Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany.
Eur Eat Disord Rev. 2018 Sep;26(5):379-393. doi: 10.1002/erv.2590. Epub 2018 Mar 26.
Contingency management in stipulating weight gain is routinely used in the treatment of anorexia nervosa, however, empirical investigations concerning its effectiveness have been scarce. This systematic review was conducted according to the PRISMA statement. Of N = 973 hits, 42 full-texts were included in the qualitative synthesis (11 theoretical texts, 19 case reports, 12 descriptive, cohort, and controlled trials). A central topic in the included publications concerns the enhancement of patients' autonomy through participation in the contingency management process. This heightened autonomy is achieved by using contingency contracts. Positive short-term effects on weight gain were shown, whereas follow-up results were heterogeneous. Although contingency contracts are widely used in clinical practice, our systematic review shows that empirical evidence on underlying mechanisms and efficacy is still scarce. Using an explicit treatment contract can enhance patients' motivation, compliance, and autonomy. Clinical practice should see further development including innovative motivation enhancing and conflict dissolving techniques in addressing the pronounced ambivalence often shown by patients with anorexia nervosa.
在治疗神经性厌食症时，通常会采用规定体重增加的权变管理，但关于其有效性的实证研究却很少。本系统评价是根据 PRISMA 声明进行的。在 N = 973 次命中中，有 42 篇全文纳入定性综合分析（11 篇理论文本、19 篇病例报告、12 篇描述性、队列和对照试验）。纳入文献的一个核心主题是通过参与权变管理过程来增强患者的自主性。这种自主性的提高是通过使用权变合同来实现的。体重增加的短期效果呈阳性，而随访结果则存在异质性。尽管权变合同在临床实践中被广泛应用，但我们的系统评价表明，关于其潜在机制和疗效的实证证据仍然很少。使用明确的治疗合同可以提高患者的动机、依从性和自主性。临床实践应进一步发展，包括创新的动机增强和冲突解决技术，以解决神经性厌食症患者常表现出的明显矛盾心理。
