A single-arm pilot study of guided self-help treatment based cognitive behavioral therapy for bulimia nervosa in Japanese clinical settings

Abstract

ObjectiveGuided self-help treatments based on cognitive behavioral therapy (CBT-GSH) are regarded as a first-line effective treatment for bulimia nervosa (BN). With limited application for CBT-GSH in Japanese clinical settings, we conducted a single arm pilot study in order to confirm the acceptability and availability of CBT-GSH in Japan.Results25 women with BN received 16–20 sessions of face-to-face CBT-GSH. Primary outcomes were the completion rate of intervention and abstinence rates from objective bingeing and purging as assessed by the Eating Disorder Examination. Secondary outcomes were other self-report measurements of the frequency of bingeing and purging, and characteristic psychopathologies of eating disorders. Assessments were conducted before CBT as baseline as well as after CBT. 92% (23/25) of the participants completed the CBT sessions. After CBT-GSH, 40% (10/25) of the participants (intention-to-treat) achieved symptom abstinence. The mean binge and purge episodes during the previous 28 days improved from 21.88 to 10.96 (50% reduction) and from 22.44 to 10.88 (52% reduction), each (before CBT-GSH to after CBT-GSH), and the within-group effect sizes were medium (Cohen’s d = 0.67, 0.65, each). Our study provided a preliminary evidence about the feasibility of CBT-GSH in Japanese clinical settings for the future.Trial registration This study was registered retrospectively in the national UMIN Clinical Trials Registry on July 10, 2013 (registration ID: UMIN000011120)

Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial

“…The results of this research are consistent with a previous RCT in the United States that used ICBT via videoconference and reported reductions in combined objective binge and purging episodes, objective binge episodes, and purging episodes (69%, 68%, and 70%, respectively) [18]. Our previous study with face-to-face CBT reported reduced combined objective binge and purging episodes, objective binge episodes, and purging episodes (51%, 50%, and 52%, respectively) [8]. This study has resulted in changes similar to our previous study.…”

“…The protocol included the following modules: assessment; explanation of CBT, motivation and goal setting, education on bulimia nervosa and how to keep a dietary diary, psychological education and monitoring for overeating behavior, psychological education and monitoring of diet, reforming of dietary habits (mindful diet), psychological education and self-monitoring of compensatory behavior, stress management and relaxation, understanding perfectionism, interpersonal relationships and assertions, acquisition of skills to associate with emotions (emotional adjustment, mindfulness, tolerance of distress, alexithymia), attention to body image, and prevention of recurrence. These modules are a development of those used in our previous study of face-to-face CBT for patients with bulimia nervosa in Japan [8,35].…”

“…Several meta-analyses of randomized controlled trials (RCTs) that included wait list controls have reported that cognitive behavioral therapy (CBT) is effective for bulimia nervosa and binge-eating disorder [3,4-7]. Our research group has recently conducted a single-arm study that confirmed the effectiveness of guided self-help CBT for Japanese patients with bulimia nervosa [8]. Although previous studies have shown the effectiveness of CBT for bulimia nervosa and binge-eating disorder, the patients who reside in rural areas or far from specialized treatment institutions cannot receive evidence-based therapy such as CBT.…”

Effectiveness of enhanced cognitive behavior therapy for bulimia nervosa in Japan: a randomized controlled trial protocol

“…A sample size of 140 with 70 per group is estimated be sufficient to test the hypothesis based on previously published BN remission rates of 45% for CBT-E and 25% for TAU [29]. A sample size of 66 patients per treatment group is required to detect a difference of this magnitude with an 80% power for the primary analysis.…”

“…There have been few studies regarding the effects of psychological treatments for EDs in Japan. A single-arm pilot study provided preliminary evidence about the feasibility of guided self-help treatments based on CBT [29], but there have been no RCTs of psychological treatments that include formal protocols or treatment manuals. The lack of supporting evidence is most likely one of the reasons that ED-focused CBT has not been widely implemented in Japan.…”