Adjusting Cognitive Behavior Therapy For Adolescents With Bulimia Nervosa: Results Of Case Series

Abstract

This article reviews the types of adjustments needed to an adult protocol of cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) to make it more acceptable to an adolescent population. Employing developmental principles as well as clinical experience as guidelines, these modifications include the involvement of parents, recognition of the interaction of treatment with normal adolescent developmental tasks, and allowances for typical cognitive and emotional immaturity on treatment procedures. Outcomes from a series of adolescents with BN who were treated with this modified-CBT approach show results similar to those expected in adult populations treated using CBT.

Cognitive‐behavioral therapy for adolescents with binge eating syndromes: A case series

“…2 Population estimates for BN in adolescents are similar to the estimates for adults, that is, 1%-2%, 3 whereas point prevalence rates for adolescents are approximately 0.5% for girls and 0.3% for boys. 4 However, in addition, many adolescents who present with clinically significant binge eating and purging behaviors do not meet diagnostic thresholds.…”

“…2,12 Adaptations provided increased attention to the development of a therapeutic relationship with the adolescent, allowed for a greater emphasis on social relationships and interpersonal struggles commonly associated with adolescence, and used cognitive restructuring strategies at a more basic level with more concrete examples consistent with adolescent abilities. Furthermore, the therapist involved the parents in the treatment to set up the environment to reduce triggers for the symptoms of BN, as well as to accompany the adolescent during and after meals to ensure they did not purge at the onset of treatment.…”

A Randomized Controlled Comparison of Family-Based Treatment and Supportive Psychotherapy for Adolescent Bulimia Nervosa

“…One obvious way to address this shortcoming would be a comparison of FBT-BN and CBT. The work of Schmidt et al 18 and recent case series work at Stanford University, Stanford, California, that adapted CBT to incorporate parents in treatment 17 indicate that this is an important issue to address. Future work should also attempt to improve on the fact that many adolescents seeking treatment for an eating disorder were excluded from participation, despite the expanded inclusion criteria for this study.…”

“…Only case series data for this patient population have been published, using family therapy, 15 family-based treatment (FBT), 16 or cognitive-behavioral therapy (CBT) with family involvement. 17 Results from these reports are promising; for example, family therapy for 8 adolescents with BN showed significant changes in bulimic symptoms from the start of treatment to 1-year follow-up. 15 In addition to these reports, the first controlled trial, to our knowledge, for adolescents with BN has recently been completed.…”

LIBER8 design and methods: An integrative intervention for loss of control eating among African American and White adolescent girls

“…This developmental period is a pivotal time for the expansion of individuals’ coping repertoire, as emerging cognitive skills can facilitate adolescents’ ability to use a wider range of coping strategies [39]. Thus, the proposed intervention will include training in distress tolerance, mindfulness, and emotion regulation.…”