A Randomized Controlled Trial of Family Therapy and Cognitive Behavior Therapy Guided Self-Care for Adolescents With Bulimia Nervosa and Related Disorders

Abstract

Objective: To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified. Method: Eighty-five adolescents with bulimia nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for bulimia nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care. Received 1-3 sessions of family therapy (N=4) Received intervention (i.e., attended ≥4 sessions) (N=29) Assigned to guided self-care (N=44): Did not take up treatment (N=6) Received 1-3 sessions of family therapy (N=7) Received intervention (i.e., attended ≥4 sessions) (N=31) Included in analysis (N=41)

Cost-effectiveness of guided self-help treatment for recurrent binge eating.

“…The sample in this study was relatively small, had limited racial and ethnic diversity, and was relatively highly educated. Although our sample does limit the generalizability of our results, the size and characteristics of our sample are not atypical in clinical trials of eating disorders (e.g., Byford et al, 2007; Schmidt et al 2007). Replication of this result in multiple sites and with populations that have greater ethnic and racial diversity would provide valuable information for decision-makers.…”

Eating Disorders, Addictions and Substance Use Disorders

“…In evaluating the efficacy of FBT-BN, a relative paucity of controlled outcome studies is apparent, although to date two large-scale controlled trials have been conducted (Le Grange, Crosby, Rathouz, & Leventhal, 2007;Schmidt et al, 2007), and while they differed slightly in the form of family therapy delivered, they point toward promising preliminary findings. In the Le Grange et al study (2007), FBT-BN was found to be statistically and clinically superior to supportive psychotherapy for adolescent BN, both at end of treatment and at 6-month follow-up.…”

Cognitive-Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents

“…The goal of treatment is to identify, monitor, and tackle the cognitions and behaviors that maintain the disorder while heightening the motivation for change 49,51-53. Given that the need for treatment far outweighs the availability of practitioners 54, current efforts are focused on increasing dissemination by modifying the traditional CBT manual into guided self help 55-57 and computer- and Internet-based versions 58,59.…”