressed . Current controlled trials IS RCT N 15562271 What kinds of evidence reliably support predictions of effectiveness for health and social care interventions ? There is increasing reliance , not only for health care policy and practice but also for more general social and economic policy deliberation , on evidence that comes from studies whose basic logic is that of JS Mill 's method of difference . These include r and omized controlled trials , case-control studies , cohort studies , and some uses of causal Bayes nets and counterfactual-licensing models like ones commonly developed in econometrics . The topic of this paper is the ' external validity ' of causal conclusions from these kinds of studies . We shall argue two cl aims . Cl aim , negative : external validity is the wrong idea ; cl aim , positive : ' capacities ' are almost always the right idea , if there is a right idea to be had . If we are right about these cl aims , it makes big problems for policy decisions . Many advice guides for grading policy predictions give top grade s to a proposed policy if it has two good Mill's- method -of difference studies that support it . But if capacities are to serve as the conduit for support from a method -of-difference study to an effectiveness prediction , much more evidence , and much different in kind , is required . We will illustrate the complexities involved with the case of multisystemic therapy , an internationally adopted intervention to try to diminish antisocial behaviour in young people Consistent predictors , and more especially moderators , of response to psychological treatments for eating disorders have not been identified . The present exploratory study examined predictors and moderators of outcome in adult patients who took part in a r and omised clinical trial comparing two leading treatments for these disorders , enhanced cognitive behavioural therapy ( CBT-E ) and interpersonal psychotherapy ( IPT ) . Four potentially important findings emerged . Firstly , patients with a longer duration of disorder were less likely to benefit from either treatment . Second , across the two treatments the presence , at baseline , of higher levels of over-evaluation of the importance of shape predicted a less good treatment outcome . Third DSM-IV diagnosis did not predict treatment outcome . Fourth , with the exception of patients with baseline low self-esteem who achieved a better outcome with CBT-E , it was generally not possible to identify a subgroup of patients who would differentially benefit from one or other treatment OBJECTIVE The aim of this study was to compare two cognitive-behavioral treatments for out patients with eating disorders , one focusing solely on eating disorder features and the other a more complex treatment that also addresses mood intolerance , clinical perfectionism , low self-esteem , or interpersonal difficulties . METHOD A total of 154 patients who had a DSM-IV eating disorder but were not markedly underweight ( body mass index over 17.5 ) , were enrolled in a two-site r and omized controlled trial involving 20 weeks of treatment and a 60-week closed period of follow-up . The control condition was an 8-week waiting list period preceding treatment . Outcomes were measured by independent assessors who were blind to treatment condition . RESULTS Patients in the waiting list control condition exhibited little change in symptom severity , whereas those in the two treatment conditions exhibited substantial and equivalent change , which was well maintained during follow-up . At the 60-week follow-up assessment , 51.3 % of the sample had a level of eating disorder features less than one st and ard deviation above the community mean . Treatment outcome did not depend on eating disorder diagnosis . Patients with marked mood intolerance , clinical perfectionism , low self-esteem , or interpersonal difficulties  appeared to respond better to the more complex treatment , with the reverse pattern evident among the remaining patients . CONCLUSIONS These two transdiagnostic treatments appear to be suitable for the majority of out patients with an eating disorder . The simpler treatment may best be viewed as the default version , with the more complex treatment reserved for patients with marked additional psychopathology of the type targeted by the treatment Anorexia nervosa is difficult to treat and no treatment is supported by robust evidence . As it is uncommon , it has been recommended that new treatments should undergo extensive preliminary testing before being evaluated in r and omized controlled trials . The aim of the present study was to establish the immediate and longer-term outcome following “ enhanced ” cognitive behaviour therapy ( CBT-E ) .  