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Three Psychological Treatments for Bulimia Nervosa: A Comparative Trial

Three Psychological Treatments for Bulimia Nervosa: A Comparative Trial Abstract • The specificity and magnitude of the effects of cognitive behavior therapy in the treatment of bulimia nervosa were evaluated. Seventy-five patients who met strict diagnostic criteria were treated with either cognitive behavior therapy, a simplified behavioral version of this treatment, or interpersonal psychotherapy. Assessment was by interview and self-report questionnaire, and many aspects of functioning were evaluated. All three treatments resulted in an improvement in the measures of the psychopathology. Cognitive behavior therapy was more effective than interpersonal psychotherapy in modifying the disturbed attitudes to shape and weight, extreme attempts to diet, and self-induced vomiting. Cognitive behavior therapy was more effective than behavior therapy in modifying the disturbed attitudes to shape and weight and extreme dieting, but it was equivalent in other respects. The findings suggest that cognitive behavior therapy, when applied to patients with bulimia nervosa, operates through mechanisms specific to this treatment and is more effective than both interpersonal psychotherapy and a simplified behavioral version of cognitive behavior therapy. References 1. Fairburn CG, Beglin SJ. Studies of the epidemiology of bulimia nervosa . Am J Psychiatry . 1990;147:401-408. 2. Russell GFM. Bulimia nervosa: an ominous variant of anorexia nervosa . Psychol Med . 1979;9:429-448.Crossref 3. Fairburn CG, Garner DM. The diagnosis of bulimia nervosa . Int J Eating Disord . 1986;5:403-419.Crossref 4. Fairburn CG, Cooper PJ. The clinical features of bulimia nervosa . Br J Psychiatry . 1984;144:238-246.Crossref 5. Norman DK, Herzog DB. A 3-year outcome study of normal-weight bulimia: assessment of psychosocial functioning and eating attitudes . Psychiatry Res . 1986;19:199-205.Crossref 6. Fairburn CG. The current status of the psychological treatments for bulimia nervosa . J Psychosom Res . 1988;32:635-645.Crossref 7. Agras WS, McCann U. The efficacy and role of antidepressants in the treatment of bulimia nervosa . Ann Behav Med . 1987;9:18-22.Crossref 8. Wilson GT, Smith D. Cognitive-behavioral treatment of bulimia nervosa . Ann Behav Med . 1987;9:12-17.Crossref 9. Fairburn CG. A cognitive behavioural approach to the management of bulimia . Psychol Med . 1981;11:707-711.Crossref 10. Fairburn CG, Kirk J, O'Connor M, Cooper PJ. A comparison of two psychological treatments for bulimia nervosa . Behav Res Ther . 1986;24:629-643.Crossref 11. Wilson GT, Rossiter E, Kleifield EI, Lindholm L. Cognitive-behavioral treatment of bulimia nervosa: a controlled evaluation . Behav Res Ther . 1986;24:277-288.Crossref 12. Luborsky L, Singer B. Comparative studies of psychotherapies . Arch Gen Psychiatry . 1975;32:995-1008.Crossref 13. Frank JD. Persuasion and Healing . Baltimore, Md: The Johns Hopkins University Press; 1973. 14. Kirkley BG, Schneider JA, Agras WS, Backman JA. A comparison of two group treatments for bulimia . J Consult Clin Psychol . 1985;53:43-48.Crossref 15. Agras WS, Schneider JA, Arnow B, Raeburn SD, Teich CF. Cognitive-behavioral and response-prevention treatments for bulimia nervosa . J Consult Clin Psychol . 1989;57:215-221.Crossref 16. Klerman GL, Weissman MM, Rounsaville BJ, Chevron ES. Interpersonal Psychotherapy of Depression . New York, NY: Basic Books Inc Publishers; 1984. 