Disorders - Bulimia Nervosa
Summers, B. J., Cougle, J. R.
BACKGROUND: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for
modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating
disorder (ED) symptoms (e.g. bulimia, drive for thinness). AIMS: The current study sought to further examine the utility of IBM for ED symptoms via
secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as
these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information. METHOD(S): We recruited 41
participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation
biases with a placebo control training (PC). RESULT(S): At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions
in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-
treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed
on drive for thinness symptoms. CONCLUSION(S): The current study suggests that cognitive interventions for individuals with primary BDD symptoms may
improve co-occurring ED symptoms such as bulimia.
Behavioural and cognitive psychotherapy, 46(6) : 676-
689
- Year: 2018
- Problem: Eating Disorders
(any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS)
Pittock, A., Hodges, L., Lawrie, S. M.
OBJECTIVE: This review looked at internet-delivered cognitive behavioural therapy (iCBT) as a possible treatment for patients with bulimic
symptoms. CBT has been established as an effective treatment; however, waiting lists lead to delayed initiation of treatment. iCBT is a possible
delivery method to combat this. Medline, EMBASE and PsycInfo were searched for controlled trials using iCBT as a treatment for patients with bulimia
nervosa (BN), subthreshold BN or 'eating disorders not otherwise specified' with bulimic characteristics (EDNOS-BN). The literature search returned
482 papers. 5 met the review criteria and were compared in characteristics, methodological quality and outcomes. Outcomes were analysed by
calculation of effect sizes; iCBT was evaluated on reduction in binge eating and purging post treatment and at follow-up. RESULT(S): Participants
were mostly female with an average age range of 23.7-31 years. 4 studies demonstrated good methodological quality. 1 did not report all of the
outcome data, increasing the likelihood of bias. Only 1 study showed widespread benefit over waiting list controls. iCBT was shown to reduce
behaviours but was not found to be superior to bibliotherapy or waiting list. Further large-scale studies are required to make conclusive
recommendations.
BMC
research notes, 11(1) : 748
- Year: 2018
- Problem: Bulimia Nervosa, Eating disorders not specified
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Leslie, M., Leppanen, J., Paloyelis, Y., Treasure, J.
The current study aimed to test the influence of oxytocin on palatable food intake, 24-h caloric consumption, and stress
in women with bulimia nervosa and binge eating disorder. We recruited 25 women with DSM-5 bulimia nervosa or binge eating disorder, and 27 weight-
matched comparison women without history of an eating disorder. We employed a double-blind, placebo-controlled crossover design in which each
participant attended the lab for two experimental sessions, receiving a divided dose of 64IU intranasal oxytocin in one session and equivalent volume
of placebo nasal spray in the opposite session. The order of administration was pseudo-randomised across participants. We hypothesised that a divided
dose of 64IU intranasal oxytocin administration would reduce subjective hunger, the immediate consumption of palatable food, 24-h calorie
consumption, and the incidence of binge eating when compared to placebo. We also hypothesised that oxytocin administration would be associated with
lower levels of stress and salivary cortisol, and that there would be an interaction with participant group such that oxytocin would reduce eating
behaviour and stress to a greater degree in women with bulimia nervosa or binge eating disorder, compared to women without history of an eating
disorder. We did not find a significant effect of oxytocin on any of the measurements of eating behaviour, subjective stress, or salivary cortisol.
We recommend that future studies test the dose-response effect of oxytocin on eating behaviours and stress in human populations with eating disorders
to further clarify the moderating factors for oxytocin's effect on eating. Copyright © 2018 Elsevier B.V.
Molecular and Cellular
Endocrinology., :
- Year: 2018
- Problem: Binge Eating Disorders, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Summers, B. J., Cougle, J. R.
BACKGROUND: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for
modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating
disorder (ED) symptoms (e.g. bulimia, drive for thinness). AIMS: The current study sought to further examine the utility of IBM for ED symptoms via
secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as
these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information. METHOD(S): We recruited 41
participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation
biases with a placebo control training (PC). RESULT(S): At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions
in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-
treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed
on drive for thinness symptoms. CONCLUSION(S): The current study suggests that cognitive interventions for individuals with primary BDD symptoms may
improve co-occurring ED symptoms such as bulimia.
