Disorders - Bulimia Nervosa
Hsu, L., Rand, W., Sullivan, S., Liu, D., Mulliken, B., McDonagh, B., Kaye, W.
Compared the effectiveness of cognitive therapy (CT), nutritional therapy (NT), the combination of cognitive and nutritional therapy (CNT),
against a control condition of support group (SG) in the treatment of bulimia nervosa. 100 female outpatients (mean age 24.5 yrs) with bulimia
nervosa were randomized to the four treatment groups. NT and CT were designed to cover different areas with minimal overlap, and CNT provided all of
the features of both of these treatments. The control condition was conducted in a group self-help format. Each of the treatments lasted 14 wks. All
three active treatments as well as SG produced significant decreases in binge/vomit episodes. Intent-to-treat analysis found CNT and CT to be
significantly more effective than SG in retaining Ss in treatment and completion of study, as well as in producing greater improvements in
dysfunctional attitudes and self-control. CNT was superior to SG in achieving abstinence from bulimic behaviour. NT was superior to SG only in
increase of self-control. Logistic regression found that the cognitive component, whether given alone or in conjunction with NT, and higher pre-
treatment self-control scores were significant predictors for both completion of study and abstinence. (PsycINFO Database Record (c) 2008 APA, all
rights reserved).
Psychological Medicine, 31(5) : 871-879
- Year: 2001
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Dietary advice, dietary change
Bachar, Eytan, Latzer, Yael, Kreitler, Shulamit, Berry, Elliot M.
The authors investigated the
applicability of self psychological treatment (SPT) and cognitive orientation treatment (COT) to the treatment of anorexia and bulimia. 33 female
patients (mean age 24 yrs) participated in this study. The bulimic patients (N=25) were randomly assigned either to SPT, COT, or control/nutritional
counseling only (C/NC). The anorexic patients (N=8) were randomly assigned to either SPT or COT. Patients were administered a battery of outcome
measures assessing eating disorders symptomatology, attitudes toward food, self structure, and general psychiatric symptoms. After SPT, significant
improvement was observed. After COT, slight but nonsignificant improvement was observed. After C/NC, almost no changes could be detected. (PsycINFO
Database Record (c) 2008 APA, all rights reserved).
Psychotherapy Practice & Research, 8(2) : 115-128
- Year: 1999
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Field, Tiffany, Schanberg, Saul, Kuhn, Cynthia, Field, Tory, Fierro, Karen, Henteleff, Tanja, Mueller, Cynthia, Yando, Regina, Shaw, Seana, Burman,
Iris
24 female adolescent bulimic
inpatients were randomly assigned to a massage therapy or a standard treatment group. Results indicate that the massaged patients showed immediate
reductions (both self-report and behavior observation) in anxiety and depression. In addition, by the last day of the therapy, they had lower
depression scores, lower cortisol (stress) levels, and higher dopamine levels, and showed improvement on several other psychological and behavioral
measures. Results suggest that massage therapy is effective as an adjunct treatment for bulimia. (PsycINFO Database Record (c) 2008 APA, all rights
reserved).
Adolescence, 33(131) : 555-563
- Year: 1998
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Massage
Goldbloom,
David S., Olmsted, Marion, Davis, Ron, Clewes, Janet, Heinmaa, Margus, Rockert, Wendi, Shaw, Brian
Compared and combined fluoxetine and individual cognitive behavioral therapy in the treatment of bulimia
nervosa. Participants were 76 women (18-45 yrs old) who sought treatment at the Eating Disorders Program of the Toronto Hospital and who met
Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for bulimia nervosa. Ss were randomly assigned to receive
fluoxetine alone, cognitive behavior therapy alone, or the two in combination and were treated over 16 wks. Short-term outcome revealed that all 3
treatment conditions were associated with clinical improvement across a wide range of parameters. The combination of pharmacotherapy and
psychotherapy was superior to pharmacotherapy alone on specific parameters and there was no statistically significant advantage to the combination
over psychotherapy alone. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Behaviour Research & Therapy, 35(9) : 803-
811
- Year: 1997
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Beumont, Pierre J., Russell, Janice D., Touyz,
Stephen W., Buckley, Cathy, Lowinger, Kitty, Talbot, Peter, Johnson, Gordon F.