17. Elkin I, Parloff MB, Hadley SW, Autry JH. NIMH Treatment of Depression Collaborative Research Program . Arch Gen Psychiatry . 1985;42:305-316.Crossref 18. Freeman CPL, Barry F, Dunkeld-Turnbull J, Henderson A. Controlled trial of psychotherapy for bulimia nervosa . BMJ . 1988;296:521-525.Crossref 19. Garner DM, Olmsted MP, Polivy J. Development and validation of a multidimensional Eating Disorder Inventory for anorexia nervosa and bulimia . Int J Eating Disord . 1983;2:15-34.Crossref 20. Wilson GT, Smith D. Assessment of bulimia nervosa: an evaluation of the Eating Disorder Examination . Int J Eating Disord . 1989;8:173-179.Crossref 21. Fairburn CG, Cooper Z, Cooper PJ. The clinical features and maintenance of bulimia nervosa . In: Brownell KD, Foreyt JP, eds. Handbook of Eating Disorders: Physiology, Psychology and Treatment of Obesity, Anorexia and Bulimia . New York, NY: Basic Books Inc Publishers; 1986:389-404. 22. Fairburn CG. Cognitive-behavioral treatment for bulimia . In: Garner DM, Garfinkel PE, eds. Handbook of Psychotherapy for Anorexia Nervosa and Bulimia . New York, NY: Guilford Press; 1985:160-192. 23. Garner DM, Fairburn CG, Davis R. Cognitive-behavioral treatment of bulimia nervosa: a critical appraisal . Behav Modif . 1987;11:398-431.Crossref 24. American Psychiatric Association, Committee on Nomenclature and Statistics. DSM-III-R in Development (10-5-85) . Washington, DC: American Psychiatric Association; 1985. 25. Fairburn CG. The definition of bulimia nervosa: guidelines for clinicians and research workers . Ann Behav Med . 1987;9:3-7.Crossref 26. Cooper Z, Fairburn CG. The Eating Disorder Examination: a semistructured interview for the assessment of the specific psychopathology of eating disorders . Int J Eating Disord . 1987;6:1-8.Crossref 27. Cooper Z, Cooper PJ, Fairburn CG. The validity of the Eating Disorder Examination and its subscales . Br J Psychiatry . 1989;154:807-812.Crossref 28. Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa . Psychol Med . 1979;9:273-279.Crossref 29. Derogatis LR, Lipman RS, Covi L. SCL 90: an outpatient psychiatric rating scale: preliminary report . Psychopharmacol Bull . 1973;9:13-28. 30. Beck AT, Ward CM, Mendelson M, Mock JE, Erbaugh JK. An inventory for measuring depression . Arch Gen Psychiatry . 1961;4:561-571.Crossref 31. Cooper PJ, Osborn M, Gath D, Feggetter G. Evaluation of a modified self-report measure of social adjustment . Br J Psychiatry . 1982;141:68-75.Crossref 32. Sackett DL, Gent M. Controversy in counting and attributing events in clinical trials . N Engl J Med . 1979;301:1410-1412.Crossref 33. Garrow JS. Obesity and Related Diseases . New York, NY: Churchill Livingstone Inc; 1988. 34. Lacey JH. Bulimia nervosa, binge-eating, and psychogenic vomiting: a controlled treatment study and long term outcome . BMJ . 1983;286:1609-1613.Crossref 35. Lee NF, Rush AJ. Cognitive-behavioral group therapy for bulimia . Int J Eating Disord . 1986;5:599-615.Crossref 36. Leitenberg H, Rosen JC, Gross J, Nudelman S, Vara LS. Exposure plus response-prevention treatment of bulimia nervosa . J Consult Clin Psychol . 1988;56:535-541.Crossref 37. Fairburn CG, Cooper PJ, Kirk J, O'Connor M. The significance of the neurotic symptoms of bulimia nervosa . J Psychiatr Res . 1985;19:135-140.Crossref 38. Cooper PJ, Fairburn CG. The depressive symptoms of bulimia nervosa . Br J Psychiatry . 1986;148:268-274.Crossref 39. Elkin I, Shea T, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP, Fiester SJ, Parloff MB. National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments . Arch Gen Psychiatry . 1989;46:971-982.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1991.01810290075014
