Guided self-help as the first step for bulimic symptoms: Implementation of a stepped-care model within specialized psychiatry


  • supported by 421-2004-2614 from Swedish Research Council and by the Söderström-Königska foundation and the Märta and Nicke Nasvell Foundation.



This study describes the implementation and effectiveness of the first step, guided self-help (GSH), in a clinical setting, of a stepped-care model of cognitive behavior therapy for patients with bulimic symptoms.


Eighty-nine patients participated.


In the intent to-treat analyses, the effect sizes were small to moderate (0.25–0.66). However, the effect sizes were substantially larger (0.44–1.66) for the patients who completed all the GSH sessions (45%). The majority of noncompleters stayed within psychiatric services. Supplementary treatments were mostly directed towards comorbid conditions, especially depression. Those discontinuing treatment in advance where characterized by more lifetime diagnoses and higher ratings on the restraint subscale of the EDE-Q.


GSH within specialized psychiatry might be effective for about 30% of the patients. There is no indication of patients losing their confidence in psychiatric services by being offered GSH as the first treatment. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)