Behavioural and cognitive psychotherapy, 46(6) : 676-
689
- Year: 2018
- Problem: Eating Disorders
(any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS)
Pittock, A., Hodges, L., Lawrie, S. M.
OBJECTIVE: This review looked at internet-delivered cognitive behavioural therapy (iCBT) as a possible treatment for patients with bulimic
symptoms. CBT has been established as an effective treatment; however, waiting lists lead to delayed initiation of treatment. iCBT is a possible
delivery method to combat this. Medline, EMBASE and PsycInfo were searched for controlled trials using iCBT as a treatment for patients with bulimia
nervosa (BN), subthreshold BN or 'eating disorders not otherwise specified' with bulimic characteristics (EDNOS-BN). The literature search returned
482 papers. 5 met the review criteria and were compared in characteristics, methodological quality and outcomes. Outcomes were analysed by
calculation of effect sizes; iCBT was evaluated on reduction in binge eating and purging post treatment and at follow-up. RESULT(S): Participants
were mostly female with an average age range of 23.7-31 years. 4 studies demonstrated good methodological quality. 1 did not report all of the
outcome data, increasing the likelihood of bias. Only 1 study showed widespread benefit over waiting list controls. iCBT was shown to reduce
behaviours but was not found to be superior to bibliotherapy or waiting list. Further large-scale studies are required to make conclusive
recommendations.
BMC
research notes, 11(1) : 748
- Year: 2018
- Problem: Bulimia Nervosa, Eating disorders not specified
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Leslie, M., Leppanen, J., Paloyelis, Y., Treasure, J.
The current study aimed to test the influence of oxytocin on palatable food intake, 24-h caloric consumption, and stress
in women with bulimia nervosa and binge eating disorder. We recruited 25 women with DSM-5 bulimia nervosa or binge eating disorder, and 27 weight-
matched comparison women without history of an eating disorder. We employed a double-blind, placebo-controlled crossover design in which each
participant attended the lab for two experimental sessions, receiving a divided dose of 64IU intranasal oxytocin in one session and equivalent volume
of placebo nasal spray in the opposite session. The order of administration was pseudo-randomised across participants. We hypothesised that a divided
dose of 64IU intranasal oxytocin administration would reduce subjective hunger, the immediate consumption of palatable food, 24-h calorie
consumption, and the incidence of binge eating when compared to placebo. We also hypothesised that oxytocin administration would be associated with
lower levels of stress and salivary cortisol, and that there would be an interaction with participant group such that oxytocin would reduce eating
behaviour and stress to a greater degree in women with bulimia nervosa or binge eating disorder, compared to women without history of an eating
disorder. We did not find a significant effect of oxytocin on any of the measurements of eating behaviour, subjective stress, or salivary cortisol.
We recommend that future studies test the dose-response effect of oxytocin on eating behaviours and stress in human populations with eating disorders
to further clarify the moderating factors for oxytocin's effect on eating. Copyright © 2018 Elsevier B.V.
Molecular and Cellular
Endocrinology., :
- Year: 2018
- Problem: Binge Eating Disorders, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Stefini, A., Salzer, S., Reich, G., Horn, H., Winkelmann, K., Bents, H., Rutz, U., Frost,
U., von-Boetticher, A., Ruhl, U., Specht,
N., Kronmuller, K-T.
Objective: The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa
(BN) in female adolescents. Method: In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received
a mean of 36.6 sessions of manualized disorder-oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome
measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission,
defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated. Results: The
remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI =
0.35-2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome
measures were found for both CBT (d = 0.51-0.82) and PDT (d = 0.24-1.10). The improvements remained stable at the 12-month follow-up in both groups.
There were small between-group effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favor of CBT and for eating concern (d = -0.35) in
favor of PDT. Conclusion: CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies
were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating
concern. Clinical trial registration information-Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or
Psychodynamic Therapy (PDT). (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of the American Academy
of Child & Adolescent Psychiatry, 56(4) : 329-335
- Year: 2017
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Psychodynamic/Psychoanalysis
Linardon, J., Wade, T. D., de-la-Piedad Garcia, X., Brennan, L.