Examined whether nutritional counselling is associated with an improvement in bulimic symptomatology, whether this improvement is
maintained during post-treatment follow-up, and whether the addition of fluoxetine confers additional benefit. 67 patients referred to specialist
eating disorder services who fulfilled strict diagnostic criteria were treated with intensive nutritional counselling and randomly assigned to either
fluoxetine or placebo. After a 1-wk wash-out, active treatment was given over 8 wks, followed by post-treatment interviews at 12 and 20 wks. Both
groups of patients improved significantly during treatment. In some respects, the fluoxetine group did slightly better as demonstrated by the items
\"restraint\", \"weight concern\" and \"shape concern\" on the Eating Disorder Examination (EDE). Fluoxetine patients decreased their energy intake
and lost a modest amount of weight. They went on to regain weight during the follow-up period, returning to levels higher than they were initially.
These patients also appeared more likely to have a recurrence of symptoms, as shown by the fall in percentage of binge-free patients and by changes
in the EDE. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Australian & New
Zealand Journal of Psychiatry, 31(4) : 514-524
- Year: 1997
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Complementary & Alternative
Interventions (CAM), Dietary advice, dietary change
Andrewes, David
G., O'Connor, Peter, Mulder, Claudia, McLennan, Jim, et al.,
Assessed a new computer-based method of health education for patients with bulimia and anorexia nervosa. 54 patients with eating
disorders were allocated randomly to 1 of 2 groups to receive either a computer-presented health education package (DIET) or a placebo computer-based
program. Both groups were assessed before and after intervention on a questionnaire measuring knowledge of eating disorders and a questionnaire
measuring attitudes to eating-disordered behavior. The DIET group members were significantly improved when compared to the placebo group in terms of
both their knowledge and attitudes towards their disorder. The patients rated the DIET program as being both easy to use and helpful. Thus, the DIET
program has been found to be a resource-efficient means of health education for patients with eating disorders. (PsycINFO Database Record (c) 2008
APA, all rights reserved).
Australian & New Zealand Journal of Psychiatry, 30(4) : 492-
497
- Year: 1996
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Psychoeducation, Technology, interventions delivered using technology (e.g. online, SMS)
Fichter, MM., Kruger, R., Rief, W., Holland, R., Dohne, J.
Tested the efficacy of fluvoxamine (FLU) in
maintaining improvement of 72 patients with bulimia nervosa treated successfully with inpatient psychotherapy. FLU and placebo, respectively, were
given over a period of about 15 wks. The variables assessed concerned bulimic behavior and other aspects of eating disorders, global status,
depression, anxieties, obsessive-compulsive behavior, and other aspects of psychopathology. Because the dropout rate was high (33%) and because it
was higher in the FLU group (19 out of 37 Ss), analyses were performed on the intent-to-treat sample (all 72 Ss). In both the intent-to-treat and the
completer analyses, the following measures showed FLU to have a significant effect in reducing the return of bulimic behavior: (1) self-ratings:
Eating Disorder Inventory (EDI); (2) expert ratings: a structured interview for anorexia and bulimia nervosa (SIAB). Two further variables (EDI-total
score and SIAB-subscale bulimia) showed the superior relapse prevention effects of FLU compared with placebo for the completer sample. (PsycINFO
Database Record (c) 2008 APA, all rights reserved).
Journal of Clinical Psychopharmacology, 16(1) : 9-
18
- Year: 1996
- Problem: Bulimia Nervosa
- Type: Controlled clinical trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Kaminski, Patricia L., McNamara, Kathleen
Empirically tested the efficacy of K. McNamara\"s (see record 1990-10424-001) 8-wk psychoeducational group program that aims at reducing
high risk behaviors for bulimia. 29 college women (mean age 18.3 yrs) evidencing low body esteem, repeated dieting efforts, and other dysfunctional
eating behaviors or attitudes were randomly assigned to group treatment or control conditions. Results show at post-test and followup, Ss who
received intervention reported significantly improved levels of self-esteem and body satisfaction, and reduction in the reliance on potentially
dangerous methods of weight management compared to controls. Ss also reported less fears of negative evaluation by others and endorsed fewer
stereotypes about thinness and attractiveness. Ss in the treatment condition showed significantly reduced levels of perfectionism at posttest, but
this change was not maintained at follow-up. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Journal of Counseling & Development, 74(3) : 288-
294
- Year: 1996
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Treasure, J., Schmidt, U., Troop, N., Tiller, J., Todd, G., Turnbull, S.
