Zeeck, Almut, Weber, Stefanie, Sandholz, Angelika, Wetzler- Burmeister, Edda, Wirsching, Michael, Scheidt, Carl Eduard, Hartmann, Armin

Inpatient versus day treatment for bulimia nervosa:Results of a one-year follow-up

Psychotherapy & Psychosomatics, 78(5) : 317-319

Walpoth, M., Hoertnagl, C., Mangweth-Matzek, B., Kemmler, G., Hinterholzl, J., Conca, A., Hausmann, A.

Repetitive transcranial magnetic stimulation in bulimia nervosa: Preliminary results of a single-centre, randomised, double-blind, sham-controlled trial in female outpatients

BACKGROUND: Bulimia nervosa (BN) is often associated with depressive symptoms and treatment with antidepressants has shown positive effects. A shared deficient serotonergic transmission was postulated for both syndromes. The left dorsolateral prefrontal cortex was argued to regulate eating behaviour and to be dysfunctional in eating disorders. METHODS: Fourteen women meeting DSM-IV criteria for BN were included in a randomised placebo-controlled double-blind trial. In order to exclude patients highly responsive to placebo, all patients were first submitted to a one-week sham treatment. Randomisation was followed by 3 weeks of active treatment or sham stimulation. As the main outcome criterion we defined the change in binges and purges. Secondary outcome variables were the decrease of the Hamilton Depression Rating Scale (HDRS), the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Scale (YBOCS) over time. RESULTS: The average number of binges per day declined significantly between baseline and the end of treatment in the two groups. There was no significant difference between sham and active stimulation in terms of purge behaviour, BDI, HDRS and YBOCS over time. CONCLUSION: These preliminary results indicate that repetitive transcranial magnetic stimulation (rTMS) in the treatment of BN does not exert additional benefit over placebo. A larger number of patients might clarify a further role of rTMS in the treatment of BN. 2008 S. Karger AG, Basel

Psychotherapy & Psychosomatics, 77(1) : 57- 60

Bloomgarden, A., Calogero, R. M.

A randomized experimental test of the efficacy of EMDR treatment on negative body image in eating disorder inpatients

Eye Movement Desensitization and Reprocessing (EMDR) therapy is being used by some clinicians to treat eating disorders. Although there is anecdotal and case study data supporting its use, there are no controlled studies examining its effectiveness with this population. This study examined the short and long-term effects of EMDR in a residential eating disorders population. A randomized, experimental design compared 43 women receiving standard residential eating disorders treatment (SRT) to 43 women receiving SRT and EMDR therapy (SRT+EMDR) on measures of negative body image and other clinical outcomes. SRT+EMDR reported less distress about negative body image memories and lower body dissatisfaction at posttreatment, 3-month, and 12-month follow-up, compared to SRT. Additional comparisons revealed no differences between the conditions pre to posttreatment on other measures of body image and clinical outcomes. The empirical evidence reported here suggests that EMDR may be used to treat specific aspects of negative body image in conjunction with SRT, but further research is necessary to determine whether or not EMDR is effective for treating the variety of eating pathology presented by eating disorder inpatients.

Eating Disorders., 16(5) : 418- 427

Burton, E., Stice, E., Bearman, S. K., Rohde, P.

Experimental test of the affect-regulation theory of bulimic symptoms and substance use: a randomized trial

Objective: Conduct a randomized trial to test whether a cognitive behavioral intervention designed to decrease de- pressive symptoms produces subsequent decreases in bulimic and substance use symptoms.\rMethod: Female participants (N 1/4 145) with elevated depressive symptoms were randomly assigned to a 4-session depres- sion intervention or a measurement-only condition and assessed through 6-month follow-up.\rResults: Relative to control partici- pants, intervention participants showed decreases in depressive symptoms. Inter-\rvention participants also showed signifi- cantly greater reductions in bulimic symptoms, but not substance use, and change in depressive symptoms medi- ated this effect for bulimic symptoms.\rConclusion: The results provide experi- mental support for the theory that affect disturbances contribute to bulimic path- ology, but do not support the affect regu- lation theory of substance use. VC 2006 by Wiley Periodicals, Inc.\rKeywords: affect-regulation; depression; bulimia; substance use; randomized trial

International Journal of Eating Disorders, 40(1) : 27- 36

Couturier, J., Lock, J.