Ninety-nine adult patients with marked anorexia nervosa ( body mass index ≤ 17.5 ) were recruited from consecutive referrals to clinics in the UK and Italy . Each was offered 40 sessions of CBT-E over 40 weeks with no concurrent treatment . Sixty-four percent of the patients were able to complete this outpatient treatment and in these patients there was a substantial increase in weight ( 7.47 kg , SD 4.93 ) and BMI ( 2.77 , SD 1.81 ) . Eating disorder features also improved markedly . Over the 60-week follow-up period there was little deterioration despite minimal additional treatment . These findings provide strong preliminary support for this use of CBT-E and justify its further evaluation in r and omized controlled trials . As CBT-E has already been established as a treatment for bulimia nervosa and eating disorder not otherwise specified , the findings also confirm that CBT-E is transdiagnostic in its scope OBJECTIVE This r and omized control trial is an evaluation of the effectiveness of enhanced cognitive behavioral treatment ( CBT-E ) for eating disorders adapted for a group setting . The study aim ed to examine the effects of group CBT-E on eating disorder psychopathology and additional maintaining pathology . METHOD A transdiagnostic sample of individuals with eating disorders with a BMI ≥ 18 kg/m2 ( N = 40 ) were r and omized to an immediate-start or delayed-start condition so as to compare therapeutic effects of group CBT-E with a waitlist control .  Global Eating Disorder Examination Question naire ( EDE-Q ) scores , BMI , and measures of Clinical Perfectionism , Self-Esteem , Interpersonal Difficulties , and Mood Intolerance were measured across the 8-week control period , throughout the group treatment and at 3-months post-treatment . RESULTS Over 70 % of those who entered the trial completed treatment . The first eight weeks of group CBT-E were more effective at reducing Global EDE-Q scores than no treatment ( waitlist control ) . By post-treatment , good outcome ( a Global EDE-Q within 1 SD of Australian community norms plus BMI ≥ 18.5 ) was achieved by 67.9 % of treatment completers and 66.7 % of the total sample . Symptom abstinence within the previous month was reported by 14.3 % of treatment completers and 10.3 % of the total sample . Significant reductions in Clinical Perfectionism , Self-Esteem , Interpersonal Difficulties , and Mood Intolerance were also observed . DISCUSSION This study demonstrated that a group version of CBT-E can be effective at reducing eating disorder psychopathology in a transdiagnostic sample of individuals with eating disorders .  Group CBT-E could provide a means of increasing availability of evidence -based treatment for eating disorders BACKGROUND There are no evidence -based treatments for severe and enduring anorexia nervosa ( SE-AN ) . This study evaluated the relative efficacy of cognitive behavioral therapy ( CBT-AN ) and specialist supportive clinical management ( SSCM ) for adults with SE-AN . METHOD Sixty-three participants with a diagnosis of AN , who had at least a 7-year illness history , were treated in a multi-site r and omized controlled trial ( RCT ) . During 30 out-patient visits spread over 8 months , they received either CBT-AN or SSCM , both modified for SE-AN . Participants were assessed at baseline , end of treatment ( EOT ) , and at 6- and 12-month post-treatment follow-ups . The main outcome measures were quality of life , mood disorder symptoms and social adjustment . Weight , eating disorder ( ED ) psychopathology , motivation for change and health-care burden were secondary outcomes . RESULTS Thirty-one participants were r and omized to CBT-AN and 32 to SSCM with a retention rate of 85 % achieved at the end of the study . At EOT and follow-up , both groups showed significant improvement . There were no differences between treatment groups at EOT . At the 6-month follow-up , CBT-AN participants had higher scores on the Weissman Social Adjustment Scale ( WSAS ; p = 0.038 ) and at 12 months they had lower Eating Disorder Examination ( EDE ) global scores ( p = 0.004 ) and higher readiness for recovery ( p = 0.013 ) compared to SSCM . CONCLUSIONS Patients with SE-AN can make meaningful improvements with both therapies . Both treatments were acceptable and high retention rates at follow-up were achieved . Between-group differences at follow-up were consistent with the nature of the treatments given BACKGROUND Anorexia nervosa ( AN ) is a serious illness leading to substantial morbidity and mortality . The treatment of AN very often is protracted ; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system . Therefore , this study aim ed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy ( FPT ) , enhanced cognitive-behavioural therapy ( CBT-E ) , and optimized treatment as usual ( TAU-O ) in the treatment of adult women with AN . METHOD The analysis was conducted alongside the r and omized controlled Anorexia Nervosa Treatment of Out Patients ( ANTOP ) study . Cost-effectiveness was determined using direct costs per recovery at 22 months post-r and omization ( n = 156 ) . Unadjusted incremental cost-effectiveness ratios ( ICERs ) were calculated . To derive cost-effectiveness acceptability curves ( CEACs ) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay ( WTP ) per additional recovery . Cost-utility and assumptions underlying the base case were investigated in exploratory analyses . RESULTS Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups . The unadjusted ICERs  indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover , FPT was dominant compared with CBT-E.  CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95 % if the WTP per recovery was ⩾€9825 and ⩾€24 550 , respectively . 
    Output:
    
Despite the limitations , this study provides additional support for CBT-E as a successful treatment across the range of EDs