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Self-help and guided self-help for eating disorders

  • Review
  • Intervention

Authors


Abstract

Background

Anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) are common and disabling disorders. Many patients experience difficulties accessing specialist psychological treatments. Pure self-help (PSH: self-help material only) or guided self-help (GSH: self-help material with therapist guidance), may bridge this gap.

Objectives

Main objective:
Evaluate evidence from randomised controlled trials (RCTs) / controlled clinical trials (CCTs) for the efficacy of PSH/GSH with respect to eating disorder symptoms, compared with waiting list or placebo/attention control, other psychological or pharmacological treatments (or combinations/augmentations) in people with eating disorders.

Secondary objective:
Evaluate evidence for the efficacy of PSH/GSH regarding comorbid symptomatology and costs.

Search methods

CCDANCTR-Studies and CCDANCTR-References were searched in November 2005, other electronic databases were searched, relevant journals and grey literature were checked, and personal approaches were made to authors.

Selection criteria

Published/unpublished RCTs/CCTs evaluating PSH/GSH for any eating disorder.

Data collection and analysis

Data was extracted using a customized spreadsheet. Relative Risks (RR) were calculated from dichotomous data and weighted/standardized mean differences (WMD/SMD) from continuous data, using a random effects model.

Main results

Twelve RCTs and three CCTs were identified, all focusing on BN, BED, EDNOS or combinations of these, in adults, using manual-based PSH/GSH across various settings.

Primary comparisons:
At end of treatment, PSH/GSH did not significantly differ from waiting list in abstinence from bingeing (RR 0.72, 95% CI 0.47 to 1.09), or purging (RR 0.86, 95% CI 0.68 to 1.08), although these treatments produced greater improvement on other eating disorder symptoms, psychiatric symptomatology and interpersonal functioning but not depression.

Compared to other formal psychological therapies, PSH/GSH did not differ significantly at end of treatment or follow-up in improvement on bingeing and purging (RR 0.99, 95% CI 0.75 to 1.31), other eating disorder symptoms, level of interpersonal functioning or depression. There were no significant differences in treatment dropout.

Secondary comparisons:
One small study in BED found that cognitive-behavioural GSH compared to a non-specific control treatment produced significantly greater improvements in abstinence from bingeing and other eating disorder symptoms. Studies comparing PSH with GSH found no significant differences between treatment groups at end of treatment or follow-up. Comparison between different types of PSH/GSH found significant differences on eating disorder symptoms but not on bingeing/purging abstinence rates.

Authors' conclusions

PSH/GSH may have some utility as a first step in treatment and may have potential as an alternative to formal therapist-delivered psychological therapy. Future research should focus on producing large well-conducted studies of self-help treatments in eating disorders including health economic evaluations, different types and modes of delivering self-help (e.g. computerised versus manual-based) and different populations and settings.

摘要

背景

飲食疾患的自助與指引性自助

心因性厭食症(Anorexia nervosa,AN),心因性暴食症(bulimia nervosa,BN),暴食症(binge eating disorder,BED),以及其他飲食疾患(eating disorder not otherwise specified ,EDNOS)是相當常見且會導致失能的疾病。很多患者在接受心理專業人員的治療上常遭遇到困難。純粹的自我幫助(PSH:只有自助的教材)或指導性自助(GSH:有治療者指引的自助教材)正好可以銜接這個缺口。

目標

主要目標:以隨機控制試驗(RCTs)評估飲食疾患接受PSH/GSH的效益。並與等候名單或安慰劑及其他心理或藥物治療(或合併治療)做比較。次要目標:評估PSH/GSH對共病症狀處理的成效與其成本耗費。

搜尋策略

2005年11月搜尋CCDANCTRStudies與CCDANCTRReference以及其他的電子資料庫,並檢索相關的期刊與灰色文獻(grey literature),並與作者聯繫。

選擇標準

不論是發表或沒發表的RCTs/CCTs的研究,只要是針對飲食疾患PSH/GSH的評估研究均納入。

資料收集與分析

以特製的電子表格擷取資料。依據隨機效果模式(random effects model),對於二分資料計算其Relative Risks (RR),連續資料則計算其加權平均值/標準平均值(WMD/SMD)。

主要結論

本研究採用了12個RCTs與3個CCTs,聚焦在BN, BED, EDNOS或合併以上的疾病,成人,在各種情境中使用PSH/GSH的手冊。主要比較結果:在治療最後,對暴食型(RR 0.72, 95% CI 0.47 to 1.09)或清除型(RR 0.86, 95% CI 0.68 to 1.08)的節制上,PSH/GSH與等候名單組並沒有顯著差異。即使這些治療能明顯改善其他飲食疾患的症狀、精神病症狀和人際關係,但不包含憂鬱。與其他正式心理治療相較之下,PSH/GSH在治療的最後與追蹤期,在改善暴食與清除(RR 0.99, 95% CI 0.75 to 1.31)、其他飲食疾患症狀、人際關係層次或憂鬱方面也沒有顯著差異。在治療退出率上沒有明顯的差異。 次要比較結果:有一個小型的暴食症研究發現,認知行為型式的GSH與控制組相較,在節制暴食與其他飲食疾患症狀上有明顯的改善。研究比較PSH與GSH,在治療後期與或追蹤方面並沒有發現顯著的差異。在比較不同形式的PSH/GSH方面,發現在飲食症狀上有明顯的差異,但在節制暴食/清除的比率上卻沒有差別。

作者結論

在治療初步上PSH/GSH是有效用的,也許可作為正規心理治療的替代療法。未來研究應把重點放在大型且設計良好的飲食疾患自助治療,探討包括健康照護的經濟效益評估,各種不同自助的型態與治療模式(如:電腦模式v.s手冊),以及在不同族群與情境的效果。

翻譯人

本摘要由彰化基督教醫院陳美貴翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

自助與指引性自助在治療飲食疾患上是有幫助的。 飲食疾患(心因性厭食症,AN,心因性暴食症,BN,暴食症BED,以及其他飲食疾患,EDNOS)會引起失能,不過往往不容易接受到專業治療。自助可能縮小隔閡。本篇回顧研究的目的在於評估所有年齡與性別的飲食疾患中,純粹的自助(PSH)介入方案與心理治療、藥物治療,或是控制組與等候名單組的差異。本篇收集了15個心因性暴食症、暴食症或其他飲食疾患,以手冊為主的自助方案。研究發現與等候名單組或控制組相較之下,PSH/GSH可減緩飲食疾患與其他症狀,且產生了可與正規心理治療相比較的結果。PSH/GSH在治療的初步階段是有用的。建議未來的研究需要設計有效操作的自助治療研究,包含或不包含指導性的經濟效益,並且調查不同族群與不同環境下,不同自助形式的效果。

Plain language summary

Self-help and guided self-help for eating disorders

The eating disorders (anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS)) are disabling conditions and specialist treatment is not always easily accessible. Self-help may bridge the gap. This review aimed to evaluate pure self-help (PSH) and guided self-help (GSH) interventions for eating disorders for all ages and genders, compared to psychological, pharmacological or control treatments and waiting list. Fifteen trials were identified, all focused on BN, BED or EDNOS, using manual-based self-help. There is some evidence that PSH/GSH reduce eating disorder and other symptoms in comparison to waiting list or control treatment and may produce comparable outcomes to formal therapist-delivered psychological therapies. PSH/GSH may have some utility as a first step in treatment. In the future there need to be large well-conducted effectiveness studies of self-help treatments with or without guidance incorporating cost evaluations and investigation of different types of self-help in different populations and settings.

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