OBJECTIVE: This meta-analysis examined the efficacy of cognitive-behavioral therapy (CBT) for eating disorders.\rMETHOD:
Randomized controlled trials of CBT were searched. Seventy-nine trials were included.\rRESULTS: Therapist-led CBT was more efficacious than inactive
(wait-lists) and active (any psychotherapy) comparisons in individuals with bulimia nervosa and binge eating disorder. Therapist-led CBT was most
efficacious when manualized CBT-BN or its enhanced version was delivered. No significant differences were observed between therapist-led CBT for
bulimia nervosa and binge eating disorder and antidepressants at posttreatment. CBT was also directly compared to other specific psychological
interventions, and therapist-led CBT resulted in greater reductions in behavioral and cognitive symptoms than interpersonal psychotherapy at
posttreatment. At follow-up, CBT outperformed interpersonal psychotherapy only on cognitive symptoms. CBT for binge eating disorder also resulted in
greater reductions in behavioral symptoms than behavioral weight loss interventions. There was no evidence that CBT was more efficacious than
behavior therapy or nonspecific supportive therapies.\rCONCLUSIONS: CBT is efficacious for eating disorders. Although CBT was equally efficacious to
certain psychological treatments, the fact that CBT outperformed all active psychological comparisons and interpersonal psychotherapy specifically,
offers some support for the specificity of psychological treatments for eating disorders. Conclusions from this study are hampered by the fact that
many trials were of poor quality. Higher quality RCTs are essential. (PsycINFO Database Record
Journal of Consulting & Clinical Psychology, 85(11) : 1080-
1094
- Year: 2017
- Problem: Anorexia Nervosa, Binge Eating Disorders, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Boerhout, C., Swart, M., Voskamp, M., Troquete, N. A., van-Busschbach, J. T., Hoek, H. W.
Objective: The objective is to evaluate a
body and movement-oriented intervention on aggression regulation, specifically aimed towards reducing anger internalization in patients with an
eating disorder. Method: Patients were randomized to treatment-as-usual (TAU) plus the intervention (n = 38) or to TAU only (n = 32). The
intervention was delivered by a psychomotor therapist. TAU consisted of multidisciplinary day treatment (3-5 days per week during 3-9 months). Anger
coping (Self-Expression and Control Scale) and eating pathology (Eating Disorder Examination-Self-report Questionnaire) were measured at baseline and
follow-up. Differences between pre-intervention and post-intervention scores were tested by using repeated measures ANOVA. Results: The intervention
group showed a significantly larger decrease of anger internalization than the control group (eta2 = 0.16, p = 0.001). Both groups showed a
significant reduction in eating pathology, but differences between groups were not significant. Discussion: A body and movement-oriented therapy
seems a viable add-on for treating anger internalization in patients with an eating disorder. (PsycINFO Database Record (c) 2017 APA, all rights
reserved)
European Eating Disorders Review, 25(1) : 52-
59
- Year: 2017
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Kekic, M., McClelland, J., Bartholdy, S., Boysen, E., Musiat, P., Dalton, B., Tiza, M., David, A. S., Campbell, I. C., Schmidt, U.
