Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-17T18:39:06.921Z Has data issue: false hasContentIssue false

Cognitive Behaviour Therapy for Bulimia Nervosa and Eating Disorders Not Otherwise Specified: Translation from Randomized Controlled Trial to a Clinical Setting

Published online by Cambridge University Press:  21 October 2014

Sarah Knott
Affiliation:
Cardiff Metropolitan University, Wales
Debbie Woodward
Affiliation:
Whitchurch Hospital, Cardiff and Vale NHS University Health Board, Wales
Antonia Hoefkens
Affiliation:
Whitchurch Hospital, Cardiff and Vale NHS University Health Board, Wales
Caroline Limbert*
Affiliation:
Cardiff Metropolitan University, Wales
*
Reprint requests to Caroline Limbert, Cardiff Metropolitan University, Llandaff Campus, Western Avenue, Cardiff CF5 2YB. Wales. E-mail: climber@cardiffmet.ac.uk

Abstract

Background: Enhanced Cognitive Behaviour Therapy (CBT-E) (Fairburn, Cooper and Shafran, 2003) was developed as a treatment approach for eating disorders focusing on both core psychopathology and additional maintenance mechanisms. Aims: To evaluate treatment outcomes associated with CBT-E in a NHS Eating Disorders Service for adults with bulimia and atypical eating disorders and to make comparisons with a previously published randomized controlled trial (Fairburn et al., 2009) and “real world” evaluation (Byrne, Fursland, Allen and Watson, 2011). Method: Participants were referred to the eating disorder service between 2002 and 2011. They were aged between 18–65 years, registered with a General Practitioner within the catchment area, and had experienced symptoms fulfilling criteria for BN or EDNOS for a minimum of 6 months. Results: CBT-E was commenced by 272 patients, with 135 completing treatment. Overall, treatment was associated with significant improvements in eating disorder and associated psychopathology, for both treatment completers and the intention to treat sample. Conclusions: Findings support dissemination of CBT-E in this context, with significant improvements in eating disorder psychopathology. Improvements to global EDE-Q scores were higher for treatment completers and lower for the intention to treat sample, compared to previous studies (Fairburn et al., 2009; Byrne et al., 2011). Level of attrition was found at 40.8% and non-completion of treatment was associated with higher levels of anxiety. Potential explanations for these findings are discussed.

Type
Clinically Grounded Clinical Intervention
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agras, W. S., Crow, S. J., Halmi, K. A., Mitchell, J. E., Wilson, G. T., and Kraemer, H. C. (2000). Outcome predictors for the cognitive behaviour treatment of bulimia nervosa: data from a multisite study. American Journal of Psychiatry, 157, 13021308.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: APA.Google Scholar
Beck, A. T. (1996). Beck Depression Inventory. New York: Harcourt Brace and Company.Google Scholar
Beck, A. T., Epstein, N., Brown, G. and Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893897.Google Scholar
Byrne, S. M., Fursland, A., Allen, K.L. and Watson, H. (2011). The effectiveness of enhanced cognitive behaviour therapy for eating disorders: an open trial. Behaviour Research and Therapy, 49, 219226.Google Scholar
Carter, J. C., Aime, A. A. and Mills, J. S. (2001). Assessment of bulimia nervosa: a comparison of interview and self report questionnaire methods. International Journal of Eating Disorders, 30, 187192.Google Scholar
Carter, J. C., Pannekoek, L., Fursland, A., Allen, K., Lampard, A. and Byrne, S. (2012). Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Behaviour Research and Therapy, 50, 487492.Google Scholar
Casasnovas, C., Fernández-Aranda, F., Granero, R., Krug, I., Jiménez-Murcia, S., Bulik, C. M., et al. (2007). Motivation to change in eating disorders: clinical and therapeutic implications. European Eating Disorders Review, 15, 449456.Google Scholar
Chakraborty, K. and Basu, D. (2010). Management of anorexia and bulimia nervosa: an evidence-based review. Indian Journal of Psychiatry, 52, 174186.Google Scholar
Fairburn, C. G. (1995). Overcoming Binge Eating. New York: Guilford Press.Google Scholar
Fairburn, C. G. (2008).Cognitive Behaviour Therapy and Eating Disorders. New York: Guilford Press.Google Scholar
Fairburn, C. G. and Beglin, S. J. (1994). Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363370.Google Scholar
Fairburn, C. G. and Bohn, K. (2005). Eating disorder NOS (EDNOS): an example of the troublesome “Not Otherwise Specified” (NOS) category in DSM-IV. Behaviour, Research and Therapy, 43, 691701.Google Scholar
Fairburn, C. G. and Cooper, Z. (1993). The eating disorder examination. In Fairburn, C. G. and Wilson, G. T.. (Eds.), Binge Eating: nature, assessment and treatment (pp.317360). New York: Guilford Press.Google Scholar
Fairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Bohn, K., Hawker, D. M., et al. (2009). Transdiagnostic cognitive-behavioural therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry, 166, 311319.Google Scholar
Fairburn, C. G., Cooper, Z. and O’Connor, M. (2014). The Eating Disorder Examination (17th edition). http://www.credo-oxford.com/pdfs/EDE_17.0D.pdf [Accessed 21 April 2014].Google Scholar
Fairburn, C. G., Cooper, Z. and Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic’’ theory and treatment. Behaviour, Research and Therapy, 41, 509528.Google Scholar
Fairburn, C. G., Marcus, M. D. and Wilson, G. T. (1993). Cognitive behaviour therapy for binge eating and bulimia nervosa: a comprehensive treatment manual. In Fairburn, C.G. and Wilson, G. T. (Eds.). Binge Eating: nature, assessment and treatment (pp. 361404). New York: Guilford Press.Google Scholar
Fairburn, C. G., Stice, E., Cooper, Z., Doll, H. A., Norman, P. A. and O’Connor, M. E. (2003). Understanding persistence in bulimia nervosa: a 5-year naturalistic study. Journal of Consulting and Clinical Psychology, 71, 103109.Google Scholar
Fassino, S., Piero, A., Tomba, E. and Abbate-Daga, G. (2009). Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry, 9, 6775.Google Scholar
Kendall, P. C., Marrs-Garcia, A., Nath, S. R. and Sheldrick, R. C. (1999). Normative comparisons for the evaluation of clinical significance. Journal of Consulting and Clinical Psychology, 67, 285299.Google Scholar
National Institute for Clinical Excellence (2004). Eating Disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (Clinical Guideline No. 9). Retrieved from http://www.nice.org.uk/nicemedia/pdf/cg009niceguidance.pdf.Google Scholar
Statistics for Wales (2010). NHS Wales Waiting Times: at end January 2010. Retrieved at http://wales.gov.uk/docs/statistics/2010/100311sdr372010en.pdf.Google Scholar
Wilfley, D. E. and Cohen, L. R. (1997). Psychological treatment of bulimia nervosa and binge eating disorder. Psychopharmacology Bulletin, 33, 437454.Google Scholar
Wilson, G. T., Fairburn, C. G., Agras, W. S., Walsh, B. T. and Kraemer, H. (2002). Cognitive behaviour therapy for bulimia nervosa: time course and mechanisms of change. Journal of Consulting and Clinical Psychology, 70, 267274.Google Scholar
Submit a response

Comments

No Comments have been published for this article.