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ANTOP: focal psychodynamic therapy, CBT-E and optimized treatment as usual

One-paragraph summary

Multicentre German RCT in 242 adult female outpatients with AN allocated to ten months of focal psychodynamic therapy (n=80), enhanced CBT (n=80), or optimized treatment as usual (n=82). BMI increased in all groups. Attrition was 54/242 (22%) by end of treatment and 73/242 (30%) by 12-month follow-up (Zipfel 2014, PMID 24131861).

Key findings

  • Largest major adult outpatient psychotherapy trial in the seed evidence.
  • All three care strategies produced weight gain.
  • Comparative effects varied by endpoint/time; no simple global winner.
  • Screened 727 adults to randomize 242 (80 FPT, 80 CBT-E, 82 optimized TAU).
  • BMI gain at end of treatment: 0.73, 0.93 and 0.69 kg/m²; at 12 months 1.64, 1.30 and 1.22 kg/m²; no significant between-group differences at either point.
  • The trial's own interpretation is more differentiated than "no winner": focal psychodynamic therapy was advantageous for recovery at 12-month follow-up, CBT-E for speed of weight gain and eating-disorder psychopathology, and optimized treatment as usual was recommended as a solid baseline.
  • A 5-year follow-up was later published (Herzog 2022, PMID 35294860): 154/242 (64%) reassessed at mean 5.96 years (SD 0.2); estimated mean BMI 18.64–18.99 kg/m² with no between-group difference; on observed data 41% (95% CI 33–49) full recovery, 41% (33–49) partial, 18% (12–24) full-syndrome AN; one suicide death between the 1- and 5-year assessments; 5-year BMI predicted by baseline BMI (p=0.0021), illness duration (p=0.0004) and baseline depression (p=0.012).

Limitations

  • Participants were adult women with BMI 15.0–18.5 kg/m² in German university-linked services.
  • Psychotherapy could not be masked.
  • Attrition limits precision and can bias complete-case impressions.
  • Optimized treatment as usual was an active structured comparator.

Why it matters

ANTOP anchors the adult “no clear winner” problem and shows why absolute improvement must be separated from comparative superiority.

Cited by wiki pages

  • Treatment in adults
  • Mortality and long-term outcome
  • Service models and setting