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Abstract

Abstract • The specificity and magnitude of the effects of cognitive behavior therapy in the treatment of bulimia nervosa were evaluated. Seventy-five patients who met strict diagnostic criteria were treated with either cognitive behavior therapy, a simplified behavioral version of this treatment, or interpersonal psychotherapy. Assessment was by interview and self-report questionnaire, and many aspects of functioning were evaluated. All three treatments resulted in an improvement in the measures of the psychopathology. Cognitive behavior therapy was more effective than interpersonal psychotherapy in modifying the disturbed attitudes to shape and weight, extreme attempts to diet, and self-induced vomiting. Cognitive behavior therapy was more effective than behavior therapy in modifying the disturbed attitudes to shape and weight and extreme dieting, but it was equivalent in other respects. The findings suggest that cognitive behavior therapy, when applied to patients with bulimia nervosa, operates through mechanisms specific to this treatment and is more effective than both interpersonal psychotherapy and a simplified behavioral version of cognitive behavior therapy. References 1. Fairburn CG, Beglin SJ. Studies of the epidemiology of bulimia nervosa . Am J Psychiatry . 1990;147:401-408. 2. Russell GFM. Bulimia nervosa: an ominous variant of anorexia nervosa . Psychol Med . 1979;9:429-448.Crossref 3. Fairburn CG, Garner DM. The diagnosis of bulimia nervosa . Int J Eating Disord . 1986;5:403-419.Crossref 4. Fairburn CG, Cooper PJ. The clinical features of bulimia nervosa . Br J Psychiatry . 1984;144:238-246.Crossref 5. Norman DK, Herzog DB. A 3-year outcome study of normal-weight bulimia: assessment of psychosocial functioning and eating attitudes . Psychiatry Res . 1986;19:199-205.Crossref 6. Fairburn CG. The current status of the psychological treatments for bulimia nervosa . J Psychosom Res . 1988;32:635-645.Crossref 7. Agras WS, McCann U. The efficacy and role of antidepressants in the treatment of bulimia nervosa . Ann Behav Med . 1987;9:18-22.Crossref 8. Wilson GT, Smith D. Cognitive-behavioral treatment of bulimia nervosa . Ann Behav Med . 1987;9:12-17.Crossref 9. Fairburn CG. A cognitive behavioural approach to the management of bulimia . Psychol Med . 1981;11:707-711.Crossref 10. Fairburn CG, Kirk J, O'Connor M, Cooper PJ. A comparison of two psychological treatments for bulimia nervosa . Behav Res Ther . 1986;24:629-643.Crossref 11. Wilson GT, Rossiter E, Kleifield EI, Lindholm L. Cognitive-behavioral treatment of bulimia nervosa: a controlled evaluation . Behav Res Ther . 1986;24:277-288.Crossref 12. Luborsky L, Singer B. Comparative studies of psychotherapies . Arch Gen Psychiatry . 1975;32:995-1008.Crossref 13. Frank JD. Persuasion and Healing . Baltimore, Md: The Johns Hopkins University Press; 1973. 14. Kirkley BG, Schneider JA, Agras WS, Backman JA. A comparison of two group treatments for bulimia . J Consult Clin Psychol . 1985;53:43-48.Crossref 15. Agras WS, Schneider JA, Arnow B, Raeburn SD, Teich CF. Cognitive-behavioral and response-prevention treatments for bulimia nervosa . J Consult Clin Psychol . 1989;57:215-221.Crossref 16. Klerman GL, Weissman MM, Rounsaville BJ, Chevron ES. Interpersonal Psychotherapy of Depression . New York, NY: Basic Books Inc Publishers; 1984. 17. Elkin I, Parloff MB, Hadley SW, Autry JH. NIMH Treatment of Depression Collaborative Research Program . Arch Gen Psychiatry . 