Psychopharmacology update: A review of medication use for children and adolescents with eating disorders

Objective: This paper aims to review the research literature on the use of medication for eating disorders in children and adolescents. Method: The literature was reviewed on the pharmacotherapy of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS). The PubMed database was searched for all articles on medication use in the child and adolescent population using the terms medication, antipsychotic, antidepressant, child, adolescent, eating disorders, anorexia nervosa and bulimia nervosa. Results: Very little literature exists on the use of medication for the treatment of eating disorders in children and adolescents. There is one retrospective study on the use of SSRIs and some case reports on atypical antipsychotics for children and adolescents with AN, and one small open trial on SSRIs for adolescent BN. Conclusions: Evidence-based pharmacological treatment for children and adolescents with eating disorders is not yet possible due to the limited number of studies available, It appears that olanzapine and other atypical antipsychotics may prove to be promising for AN at low body weights. It remains uncertain whether SSRIs are helpful in preventing relapse in AN. For children and adolescents with BN, the first line pharmacological option is fluoxetine given the large evidence base of this drug with the adult population and a small open trial of adolescents with BN.

Canadian Child & Adolescent Psychiatry Review, :

Cooper, M. J., Todd, G., Turner, H.

The effects of using imagery to modify core emotional beliefs in bulimia nervosa: An experimental pilot study

Imagery modification was administered in a pilot study to patients with bulimia nervosa. The aim was to change patients' emotionally held negative self-beliefs. Negative self-beliefs were identified and belief ratings obtained. A single session imagery intervention, focused on an early memory associated with these beliefs, was then conducted with the experimental group, while a control group received a control intervention. Significant changes were found in the experimental group, compared to the control group, in belief ratings for emotionally held negative self-belief ratings. Emotional (and rational) self-belief change was associated with mood and behavior change, including decreased urge to binge. The implications and limitations of the study are discussed. copyright 2007 Springer Publishing Company.

Journal of Cognitive Psychotherapy., 21(2) : 117- 122

leGrange, Daniel, Crosby, Ross D., Rathouz, Paul J., Leventhal, Bennett L.

A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa

CONTEXT: Evidenced-based treatment trials for adolescents with bulimia nervosa are largely absent. OBJECTIVE: To evaluate the relative efficacy of family-based treatment (FBT) and supportive psychotherapy (SPT) for adolescents with bulimia nervosa. DESIGN: Randomized controlled trial. SETTING: The University of Chicago from April 1, 2001, through June 30, 2006. PARTICIPANTS: Eighty patients, aged 12 to 19 years, with a DSM-IV diagnosis of bulimia nervosa or a strict definition of partial bulimia nervosa. INTERVENTIONS: Twenty outpatient visits over 6 months of FBT or SPT. Participants were followed up at 6 months posttreatment. MAIN OUTCOME MEASURES: Abstinence from binge-and-purge episodes as measured by the Eating Disorder Examination. Secondary outcome measures were Eating Disorder Examination binge-and-purge frequency and Eating Disorder Examination subscale scores. RESULTS: Forty-one patients were assigned to FBT and 39 to SPT. Categorical outcomes at posttreatment demonstrated that significantly more patients receiving FBT (16 [39%]) were binge-and-purge abstinent compared with those receiving SPT (7 [18%]) (P = .049). Somewhat fewer patients were abstinent at the 6-month follow-up; however, the difference was statistically in favor of FBT vs SPT (12 patients [29%] vs 4 patients [10%]; P = .05). Secondary outcome assessment, based on random regression analysis, revealed main effects in favor of FBT on all measures of eating pathological features (P = .003 to P = .03 for all). CONCLUSIONS: Family-based treatment showed a clinical and statistical advantage over SPT at posttreatment and at 6-month follow-up. Reduction in core bulimic symptoms was also more immediate for patients receiving FBT vs SPT.

Archives of General Psychiatry, 64(9) : 1049-56

Schmidt, Ulrike, Lee, Sally, Beecham, Jennifer, Perkins, Sarah, Treasure, Janet, Yi, Irene, Winn, Suzanne, Robinson, Paul, Murphy, Rebecca, Keville, Saskia, Johnson- Sabine, Eric, Jenkins, Mari, Frost, Susie, Dodge, Liz, Berelowitz, Mark, Eisler, Ivan

A randomized controlled trial of family therapy and cognitive behavior therapy guided self-care for adolescents with bulimia nervosa and related disorders

OBJECTIVE: To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified. METHOD: Eighty-five adolescents with bulimia nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for bulimia nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care. RESULTS: Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories. CONCLUSIONS: Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.

