A group treatment program for bulimia nervosa

Seventeen female patients diagnosed as exhibiting bulimia nervosa participated in a shortterm group treatment program. A combination of exposure with response prevention, life skills training, and psychodynamic group interaction was provided. Results in pretest vs. posttest scores on a battery of tests demonstrated improved control over eating behavior and lowered anxiety and depression.     

Outcome of group cognitive-behavior therapy for bulimia nervosa: the role of core beliefs

It is hypothesized that individuals who benefit less from CBT will be those who have more pathological core beliefs (unconditional beliefs, unrelated to food, shape and weight). Twenty bulimic women were treated using 12 sessions of conventional group CBT. Eating behavior and attitudes were assessed pre- and posttreatment. Core beliefs were assessed at the beginning of the programme, and were used as predictors of change across treatment (once any effect of pretreatment psychopathology was taken into account). Group CBT was effective, with reductions of over 50% in bulimic symptoms. Outcome on most indices was associated with pretreatment levels of pathological core beliefs. Possible reasons for these findings are discussed.     

Efficacy of a brief group psychoeducational intervention for bulimia nervosa

This study compared a brief group treatment that was designed to be purely educational (ED) with a longer course of individual cognitive-behavioural (CB) therapy intended to represent more standard clinical care. Participants were 65 women who sought treatment at Toronto General Hospital, met DSM-III criteria for bulimia nervosa at a normal weight and reported vomiting at least twice weekly. Results indicated that the CB treatment, as expected, was generally more effective than the ED intervention, but on several important outcome indices both treatments appeared to be equally effective for the healthiest 25-45% of the sample. The more intensive individual CB treatment was associated with greater improvement in patients who were more severely symptomatic. However, the ED intervention proved significantly more cost-effective and it was suggested that a sequential treatment program might achieve the superior benefits associated with the longer individual CB treatment at a reduced cost.     

Family therapy for bulimia nervosa in adolescents: an exploratory study

Family therapy has only rarely been reported as a treatment for bulimia nervosa and not specifically’for adolescents. This account describes family therapy with eight adolescents who suffered from bulimia nervosa. Change was measured by assessing symptomatic behaviours and global measures of family and social function prior to treatment and again one year later. At reassessment there was a significant reduction in bulimic behaviours although many had some continuing symptoms. Some aspects of the therapy are described and implications for further study of treatment for adolescent bulimia are discussed.     

A time-limited group therapy model for men sexually abused as children

This article explores the clinical dimensions of male child sexual abuse, and its effects upon these children in their adult lives. The number of men receiving therapeutic help for their sexually abusive past is unknown. Prevalence figures are equally elusive, but reporting of this abuse has steadily increased over the last decade. The majority of these children never tell anyone about their sexual victimization, and enter their adulthoods with long-term psychological difficulties. A short-term psycho/educational model is presented in order that more clinicians will treat this vastly underserved population.This article is dedicated to Marion Dragoon, with special thanks to Len Solomon, James Garland, and the staff of St. Luke's.     

Evaluation of manual-based cognitive-behavioral therapy for bulimia nervosa in a service setting

In the present study manual-based cognitive-behavioral therapy for bulimia nervosa was evaluated on an unselected sample of an out-patient service facility. A total of 73 female patients who asked for treatment received the primary diagnosis of bulimia nervosa. Of these, 67 took up treatment. Treatment was completed by 66 patients. Outcome variables were the number of binge episodes along with questionnaire scores for restraint eating, emotional eating, body dissatisfaction and depressiveness. At the end of treatment and 1 year after the end of treatment significant improvements were found in all outcome variables. Effect sizes for outcome variables were within the range of those of controlled research. Therefore, the present study delivered empirical evidence that manual-based cognitive-behavioral therapy is an effective treatment for bulimia nervosa not only within the restricted area of research.     

Multifactorial assessment of bulimia nervosa

We investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. Two hundred forty-five bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing undimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients.     