1985;42:305-316.Crossref 18. Freeman CPL, Barry F, Dunkeld-Turnbull J, Henderson A. Controlled trial of psychotherapy for bulimia nervosa . BMJ . 1988;296:521-525.Crossref 19. Garner DM, Olmsted MP, Polivy J. Development and validation of a multidimensional Eating Disorder Inventory for anorexia nervosa and bulimia . Int J Eating Disord . 1983;2:15-34.Crossref 20. Wilson GT, Smith D. Assessment of bulimia nervosa: an evaluation of the Eating Disorder Examination . Int J Eating Disord . 1989;8:173-179.Crossref 21. Fairburn CG, Cooper Z, Cooper PJ. The clinical features and maintenance of bulimia nervosa . In: Brownell KD, Foreyt JP, eds. Handbook of Eating Disorders: Physiology, Psychology and Treatment of Obesity, Anorexia and Bulimia . New York, NY: Basic Books Inc Publishers; 1986:389-404. 22. Fairburn CG. Cognitive-behavioral treatment for bulimia . In: Garner DM, Garfinkel PE, eds. Handbook of Psychotherapy for Anorexia Nervosa and Bulimia . New York, NY: Guilford Press; 1985:160-192. 23. Garner DM, Fairburn CG, Davis R. Cognitive-behavioral treatment of bulimia nervosa: a critical appraisal . Behav Modif . 1987;11:398-431.Crossref 24. American Psychiatric Association, Committee on Nomenclature and Statistics. DSM-III-R in Development (10-5-85) . Washington, DC: American Psychiatric Association; 1985. 25. Fairburn CG. The definition of bulimia nervosa: guidelines for clinicians and research workers . Ann Behav Med . 1987;9:3-7.Crossref 26. Cooper Z, Fairburn CG. The Eating Disorder Examination: a semistructured interview for the assessment of the specific psychopathology of eating disorders . Int J Eating Disord . 1987;6:1-8.Crossref 27. Cooper Z, Cooper PJ, Fairburn CG. The validity of the Eating Disorder Examination and its subscales . Br J Psychiatry . 1989;154:807-812.Crossref 28. Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa . Psychol Med . 1979;9:273-279.Crossref 29. Derogatis LR, Lipman RS, Covi L. SCL 90: an outpatient psychiatric rating scale: preliminary report . Psychopharmacol Bull . 1973;9:13-28. 30. Beck AT, Ward CM, Mendelson M, Mock JE, Erbaugh JK. An inventory for measuring depression . Arch Gen Psychiatry . 1961;4:561-571.Crossref 31. Cooper PJ, Osborn M, Gath D, Feggetter G. Evaluation of a modified self-report measure of social adjustment . Br J Psychiatry . 1982;141:68-75.Crossref 32. Sackett DL, Gent M. Controversy in counting and attributing events in clinical trials . N Engl J Med . 1979;301:1410-1412.Crossref 33. Garrow JS. Obesity and Related Diseases . New York, NY: Churchill Livingstone Inc; 1988. 34. Lacey JH. Bulimia nervosa, binge-eating, and psychogenic vomiting: a controlled treatment study and long term outcome . BMJ . 1983;286:1609-1613.Crossref 35. Lee NF, Rush AJ. Cognitive-behavioral group therapy for bulimia . Int J Eating Disord . 1986;5:599-615.Crossref 36. Leitenberg H, Rosen JC, Gross J, Nudelman S, Vara LS. Exposure plus response-prevention treatment of bulimia nervosa . J Consult Clin Psychol . 1988;56:535-541.Crossref 37. Fairburn CG, Cooper PJ, Kirk J, O'Connor M. The significance of the neurotic symptoms of bulimia nervosa . J Psychiatr Res . 1985;19:135-140.Crossref 38. Cooper PJ, Fairburn CG. The depressive symptoms of bulimia nervosa . Br J Psychiatry . 1986;148:268-274.Crossref 39. Elkin I, Shea T, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP, Fiester SJ, Parloff MB. National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments . Arch Gen Psychiatry . 1989;46:971-982.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: May 1, 1991

References