Psychotherapy For Bulimia Nervosa Research Articles

Innovative Moments and the Process of Change in the Treatment of Bulimia Nervosa

Problematic patient narratives emerging in the process of treatment have been identified as important factors in the maintenance of psychopathology, and their change is associated with desired treatment outcomes. This increased focus in psychotherapy research has triggered the investigation of innovative moments (IMs) as novelties in patient narratives in therapy. This exploratory study aims to investigate the development of IMs throughout treatment in bulimia nervosa (BN) in a sample of good and poor outcome cases, and examine their longitudinal associations with binge and purge frequency change. IMs were coded in sixty sessions across five good outcome and five poor outcome cases in different stages of treatment. Generalized estimating equation analyses indicated that IMs evolved significantly over time, with different trajectories between good and poor outcome groups. High-level IMs showed higher proportion in the good outcome group at the end of treatment indicating that the ability to elaborate on how and why change might occur (as measured by high-level IMs) plays a role in the process of change in BN. Additionally, both low- and high-level IMs predicted symptom decrease in the following session. The study provides a preliminary understanding of important patient narrative processes in psychotherapy for BN and their association with treatment change.

Patient baseline interpersonal problems as moderators of outcome in two psychotherapies for bulimia nervosa

Objective: We tested an aptitude by treatment interaction; namely, whether patients’ baseline interpersonal problems moderated the comparative efficacy of cognitive-behavioral therapy (CBT) vs. interpersonal psychotherapy (IPT) for bulimia nervosa (BN). Method: Data derived from a randomized-controlled trial. Patients reported on their interpersonal problems at baseline; purge frequency at baseline, midtreatment, and posttreatment; and global eating disorder severity at baseline and posttreatment. We estimated the rate of change in purge frequency across therapy, and the likelihood of attaining clinically meaningful improvement (recovery) in global eating disorder severity by posttreatment. We then tested the interpersonal problem by treatment interactions as predictors of both outcomes. Results: Patients with more baseline overly communal/friendly problems showed steeper reduction in likelihood of purging when treated with CBT vs. IPT. Patients with more problems of being under communal/cold had similar reductions in likelihood of purging across both treatments. Patients with more baseline problems of being overly agentic were more likely to recover when treated with IPT vs. CBT, whereas patients with more problems of being under agentic were more likely to recover when treated with CBT vs. IPT. Conclusions: Interpersonal problems related to communion and agency may inform treatment fit among two empirically supported therapies for BN.

Psychotherapy for bulimia nervosa on symptoms of depression: A meta-analysis of randomized controlled trials.

Depressive symptoms are an important risk factor and consequence of binge eating and purging behavior in bulimia nervosa (BN). Although psychotherapy is effective in reducing symptoms of BN in the short- and long-term, it is unclear whether psychotherapy for BN is also effective in reducing depressive symptoms. This meta-analysis examined the efficacy of psychotherapy for BN on depressive symptoms in the short- and long-term. Randomized controlled trials (RCTs) on BN that assessed depressive symptoms as an outcome were identified. Twenty-six RCTs were included. Psychotherapy was more efficacious at reducing symptoms of depression at post-treatment (g = 0.47) than wait-lists. This effect was strongest when studies delivered therapist-led, rather than guided self-help, treatment. No significant differences were observed between psychotherapy and antidepressants. There was no significant post-treatment difference between CBT and other active psychological comparisons at reducing symptoms of depression. However, when only therapist-led CBT was analyzed, therapist-led CBT was significantly more efficacious (g = 0.25) than active comparisons at reducing depressive symptoms. The magnitude of the improvement in depressive symptoms was predicted by the magnitude of the improvement in BN symptoms. These findings suggest that psychotherapy is effective for reducing depressive symptoms in BN in the short-term. Whether these effects are sustained in the long-term is yet to be determined, as too few studies conducted follow-up assessments. Moreover, findings demonstrate that, in addition to being the front-running treatment for BN symptoms, CBT might also be the most effective psychotherapy for improving the symptoms of depression that commonly co-occur in BN.

Relationship-focused therapy for bulimia and binge eating: Introduction to the special section.

