Guided Self-Help Treatment for Recurrent Binge Eating: Replication and Extension

Abstract

Objective The aim of this study was to replicate and extend results of a previous blended efficacy and effectiveness trial of a low-intensity, manual-based guided self-help form of cognitive-behavioral therapy (CBT-GSH) for the treatment of binge eating disorders in a large health maintenance organization (HMO) and to compare them with usual care. Methods To extend earlier findings, the investigators modified earlier recruitment and assessment approaches and conducted a randomized clinical trial to better reflect procedures that may be reasonably carried out in real-world practices. The intervention was delivered by master’s-level interventionists to 160 female members of a health maintenance organization who met diagnostic criteria for recurrent binge eating. Data collected at baseline, immediately posttreatment, and at six- and 12-month follow-ups were used in intent-to-treat analyses. Results At the 12-month follow-up, CBT-GSH resulted in greater remission from binge eating (35%, N=26) than usual care (14%, N=10) (number needed to treat=5). The CBT-GSH group also demonstrated greater improvements in dietary restraint (d=.71) and eating, shape, and weight concerns (d=1.10, 1.24, and .98, respectively) but not weight change. Conclusions Replication of the pattern of previous findings suggests that CBT-GSH is a robust treatment for patients with recurrent binge eating. The magnitude of changes was significantly smaller than in the original study, however, suggesting that patients recruited and assessed with less intensive procedures may respond differently from their counterparts enrolled in trials requiring more comprehensive procedures.

Dropout from cognitive‐behavioral therapy for eating disorders: A meta‐analysis of randomized, controlled trials

“…This is thought to be a result of the differences in the degree of control over variables, including the types of individuals treated (e.g., multiple comorbidities typically excluded in efficacy studies), who delivers the treatment (e.g., highly trained clinicians, with a low caseload, who receive frequent supervision in efficacy trials), and where the treatment is conducted (e.g., university clinic versus private practice; Swift & Greenberg, ). Although research trials can be designed to maximise external validity and match certain characteristics of effectiveness studies (e.g., few exclusion criteria, delivering treatment in a primary care setting), only three RCTs included in the present review described themselves as a blended efficacy–effectiveness study (Carter & Fairburn, ; DeBar et al, ; Striegel‐Moore et al, ). An important next step in research is to therefore focus on dropout from CBT for eating disorders in uncontrolled, effectiveness studies.…”

“…This is because those who drop out are less likely to benefit from treatment (Klein, Stone, Hicks, & Pritchard, ), and because the requirements for RCTs to report and interpret intention‐to‐treat analyses means that patient drop out results in a reduced overall remission/recovery rate (White, Carpenter, & Horton, ). Although some RCTs of CBT for eating disorders have reported low dropout rates (e.g., <10%; Agras, Schneider, Arnow, Raeburn, & Telch, ; Davis, McVey, Heinmaa, Rockert, & Kennedy, ), other have reported high dropout rates (e.g., 30–40%; Agras, Walsh, Fairburn, Wilson, & Kraemer, ; DeBar et al, ), suggesting that dropout from CBT represents a major challenge in providing effective treatments and in conducting treatment research in this population.…”

Meta‐analysis of the effects of cognitive‐behavioral therapy for binge‐eating–type disorders on abstinence rates in nonrandomized effectiveness studies: Comparable outcomes to randomized, controlled trials?

“…Further, unless data were reported separately for BN, BED, or OSFED patients, studies that used a transdiagnostic sample that included patients with anorexia nervosa were excluded. It is important to note that only five randomized studies that considered themselves as blended efficacy‐effectiveness trials (e.g., because of the delivery of treatment in primary care and with nonspecialist therapists) were excluded from the present meta‐analysis (Carter & Fairburn, ; DeBar et al, ; DeBar et al, ; Striegel‐Moore et al, ; Walsh, Fairburn, Mickley, Sysko, & Parides, ).…”

Cultural Adaptation of a Cognitive Behavior Therapy Guided Self‐Help Program for Mexican American Women With Binge Eating Disorders

“…CBT requires specialized training and expertise, making it less readily available. Hence, implementation science researchers have begun to examine the effectiveness of CBT‐based guided self‐help (GSH) as a more easily disseminated intervention or first step in the treatment of binge‐eating‐related problems (DeBar et al, 2011; Lynch et al, 2010; Striegel‐Moore et al, 2010). CBT‐GSH is a low‐intensity intervention in which clients use a self‐help manual with only limited support and instruction from either a specialist or nonspecialist in clinical or nonclinical settings.…”