Abstract
BackgroundThe effectiveness of psychotherapeutic interventions for eating disorders (EDs) is widely studied in Europe, North America, and Australia/New Zealand. However, few controlled studies and no randomized controlled trials (RCTs) have been conducted in Japan despite the relatively high prevalence of EDs in the Japanese population. The aim of this study is to evaluate the effect of enhanced cognitive behavior therapy (CBT-E), an evidence-supported ED-focused form of cognitive behavior therapy (CBT), for the treatment of bulimia nervosa (BN) in Japan.Methods/designThis multicenter RCT will compare CBT-E with treatment as usual (TAU), which is widely used in Japan. A group of 140 adult outpatients with a Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) diagnosis of BN, ≥18 years of age, a body mass index (BMI) > 17.5 and < 40 kg/m2 will be randomly assigned to CBT-E or TAU. Participants will be stratified by intervention site and BN severity. CBT-E participants will receive 20 sessions of focused form CBT-E for 20 weeks. Those in the TAU group will receive routine treatment provided by specialists. Assessment will be performed in a blinded manner prior to the start of treatment, after 6 weeks of treatment, at the end of treatment (20 weeks), and at follow-up at 40 and 80 weeks after the start of treatment. The primary outcome is the remission of BN, defined by the absence, in the previous 4 weeks, of symptoms required to meet the DSM-5 criteria for a diagnosis of BN. Secondary outcomes include the levels of ED psychopathology and impairment due to the ED, anxiety, depression, family function, and satisfaction with treatment.DiscussionThis will be the first RCT conducted in Japan to compare CBT-E and TAU for the treatment of BN. If CBT-E is found to be more effective than TAU, then the evidence would support its wider use for patients with BN in Japan. Because it is possible to train therapists who do not possess extensive specialist experience, wider use is also likely to be practically feasible. In addition, demonstrating the effectiveness of CBT-E in Japan would demonstrate that it could be successfully extended to additional world cultures and regions.Trial registrationUMIN, UMIN000031625. Registered 7 Mar 2018.
Highlights
The effectiveness of psychotherapeutic interventions for eating disorders (EDs) is widely studied in Europe, North America, and Australia/New Zealand
This will be the first Randomized controlled trials (RCT) conducted in Japan to compare cognitive behavior therapy (CBT)-E and treatment as usual (TAU) for the treatment of bulimia nervosa (BN)
If cognitive behavior therapy (CBT-E) is found to be more effective than TAU, the evidence would support its wider use for patients with BN in Japan
Summary
This will be the first RCT to investigate the effectiveness of ED-focused CBT treatment in Asia. Patients will be followed up for 60 weeks after the end of treatment to determine whether treatment effects are maintained over the long-term Multicenter recruitment makes it possible to enroll a large enough number of participants to ensure that the study is adequately powered. Using TAU as a comparison group allows evaluation of the effects of CBT-E versus the best currently available treatment in Japan [30] Both the CBT-E and TAU therapists will be experienced in the treatment of EDs. CBT-E will be implemented by competent therapists and its proper administration will be ensured.
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