Individuals with bulimia nervosa and binge eating disorder commonly report co-occurring interpersonal problems, and treatment that focuses on relationships and relational functioning has shown benefit relative to other forms of treatment. Relational psychotherapy for eating disorders can vary on several important dimensions, such as how structured and symptom-focused versus exploratory and patient-directed it is, whether it focuses on past relationships and patterns in relationships over time versus focusing on current relationships, and whether it includes the relationship with the therapist as an explicit topic of conversation and mechanism for relational change. The cases in this special section provide the opportunity to closely compare 3 therapeutic approaches on each of these dimensions. Psychoanalytic Psychotherapy for Bulimia Nervosa, Integrative Dynamic Therapy for Bulimia Nervosa, and Interpersonal Psychotherapy for the Prevention of Weight Gain and Eating Disorders are each highly distinct approaches. The authors of each case explain the intended mechanisms of treatment response, the measures that assess changes in eating disorder symptoms as well as the mechanisms of change, and provide extensive excerpts from case material to demonstrate and illustrate the particular evidence-based treatment. Therapists and researchers may usefully consider the process and outcome variables described in these interpersonal approaches. (PsycINFO Database Record

Client attachment security predicts alliance in a randomized controlled trial of two psychotherapies for bulimia nervosa

Objective: This study investigated the relation between clients' attachment patterns and the therapeutic alliance in two psychotherapies for bulimia nervosa. Method: Data derive from a randomized clinical trial comparing cognitive-behavioral therapy (CBT) and psychoanalytic psychotherapy (PPT) for bulimia nervosa. Client attachment patterns were assessed with the Adult Attachment Interview. Independent raters scored audiotapes of early, middle, and late therapy sessions for 68 clients (175 sessions) using the Vanderbilt Therapeutic Alliance Scale. Results: Client attachment security was found to be a significant (p = .007) predictor of alliance levels at the three measured time points, with clients higher on attachment security developing stronger alliances with their therapists in both treatments as compared to clients higher on attachment insecurity. No evidence was found to support a hypothesized interaction whereby dismissing clients would develop weaker alliances in PPT and preoccupied clients would develop weaker alliances in CBT. Conclusions: As the first study to examine client attachment and therapeutic alliance using observer-based instruments, this study supports the theoretical assumption that clients with secure attachment patterns are likely to develop stronger alliances with their therapist across different treatment settings.

A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa

The purpose of this investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, 'enhanced' cognitive-behavioral therapy (CBT-E). Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat). Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different. ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.

Treatment of chronic bulimic symptoms: new answers, more questions

Bulimia nervosa has been recognised for only about 30 years. 1 Russell G Bulimia nervosa: an ominous variant of anorexia nervosa. Psychol Med. 1979; 9: 429-448 Crossref PubMed Scopus (1233) Google Scholar Its essential features are binge eating and inappropriate methods of preventing weight gain. The selfsteem of these individuals is excessively influenced by body shape and weight. 2 American Psychiatric Association.Diagnostic and statistical manual of mental disorders: DSM-IV, 4th edn. Washington DC, 1994: 539–50. Google Scholar Treatment consists of psychotherapy, antidepressant drugs, or both. A recent review reports on efficacy of cognitive-behavioural psychotherapy, 3 Hay PJ Bacaltchuk J Psychotherapy for bulimia nervosa and binging (Cochrane Review). Cochrane Library, Issue 4. Update Software, Oxford1999 Google Scholar but other forms of psychotherapy, such as interpersonal psychotherapy, can also be effective. 4 Fairburn CG Norman PA Welch SL O'Connor ME Doll HA Peveler RC A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Arch Gen Psychiatry. 1995; 52: 304-312 Crossref PubMed Scopus (374) Google Scholar Most placebocontrolled trials of antidepressants have confirmed the efficacy of the active agent in reducing binge-eating and purging. In clinical practice, serotonin-reuptake inhibitors are the most commonly used drugs because they do not produce many side-effects. The combination of psychotherapy and antidepressants seems to be more effective than either alone. 5 Walsh BT Wilson GT Loeb KL et al. Medication and psychotherapy in the treatment of bulimia nervosa. Am J Psychiatry. 1997; 154: 523-531 Crossref PubMed Scopus (232) Google Scholar Effect of decreasing afferent vagal activity with ondansetron on symptoms of bulimia nervosa: a randomised, double-blind trialThe decrease in binge-eating and vomiting under ondansetron treatment was not achieved by compensatory changes in eating behaviour such as by a smaller number of binges of longer duration, or by not eating, or by binge-eating without vomiting. Instead, our findings indicate a normalisation of the physiological mechanism(s) controlling meal termination and satiation. Since meal termination and satiety are mainly vagally mediated functions, since binge-eating and vomiting produce intense stimulation of vagal afferent fibres, and since ondansetron and other 5-HT3 antagonists decrease afferent vagal activity, the symptom improvement may result from a pharmacological correction of abnormal vagal neurotransmission. Full-Text PDF