American Journal of Psychiatry, 164(4) : 591- 8

Richards, P. Scott, Berrett, Michael E., Hardman, Randy K., Eggett, Dennis L.

Comparative efficacy of spirituality, cognitive, and emotional support groups for treating eating disorder inpatients

Spiritual interventions are rarely used in contemporary treatment programs and little empirical evidence is available concerning their effectiveness. The purpose of the present study was to evaluate the effectiveness of a spiritual group intervention for eating disorder inpatients. We compared the effectiveness of a Spirituality group with Cognitive and Emotional Support groups using a randomized, control group design. Participants were 122 women receiving inpatient eating disorder treatment. Patients in the Spirituality group tended to score significantly lower on psychological disturbance and eating disorder symptoms at the conclusion of treatment compared to patients in the other groups, and higher on spiritual well-being. On weekly outcome measures, patients in the Spirituality group improved significantly more quickly during the first four weeks of treatment. This study provides preliminary evidence that attending to eating disorder patients' spiritual growth and well- being during inpatient treatment may help reduce depression and anxiety, relationship distress, social role conflict, and eating disorder symptoms.

Brunner-Mazel Eating Disorders Monograph Series, 14(5) : 401-15

Nevonen, L., Broberg, A. G.

A comparison of sequenced individual and group psychotherapy for patients with bulimia nervosa

Objective: The current study examined the effectiveness of individual (IND) versus group (GRP) therapy for patients with bulimia nervosa (BN), using a manual of sequenced treatment with cognitive-behavioral therapy (CBT) followed by interpersonal psychotherapy (IPT). Method: Eighty-six participants with BN were matched and randomized to 23 sessions of IND or GRP. Participants were measured pretreatment and post-treatment and at 1-year and 2.5-year follow-ups using both intent-to-treat and completer samples. Results: The intent-to-treat analysis revealed that the percentage of participants recovered and remitted was equivalent between IND and GRP. Significant group differences were found between completers on binge eating and compensatory behavior with greater improvement for IND. On most measures, effect sizes were larger for IND at 1-year follow-up. Conclusion: Sequencing CBT and IPT worked well in both IND and GRP formats. We found few outcome differences between IND as opposed to GRP. copyright 2005 by Wiley Periodicals, Inc.

International Journal of Eating Disorders., 39(2) : 117- 127

Dunn, Eric C., Neighbors, Clayton, Larimer, Mary E.

Motivational enhancement therapy and self-help treatment for binge eaters

OBJECTIVE: The aims of this study were to evaluate whether a single session of motivational enhancement therapy (MET) would increase participant readiness to change, improve the efficacy of self-help treatment for binge eaters, and improve participant compliance with the self-help manual. METHOD: Participants with bulimia nervosa or binge eating disorder were randomly assigned either to attend a 1-hr MET session prior to receiving the self-help manual (n = 45) or to receive the self-help manual only (n = 45). Participants were followed for 4 months for assessment of self-reported eating disorder outcome and compliance. RESULTS: The MET intervention resulted in increased readiness to change for binge eating compared with the self-help-only (SH) condition. Few differences were found between the MET condition and the SH condition for changes in eating attitudes and frequency of binge eating and compensatory behaviors. No significant effects were found for compliance. DISCUSSION: This research adds to the literature regarding the use of brief motivational interventions to enhance readiness for change in populations with eating disorders.

Psychology of Addictive Behaviors, 20(1) : 44- 52

Burton, Emily, Stice, Eric

Evaluation of a healthy-weight treatment program for bulimia nervosa: A preliminary randomized trial

OBJECTIVE: Conduct a randomized treatment trial to test whether healthy dieting maintains bulimic symptoms or effectively reduces this eating disturbance. METHODS: Female participants (n=85) with full- and sub-threshold bulimia nervosa were randomly assigned to a 6-session healthy dieting intervention or waitlist condition and assessed through 3-month follow-up. RESULTS: Relative to control participants, intervention participants showed modest weight loss during treatment and demonstrated significant improvements in bulimic symptoms that persisted through follow-up. DISCUSSION: These preliminary results suggest that this intervention shows potential for the treatment of bulimia nervosa and may be worthy of future refinement and evaluation. Results also provide experimental evidence that dieting behaviors do not maintain bulimia nervosa, suggesting the need to reconsider maintenance models for this eating disorder.

Behaviour Research & Therapy, 44(12) : 1727-38