Subtyping adolescents with bulimia nervosa

Cluster analyses of eating disorder patients have yielded a "dietary-depressive" subtype, typified by greater negative affect, and a "dietary" subtype, typified by dietary restraint. This study aimed to replicate these findings in an adolescent sample with bulimia nervosa (BN) from a randomized controlled trial and to examine the validity and reliability of this methodology. In the sample of BN adolescents (N=80), cluster analysis revealed a "dietary-depressive" subtype (37.5%) and a "dietary" subtype (62.5%) using the Beck Depression Inventory, Rosenberg Self-Esteem Scale and Eating Disorder Examination Restraint subscale. The "dietary-depressive" subtype compared to the "dietary" subtype was significantly more likely to: (1) report co-occurring disorders, (2) greater eating and weight concerns, and (3) less vomiting abstinence at post-treatment (all p's<.05). The cluster analysis based on "dietary" and "dietary-depressive" subtypes appeared to have concurrent validity, yielding more distinct groups than subtyping by vomiting frequency. In order to assess the reliability of the subtyping scheme, a larger sample of adolescents with mixed eating and weight disorders in an outpatient eating disorder clinic (N=149) was subtyped, yielding similar subtypes. These results support the validity and reliability of the subtyping strategy in two adolescent samples.     

Cognitive behaviour therapy to treating bulimia nervosa: A case study

The general cognitive behaviour therapy postulates that bulimic symptoms are maintained by a characteristic set of overvalued thoughts about the personal implications of body shape and weight. Research shows that there is both a close relationship and specific interaction between thoughts and behaviours that help to maintain the overvalued thoughts. This theoretical proposition concerning the role of behaviours in the maintenance of psychological problems is commonly accepted and empirically validated. To ensure a sustainable therapeutic change in the treatment of bulimia nervosa, therapists may need to initially target these overvalued thoughts about the personal implications of body shape and weight; and then to work on the behaviours that help to maintain the bulimic symptoms. The purpose of the present paper is to discuss the conceptual and practical issues underpinning a therapeutic focus that reflects an integrated clinical approach in the treatment of bulimia nervosa. This integrated approach includes the assessment and disputation of the overvalued thoughts that are causal to bulimia nervosa, and various strategies that facilitate the change in those behaviours that help to maintain the bulimic conditions. Using a case example, this paper also discusses the cognitive behaviour conceptualization in the maintenance of bulimia nervosa.     

Quantitative evidence for distinct cognitive impairment in anorexia nervosa and bulimia nervosa

It is generally agreed that at least some aspects of abnormal eating behaviour is indeed due in part to disordered cognition. The accumulated literature illustrates cognitive impairment in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Yet beyond being inconsistent, these independent studies also do not reveal the magnitude of impairment within and across studies and fail to give due consideration to the magnitude of impairment so as to understand the severity and breadth of impairment and/or differences in cognitive profiles between patients with AN and BN. Hence, the present review on the subject sought to articulate the magnitude of cognitive impairment in patients with AN and BN by quantitatively synthesizing the existing literature using meta-analytic methodology. The results demonstrate modest evidence of cognitive impairment specific to AN and BN that is related to body mass index in AN in terms of its severity, and is differentially impaired between disorders. Together, these results suggest that disturbed cognition is figural in the presentation of eating disorders and may serve to play an integral role in its cause and maintenance. Implications of these findings with respects to future research are discussed.     

A model of time-limited group therapy for men: Its use with recovering addicts

An array of men's issues from a newly emerging paradigm is reviewed—problems such as the dysfunctional development of masculine identity, fatherlessness, and gender role strain. The effects of social and psychological pressures on men are documented, and the need for gender-specific treatment is advocated. A brief evaluation of other group approaches to therapy for men is offered. An argument is made in favor of a more directive model of treating men in group for gender issues. The phases, components, and techniques of a new model of therapy for men are described in detail. The model focuses on the treatment of four primary emotions—grief, anger, fear, and shame—the socialization of which have caused great harm to men.     

The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

Objective

A number of effective treatments for bulimia nervosa have been developed, but they are infrequently used, in part due to problems with dissemination. The goal of this study was to examine the cost effectiveness of telemedicine delivery of cognitive behavioral therapy for bulimia nervosa.

Method

A randomized controlled trial of face-to-face versus telemedicine cognitive behavioral therapy for bulimia nervosa. One hundred twenty eight women with DSM-IV bulimia nervosa or eating disorder, not otherwise specified subsyndromal variants of bulimia nervosa were randomized to 20 sessions of treatment over 16 weeks. A cost effectiveness analysis from a societal perspective was conducted.

Results

The total cost per recovered (abstinent) subject was $9324.68 for face-to-face CBT, and $7300.40 for telemedicine CBT. The cost differential was accounted for largely by therapist travel costs. Sensitivity analyses examining therapy session costs, gasoline costs and telemedicine connection costs yielded fundamentally similar results.

Discussion

In this study, CBT delivered face-to-face and via telemedicine were similarly effective, and telemedicine delivery cost substantially less. These findings underscore the potential applicability of telemedicine approaches to eating disorder treatment and psychiatric treatment in general.     

Thoughts about eating, weight and shape in anorexia nervosa and bulimia nervosa.

Concurrent verbalisation and a self-report questionnaire were used to investigate self-statements in patients with anorexia nervosa, patients with bulimia nervosa, two groups of dieters and non-dieting controls. Thoughts were collected while subjects performed three behavioural tasks, looking at themselves in a full-length mirror, weighing themselves and eating a chocolate covered mint. Both groups of patients had more negative thoughts related to eating, weight and shape than those in the three control groups. In addition, patients with anorexia nervosa showed a greater concern with eating while patients with bulimia nervosa showed a greater concern with weight and appearance. Differences were found between the patients and non-dieting controls using both methods but the self-report questionnaire was less sensitive than concurrent verbalisation to differences between the patients and dieters. Implications of the findings for cognitive-behavioural treatments of the two disorders are discussed.     

A comparison of two psychological treatments for bulimia nervosa

Two standardized psychological treatments for bulimia nervosa were studied. A cognitive behavioural approach was compared with a form of short-term focal psychotherapy. Twenty-four patients who met strict diagnostic criteria for bulimia nervosa were randomly allocated to the two treatments. All the interviews were tape-recorded so that checks on their content could be made. Assessments took place at the beginning and end of treatment, and at 4-, 8- and 12-month follow-up. None of the patients dropped out of treatment or follow-up, but 1 patient from each treatment group had to be withdrawn on clinical grounds. Patients in both groups made substantial improvements which were well maintained over the 12-month treatment-free follow-up period. The cognitive behavioural approach was superior to short-term focal psychotherapy in terms of its effect on the patients' overall clinical state, their general psychopathology and social adjustment, and their assessment of their outcome.     

Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa

Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.     

Predictors of short-term treatment outcome in bulimia nervosa inpatients.

Recent studies, mostly performed on bulimic outpatients, did not find consistent predictors of treatment outcome in bulimia nervosa. This is the first study to investigate anamnestic and clinical factors predictive of the short-term outcome of hospital treatment in 31 female bulimia nervosa patients with a mean age of 22.9 yr. Treatment outcome was assessed by several self-rating instruments measuring different features of the specific and unspecific psychopathology of bulimia nervosa. The most relevant predictors of the outcome of the 8-week hospital treatment were duration of previous inpatient treatments for bulimia, the intensity of anorexic tendency and the pretreatment level of depression. The majority of predictors tested did not show a strong relationship to treatment outcome. The findings are discussed in relation to results of other studies as well as to possible implications for treatment and research.     

Possible differences in family patterns in anorexia nervosa and bulimia nervosa

This paper examines the interactions in three families, one where the daughter had anorexia nervosa and two where the daughters had bulimia nervosa, and proposes some differences in the families’ patterns of enmeshment. It is hypothesized that these may be linked to differences in the development of the mother—child relationship. Implications for the choice of therapeutic strategies are discussed.     

Patient personality and time-limited group psychotherapy for complicated grief

We used a randomized clinical trial to investigate the interaction of two patient personality characteristics (quality of object relations [QOR] and psychological mindedness [PM]) with two forms of time-limited, short-term group therapy (interpretive and supportive) for 139 psychiatric outpatients with complicated grief. Findings differed depending on the outcome variable (e.g., grief symptoms, general symptoms) and the statistical criterion (e.g., statistical significance, clinical significance, magnitude of effect). Patients in both therapies improved. For grief symptoms, a significant interaction effect was found for QOR. High-QOR patients improved more in interpretive therapy and low-QOR patients improved more in supportive therapy. A main effect was found for PM. High-PM patients improved more in both therapies. For general symptoms, clinical significance favored interpretive therapy over supportive therapy. Clinical implications concerning patient-treatment matching are discussed.