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Psychotherapy and Bulimia Nervosa

549 citations0/0 files storedArchives of General Psychiatry

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Eating Disorders and Behaviors Nutrition, Health and Food Behavior Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Abstract

OBJECTIVE: To determine whether cognitive behavior therapy (CBT) for bulimia nervosa has a specific therapeutic effect and determine whether a simplified behavioral treatment (BT) of CBT is as effective as the full treatment. DESIGN: Randomized controlled trial involving three psychological treatments. Two planned comparisons, CBT with interpersonal psychotherapy (IPT), and CBT with BT. Closed 12-month follow-up period. Independent assessors. SETTING: Secondary referral center. PATIENTS: Seventy-five consecutively referred patients with bulimia nervosa. Patients with concurrent anorexia nervosa were excluded. INTERVENTIONS: Cognitive behavior therapy, IPT, BT conducted on an individual outpatient basis. There were nineteen sessions over 18 weeks. Six experienced therapists administered all three treatments. There was no concurrent treatment. MAIN OUTCOME MEASURE: Frequency of binge eating and purging. RESULTS: High rate (48%) of attrition and withdrawal among the patients who received BT. Over follow-up, few patients undergoing BT met criteria for a good outcome (cessation of all forms of binge eating and purging). Patients in the CBT and IPT treatments made equivalent, substantial, and lasting changes across all areas of symptoms, although there were clear temporal differences in the pattern of response, with IPT taking longer to achieve its effects. CONCLUSIONS: Bulimia nervosa may be treated successfully without focusing directly on the patient's eating habits and attitudes to shape and weight. Cognitive behavior therapy and IPT achieved equivalent effects through the operation of apparently different mediating mechanisms. A further comparison of CBT and IPT is warranted. The behavioral version of CBT was markedly less effective than the full treatment.

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References

1961An Inventory for Measuring Depression 1965Society and the Adolescent Self-Image 1973SCL-90: an outpatient psychiatric rating scale--preliminary report.1979The Eating Attitudes Test: an index of the symptoms of anorexia nervosa 1979Bulimia nervosa: an ominous variant of anorexia nervosa 2024Persuasion and Healing 1987The eating disorder examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders 1984Interpersonal Psychotherapy Of Depression

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2004The Efficacy of Short-term Psychodynamic Psychotherapy in SpecificPsychiatric Disorders 1995A Prospective Study of Outcome in Bulimia Nervosa and the Long-term Effects of Three Psychological Treatments 2004Eating disorder prevention programs: A meta-analytic review.2005Three Psychotherapies for Anorexia Nervosa: A Randomized, Controlled Trial 1998Efficacy of Parent-Child Interaction Therapy: Interim Report of a Randomized Trial with Short-Term Maintenance

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