Vol.:(0123456789) 1 3 Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity https://doi.org/10.1007/s40519-019-00643-6 ORIGINAL ARTICLE Combining day treatment and outpatient treatment for eating disorders: fndings from a naturalistic setting Ina Beintner 1  · Kristian Hütter 1  · Katrin Gramatke 2  · Corinna Jacobi 1 Received: 17 October 2018 / Accepted: 16 January 2019 © Springer Nature Switzerland AG 2019 Abstract Background Day treatment programs for individuals with eating disorders (ED) have been the subject of research and are promoted as an alternative to inpatient treatment due to their therapeutic and economic advantages, but have not regularly been implemented in regular care. Purpose We investigated the long-term efectiveness of a transdiagnostic combined eating disorder treatment program which consisted of an 8-week day treatment phase followed by an average of 19 sessions of outpatient treatment over an average of 39 weeks in a naturalistic setting. Methods We accepted 148 patients with diferent diagnoses of eating disorders into our combined treatment program. We assessed weight, behavioral eating disorder symptoms and eating disorder related cognitions and attitudes at the beginning and the end of the day treatment phase and after 6, 12 and 26 months. Results Over the course of the 8-week day treatment phase, patients with initial binge eating, purging and/or fasting behavior reduced these symptoms by 91%, 90% and, 86%. Patients who were underweight at baseline gained on average 1.05 BMI points (d = 0.76). In addition, eating disorder related cognitions and attitudes of all patients signifcantly improved with large efect sizes (d = 1.12). On average, all improvements remained stable during the follow-up period. Conclusions Our fndings add to the existing studies on day treatment and support previously found encouraging efects of treatment programs that combine day treatment and consecutive outpatient treatment for eating disorders. Level of evidence Level III, longitudinal cohort study. Keywords Eating disorders · Day treatment · Naturalistic study Introduction Cognitive behavior therapy (CBT) is the frst choice psycho- logical treatment for bulimia nervosa (BN) and binge eating disorder (BED) and part of the recommendations in treat- ment guidelines for anorexia nervosa (AN) and subthreshold eating disorders [1–4]. The optimum treatment setting and intensity remains subject of debate [5–7]. Day treatment has been proposed as a link between outpa- tient and inpatient treatment, either as part of a stepped-care approach [8], or to facilitate the transition from inpatient to outpatient treatment [4, 9, 10]. A number of day treatment programs for eating disorders have been described in the literature, e.g. [11–16]. In a review on publications on day treatment programs, two diferent models became apparent: shorter, symptom-focused treatments based on cognitive behavioral therapy (CBT) and longer, individual-focused treatments based on psychodynamic therapy [17]. The efectiveness of day treatment for eating disorders has mainly been investigated in uncontrolled naturalistic studies [18]. Treatment programs were multimodal and incorporated elements of cognitive behavioral therapy and—if patients are adolescents—family based therapy; psychodynamic treat- ments were less often investigated [18]. The duration of the day treatment varied between 6 weeks [e.g. 19] and 6 months [e.g. 20]. Results showed mainly moderate to large short * Ina Beintner Ina.Beintner@tu-dresden.de 1 Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01062 Dresden, Germany 2 Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Universitätsklinikum Carl-Gustav-Carus, Schubertstraße 42, 01307 Dresden, Germany