Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: Effectiveness in clinical settings

Authors

  • Glenn Waller DPhil,

    Corresponding author
    1. Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, Sheffield, England, United Kingdom
    • Correspondence to: Glenn Waller, Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK. E-mail: g.waller@sheffield.ac.uk

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  • Emma Gray DClinPsych,

    1. British CBT and Counselling Service, London, England, United Kingdom
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  • Hendrik Hinrichsen DClinPsych,

    1. Sutton and Merton IAPT Service, South West London and St. George's Mental Health NHS Trust, Springfield University Hospital, London, England, United Kingdom
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  • Victoria Mountford DClinPsy,

    1. Eating Disorders Section, Institute of Psychiatry, King's College London, London, England, United Kingdom
    2. Eating Disorders Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, England, United Kingdom
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  • Rachel Lawson MA,

    1. South Island Eating Disorders Service, Christchurch, New Zealand
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  • Eloise Patient BSc

    1. North Staffordshire Wellbeing Service, Newcastle-under-Lyme, Staffordshire, England, United Kingdom
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ABSTRACT

Objective

The efficacy of cognitive-behavioral therapy (CBT) for bulimic disorders has been established in research trials. This study examined whether that efficacy can be translated into effectiveness in routine clinical practice.

Method

Seventy-eight adult women with bulimic disorders (bulimia nervosa and atypical bulimia nervosa) undertook individual CBT, with few exclusion criteria and a treatment protocol based on evidence-based approaches, utilizing individualized formulations. Patients completed measures of eating behaviors, eating attitudes, and depression pre- and post-treatment. Eight patients dropped out. The mean number of sessions attended was 19.2.

Results

No pretreatment features predicted drop-out. Treatment outcome was similar whether using treatment completer or intent to treat analyses. Approximately 50% of patients were in remission by the end of treatment. There were significant improvements in mood, eating attitudes, and eating behaviors. Reductions in bingeing and vomiting were comparable to efficacy trials.

Discussion

The improvements in this “real-world” trial of CBT for adults with bulimic disorders mirrored those from large, funded research trials, though the conclusions that can be reached are inevitably limited by the nature of the trial (e.g., lack of control group and therapy validation). © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:13–17)

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