BACKGROUND: Evidence suggests that pathological eating
behaviours in bulimia nervosa (BN) are underpinned by alterations in reward processing and self-regulatory control, and by functional changes in
neurocircuitry encompassing the dorsolateral prefrontal cortex (DLPFC). Manipulation of this region with transcranial direct current stimulation
(tDCS) may therefore alleviate symptoms of the disorder.\rOBJECTIVE: This double-blind sham-controlled proof-of-principle trial investigated the
effects of bilateral tDCS over the DLPFC in adults with BN.\rMETHODS: Thirty-nine participants (two males) received three sessions of tDCS in a
randomised and counterbalanced order: anode right/cathode left (AR/CL), anode left/cathode right (AL/CR), and sham. A battery of
psychological/neurocognitive measures was completed before and after each session and the frequency of bulimic behaviours during the following 24-
hours was recorded.\rRESULTS: AR/CL tDCS reduced eating disorder cognitions (indexed by the Mizes Eating Disorder Cognitions Questionnaire-Revised)
when compared to AL/CR and sham tDCS. Both active conditions suppressed the self-reported urge to binge-eat and increased self-regulatory control
during a temporal discounting task. Compared to sham stimulation, mood (assessed with the Profile of Mood States) improved after AR/CL but not AL/CR
tDCS. Lastly, the three tDCS sessions had comparable effects on the wanting/liking of food and on bulimic behaviours during the 24 hours post-
stimulation.\rCONCLUSIONS: These data suggest that single-session tDCS transiently improves symptoms of BN. They also help to elucidate possible
mechanisms of action and highlight the importance of selecting the optimal electrode montage. Multi-session trials are needed to determine whether
tDCS has potential for development as a treatment for adult BN.
, 12(1) : e0167606
- Year: 2017
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Thompson-Brenner, H., Shingleton, R. M., Thompson, D. R., Satir, D. A., Richards, L.
K., Pratt, E. M., Barlow, D. H.
Objective: A subset of individuals with bulimia nervosa (BN) have borderline personality disorder (BPD) symptoms, including chronic negative
affect and interpersonal problems. These symptoms predict poor BN treatment outcome in some studies. The broad version of Enhanced Cognitive Behavior
Therapy (CBT-E) was developed to address co-occurring problems that interfere with treatment response. The current study investigated the relative
effects, predictors, and moderators of CBT-E for BN with BPD and co-occurring mood/anxiety disorders. Method: Fifty patients with BN and threshold or
sub-threshold BPD and current or recent Axis I mood or anxiety disorders were randomly assigned to receive focused CBT-E (CBT-Ef) or broad CBT-E
(CBT-Eb) specifically including an interpersonal module and additional attention to mood intolerance. Results: Forty-two percent of the sample
reported remission from binge eating and purging at termination. Significant changes across symptom domains were observed at termination and at 6-
month follow-up. Though CBT-Ef predicted good outcomes in multivariate models, the severity of affective/interpersonal problems moderated treatment
effects: participants with higher severity showed better ED outcomes in CBT-Eb, whereas those with lower severity showed better outcomes in CBT-Ef.
Severity of affective/ interpersonal BPD symptoms at baseline predicted negative outcomes overall. Follow-up BPD affective/interpersonal problems
were predicted by baseline affective/interpersonal problems and by termination EDE score. Discussion: This study supports the utility of CBT-E for
patients with BN and complex comorbidity. CBT-Ef appears to be more efficacious for patients with relatively less severe BPD symptoms, whereas CBT-Eb
appears to be more efficacious for patients with more severe BPD symptoms. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
International Journal of Eating Disorders, 49(1) : 36-
49
- Year: 2016
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Boerhout, C., Swart, M., Van-Busschbach, J. T., Hoek, H. W.
OBJECTIVE: The objective of the study is to evaluate the effect of a brief body and movement oriented intervention on aggression
regulation and eating disorder pathology for individuals with eating disorders.\rMETHOD: In a first randomized controlled trial, 40 women were
allocated to either the aggression regulation intervention plus supportive contact or a control condition of supportive contact only. The
intervention was delivered by a psychomotor therapist. Participants completed questionnaires on anger coping and eating disorder pathology.
Independent samples t-tests were performed on the difference between pre-treatment and post-treatment scores.\rRESULTS: Twenty-nine participants
completed questionnaires at pre-intervention and post-intervention. The intervention resulted in a significantly greater improvement of anger coping,
as well as of eating disorder pathology.\rDISCUSSION: Results indicate that body and movement-oriented aggression regulation may be a viable add-on
for treating eating disorders. It tackles a difficult to treat emotion which may have a role in blocking the entire process of treating eating
disorders.\rCopyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders
Review, 24(2) : 114-21
- Year: 2016
- Problem: Anorexia Nervosa, Binge Eating Disorders, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise