Anorexia nervosa treated with response prevention and prolonged exposure

This paper presents two cases of anorexia nervosa who became overweight following an operant behavioral inpatient treatment program which, in addition, included prolonged exposure to phobic stimuli and response prevention of compulsive exercising.     

The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy

In this study (1) exposure in vivo plus response prevention, (2) cognitive therapy and (3) a waiting-list control condition were compared on their efficacy on the treatment of hypochondriasis. Seventy-eight patients with a DSM-IV diagnosis of hypochondriasis were randomly assigned to one of these conditions. Patients in both active treatment conditions improved significantly on all the measures, whereas the patients in the waiting-list control condition did not improve. The improvements were clinically significant. Exposure in vivo plus response prevention and cognitive therapy were equally effective. The improvements were maintained at the 7 months follow up.     

Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention

The efficacy of contemporary cognitive therapy for obsessive–compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.     

Cognitive-behavioral treatment with and without response prevention for Bulimia

We compared cognitive-behavior therapy (CBT) with and without exposure and response prevention (ERP) in the treatment of eating disorder patients who both binged and purged, and reported abnormal attitudes concerning body weight and shape. Both treatments produced significant and comparable reductions in binge-eating and purging, eating patterns, and attitudes about weight and shape at posttreatment. Treatment effects were generalized to improvements in different measures of general psychopathology, and were maintained over follow-ups of 3 and 12 months. The findings are consistent with prior research showing that CBT is an effective treatment for patients with the core features of bulimia nervosa. Furthermore, the data suggest that the addition of in-session exposure and response prevention does not enhance the effectiveness of the basic CBT program.     

Bulimia nervosa: a descriptive and therapeutic study

This study examined a sample of 24 Ss who met strict criteria for a diagnosis of bulimia nervosa. Assessments were made on: (1) demographic characteristics, (2) eating attitudes and behaviour and (3) personality measures. The effectiveness of two types of therapeutic intervention (cognitive-behavioural group therapy vs cognitive-behavioural group therapy plus specific behavioural instruction) was examined in a baseline, therapy intervention, follow-up design.The group was characterized prior to therapy by high N, Depression and Anxiety and low Self-esteem scores compared with control group data. Following therapy, Depression and Anxiety scores were significantly lower and Self-esteem scores higher, whereas N scores remained high. Binge-purging frequencies were significantly reduced in some of the Ss but the reduction could not unequivocally be attributed to the therapeutic interventions. The pattern of results suggested that bulimia nervosa (defined by a binge-purging pattern in association with high neuroticism) should be distinguished from bulimia (defined by a binge pattern not related to purging or high neuroticism) and that DSM-III should be revised to reflect this distinction. A theory is advanced to account for the rapid association of binging and purging in Ss high in neuroticism but not in Ss low in neuroticism.     

Integrative time-limited group therapy for bulimia nervosa.

This article presents an integrative group therapy model for the treatment of bulimia nervosa (BN) and describes the 12-session format, incorporating components of cognitive-behavioral therapy (CBT), psychoeducation, interpersonal therapy (IPT), and relational therapy (RT), in detail. Previous reports have found CBT, IPT, and RT to be effective approaches for BN when used separately. The integrative approach may have the advantage of achieving symptom reduction by two different mediating mechanisms, those that directly affect eating behaviors and those that address the interpersonal and relational context in which the disordered eating has developed. The group approach makes use of the peer group in providing new opportunities for self-exploration and self-correction. One advantage of an integrative model is patients' exposure to several different treatment modalities from which they can identify specific approaches that are most helpful to their recovery. This identification is valuable in directing future treatment, if needed. Pilot data for this approach are presented.     

Cue exposure and response prevention with alcoholics: a controlled trial

Ten severely alcohol-dependent subjects were divided into two groups, one of which received only 6 sessions of in-vivo cue exposure and response prevention and the other of which received 6 sessions of imaginal cue exposure, followed by 6 sessions of in-vivo cue exposure and response prevention. The in-vivo cue exposure produced significant decrements on behavioural and subjective measures for both experimental groups on Desire to Drink and Difficulty to Resist Alcohol. Imaginal cue exposure produced trivial changes on these measures. The implications for both theory and practice are discussed.     

Bulimia nervosa in undergraduate women: Factors associated with internalization of the sociocultural standard of thinness

Diverse areas of research and theory are integrated in an attempt to better understand the specific risk factors for bulimia nervosa identified in the literature. It is suspected that the interplay of risk factors may be unique to different groups of individuals who develop bulimia. Further, it is proposed that specific determinants be studied individually to determine their particular influence in the etiology of bulimia. It is suggested that the investigation of specific risk factors for bulimia in certain groups will benefit researchers and clinicians in gaining a better conceptual understanding of the process involved in the development of the disorder. This article focuses on the determinants of a specific risk factor (i.e., internalization of the sociocultural standard of thinness) for bulimia in undergraduate women, a group identified as particularly vulnerable to this disorder. Research and theory are integrated to suggest that a combination of specific individual differences, family, and social factors make some undergraduate women more vulnerable to the influence of the sociocultural standard of thinness and bulimia. Suggestions for the inclusion of these psychosocial factors in future empirical investigations and treatment programs are also discussed.     

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.     

Familiarity, group exposure, and risk-taking behavior in gambling

This research studied the effect of familiarity and individual versus group participation on risk-taking behavior in gambling (American roulette). Thirty-eight subjects (21 men and 17 women) were randomly selected and assigned to two experimental groups that gambled either individually or in groups. Results revealed that players bet more heavily as they became more familiar with the game, whether playing alone or in groups.     

Challenging the omnipotence of voices: group cognitive behavior therapy for voices

The present study examines the impact of group based cognitive behavior therapy (CBT) for drug resistant auditory hallucinations, or voices. In particular it assesses treatment effect on beliefs in a voice's omnipotence and control. Twenty-two participants entered one of five 8-session CBT groups. Measures of omnipotence, control, process measures, and symptoms of anxiety and depression were completed at assessment, and first and last group sessions. The groups achieved a significant reduction in conviction in beliefs about omnipotence (df 2, P = 0.002) and control (df 2, P = 0.001). There were no affective changes. Certain participants showed important spontaneous changes in behavior. Process measures suggested that participants valued the groups and benefited from them. These results are promising and the treatment may prove a useful addition to existing psychological interventions.