Background. The aim of
this study was to evaluate the effectiveness of a stepped care approach to the treatment of bulimia nervosa: a self-care manual followed, if
necessary, by a course of attenuated cognitive behavioural treatment (CBT) in comparison with standard CBT. Method. One hundred and ten patients,
presenting at a tertiary referral centre with ICD-10 bulimia nervosa or atypical bulimia nervosa, were randomly assigned to one of two treatment
conditions; a) a sequential treatment group: 8 weeks with a self- care manual followed by up to eight sessions of CBT (if still symptomatic) or b) 16
sessions of CBT. Results. Bulimic symptoms improved significantly in both groups with no significant differences between the two groups on any of the
measures at the end of treatment or at 18 months follow-up. At end of treatment 30% (95% CI: 18-46%) of the sequential group and 30% (95% CI: 17-
47%) of the standard treatment group were free from all bulimic symptoms. Sixteen of those in the sequential group improved significantly with self-
care and did not require additional treatment. The median number of sessions taken by the sequential group was three (95% CI: 0-6). At 18 months
follow- up 40% (95% CI: 23-59%) of the sequential group and 41% (95% CI: 25-59%) of the CBT group were symptom free. Conclusions. A sequential
approach to the treatment of bulimia may be as effective as standard CBT and can considerably reduce the amount of therapist contact required.
British Journal of
Psychiatry., 168(JAN) : 94-98
- Year: 1996
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Kaneva, Riitta, Rissanen, Aila, Sarna, Seppo
Compared the efficacy of fluoxetine with placebo in an 8-wk double-blind study of bulimia
nervosa female patients. Efficacy was evaluated by semistructured interviews and self-ratings. 22 patients in the fluoxetine group and 24 in the
placebo group completed the study. The ratings of Ss on the Hamilton Rating Scale for Depression and on the depression subscale improved
significantly more with fluoxetine than with placebo. The efficacy of fluoxetine emerged within the 1st 4 wks. Clinician-rated anxiety and self-rated
anxiety were significantly reduced with fluoxetine. Fluoxetine was superior in increasing the feeling of energy. Fluoxetine also reduced eating-
related symptoms, and the patients taking fluoxetine lost weight; in contrast, patients taking placebo gained weight. (PsycINFO Database Record (c)
2008 APA, all rights reserved).
Nordic Journal of Psychiatry, 49(4) : 237-
242
- Year: 1995
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Cooper, P. J., Steere, J.
In an effort to elucidate the role of cognitive factors in the maintenance of bulimia nervosa, the efficacy of two
psychological treatments was examined in a randomised control trial: cognitive behaviour therapy in the absence of explicit exposure instructions was
compared with exposure and response prevention treatment in the absence of cognitive restructuring procedures. In the short term both treatments were
successful at effecting substantial improvement in both the specific and the non-specific psychopathology of the disorder. However, at a one year
follow up, whilst improvements were well maintained for those who had received the cognitive-behavioural treatment, virtually all of those who had
responded to the purely behavioural treatment had relapsed. This provides some support for the cognitive model of the maintenance of bulimia nervosa.
Nevertheless, the two treatment groups could not be distinguished on post-treatment measures of cognitive disturbance and neither was it the case
that residual levels of cognitive disturbance, as assessed, predicted relapse. This may suggest that the level at which the necessary cognitive
change takes place may not be accessible by conventional assessment procedures.
Behaviour
Research & Therapy., 33(8) : 875-885
- Year: 1995
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention
Griffiths, Rosalyn A., Hadzi-Pavlovic, Dusan, Channon-Little, Lorna
Reports the pre-post findings from a controlled comparative
evaluation of treatments for bulimia nervosa. These pre-post results allow comparison of the hypnobehavioural and cognitive behavioural treatments
with a waiting list control group and a comparison of the immediate effects of the 2 modalities. 130 Ss were screened to enter the study. 78 Ss (mean
age 25.91 yrs) entered the investigation after being randomly allocated to either a waiting list control group, or to hypnobehavioural or cognitive
behavioural groups. The treatments were delivered individually and matched in duration (8 wks) and the number of sessions. Pre- to posttreatment
outcome indicated significant differences between the control group and the 2 treatments in reductions in bulimic behaviours and related eating
pathology. The immediate effects of both treatments were equal. There were no differences at posttreatment between the treatments in abstinence from
either bingeing or purging. The treatment effects were also similar to the immediate effects obtained by longer therapeutic approaches. (PsycINFO
Database Record (c) 2008 APA, all rights reserved).
European Eating Disorders Review, 2(4) : 202-220
- Year: 1994
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions