E-Mail karger@karger.com Letter to the Editor therapeutic alliance and have learned to deal adaptively with dis- tress. Previous psychotherapy research has demonstrated that emotional processing particularly during mid-treatment predicts favourable treatment outcomes [4]. Our main hypothesis was that greater expression of negative emotions, particularly during mid- treatment, is associated with favourable outcomes in AN treat- ment, independent of the psychotherapeutic approach. Data were obtained from a multicentre randomised controlled trial comparing 40 sessions of manualised focal psychodynamic therapy (FPT) and enhanced cognitive behaviour therapy (CBT-E) against optimised treatment-as-usual in adult outpatients with AN (for more details of the ANTOP study see [5]). Participants were female, ≥18 years, and had a DSM-IV diagnosis of full-syndrome/ subthreshold AN (BMI 15.0–18.5). Written informed consent was obtained from each participant. Independent research ethics com- mittees approved the study. Participants were randomised to re- ceive either FPT, CBT-E, or optimised treatment-as-usual. Ses- sions were recorded and stored as audio files only in the FPT and CBT-E condition. Recordings were not available in 21% of the cas- es because either the patient or the therapist refused to give in- formed consent to use the recordings, and in 23% of the cases recordings were either incomplete or of insufficient quality. The analysis is thus based on the data from 89 patients (FPT: 43; CBT- E: 46), i.e., 56% of the original samples, which corresponds to sim- ilar studies [6]. These patients did not differ from those excluded regarding BMI, illness duration, eating disorder psychopathology, proportion of restricting subtype, and comorbid disorders at base- line (all p > 0.073). Likewise, FPT and CBT-E participants in this sample did not differ in these variables at baseline, end of treat- ment, and follow-up (all p > 0.129), except for more common co- morbid MDD among CBT-E patients at baseline, χ 2 (1) = 5.169, p = 0.023. However, patients with and without comorbid MDD did not differ regarding emotional expression in any treatment phase (all p > 0.156). FPT comprised 3 treatment phases: sessions 1–15 focused on therapeutic alliance, pro-anorectic behaviour/beliefs, and self-es- teem, sessions 16–32 emphasised emotional experiencing, inter- personal relationships, and their association with problematic eat- ing behaviour, and sessions 33–40 focused on transfer to everyday life, anticipation of treatment termination, and parting. CBT-E comprised several modules: motivation, normalisation of nutri- tion, creating a formulation, and relapse prevention (mandatory), and cognitive restructuring, mood regulation, social skills, shape concern, and self-esteem (optional). BMI (calculated as kilograms/metres squared) at end of treat- ment and at the 12-month follow-up served as the primary out- come. Secondary outcomes were self-reported (Eating Disorders Treatment outcomes for adult anorexia nervosa (AN) patients are generally poor [1]. Examining elements of the therapeutic pro- cess could provide helpful new insights into cognitive and behav- ioural factors associated with a favourable outcome. AN patients typically show strong emotional avoidance, emotion dysregula- tion, and reduced emotional expression [2, 3]. AN behaviours such as dietary restraint may serve as maladaptive mechanisms of emo- tion regulation by reducing aversive emotional experience [3]. High levels of emotional processing during psychotherapy are usu- ally associated with symptom reduction [4]. This is most likely to occur during mid-treatment when patients rely on the established Received: May 10, 2016 Accepted after revision: November 17, 2016 Published online: February 10, 2017 © 2017 S. Karger AG, Basel www.karger.com/pps Psychother Psychosom 2017;86:108–110 DOI: 10.1159/000453582 Emotional Expression Predicts Treatment Outcome in Focal Psychodynamic and Cognitive Behavioural Therapy for Anorexia Nervosa: Findings from the ANTOP Study Hans-Christoph Friederich a, b , Timo Brockmeyer a, b, m , Beate Wild b , Gaby Resmark c , Martina de Zwaan d, e , Andreas Dinkel f , Stephan Herpertz g , Markus Burgmer h , Bernd Löwe i , Sefik Tagay j , Eva Rothermund k , Almut Zeeck l , Stephan Zipfel c , Wolfgang Herzog b a Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, b Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, c Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, d Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Erlangen, e Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, f Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, g Department for Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University of Bochum, Bochum, h Department for Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, i Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, j Department of Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, Essen, k Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, and l Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Freiburg, Germany; m Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK Dr. Timo Brockmeyer Department of Psychosomatic Medicine and Psychotherapy Medical Faculty, Heinrich Heine University Düsseldorf Bergische Landstrasse 2, DE-40629 Düsseldorf (Germany) E-Mail timo.brockmeyer  @  hhu.de Hans-Christoph Friederich and Timo Brockmeyer contributed equally to this work.