Modified nutritional counselling to increase motivation to treatment in anorexia nervosa.

Cognitive-behavioural therapy (CBT) and nutritional counselling are the most largely diffused approaches to treat anorexia nervosa (AN). The primary target of CBT is the modification of patients’ negative ideas and dysfunctional assumptions regarding eating and body shape and weight, whereas nutritional counselling mainly consists of meal planning, nutritional education and weekly weighting [3]. Few studies have compared the efficacy of CBT vs. nutritional counselling in AN patients [1,2] and provide evidence that individual CBT is superior to nutritional counselling in preventing relapse in weight-restored patients. In our Department, since 1999 an integrated approach has been implemented, in which hospital intervention, cognitive psychotherapy, nutritional and family counselling are organized as phases of a single therapeutic plan by the same therapist. Nutritional counselling during the acute phasewas modified to allow stabilization of patients’ physical conditions, augmentation of self-observation abilities and early psychological reformulation of the symptoms, in order to increase the motivation to psychotherapy. In the present report, modified nutritional counselling and its integration with cognitive-behavioural interventions since the engagement phase of the treatment will be illustrated by discussing a clinical case