Prognostic indicators in bulimia nervosa treated with cognitive-behavioral group therapy

Abstract

Prognostic indicators of short‐term outcome were identified in 69 women with the DSM‐III‐R diagnosis of bulimia nervosa who participated in a weekly 10‐session structured cognitive‐behavioral outpatient group program. Prior to treatment, all subjects completed the computerized Diagnostic Interview Schedule (DIS), the Moos Family Environment Scale (FES), the Diagnostic Survey for Eating Disorders (DSED), the Beck Depression Inventory (BDI), the Hopkins Symptom Checklist, Revised (SCL‐90‐R), the Bulimic Cognitive Distortions Scale (BCDS), the Eating Disorders Inventory (EDI), and the Bulimic Symptoms Checklist (BSCL). The latter three scales were readministered on completion of the 10‐week group. Symptom improvement was assessed by examining percentage reduction in binge frequency, purge frequency, and summed scores for the EDI subscales Bulimia, Drive for Thinness, and Body Dissatisfaction. The only significant predictor of improvement in binge frequency and bulimic cognitions was family environment. Conflicted, controlling, and overorganized family environments appear to impede both reductions in binge frequency and changes in bulimic cognitions. Reduction in vomit frequency was associated with weight history and with laxative or diuretic use. The implications for planning psychotherapeutic interventions in bulimia nervosa are discussed. © 1994 bylohn Wiley & Sons, Inc.

Guided self‐help versus cognitive‐behavioral group therapy in the treatment of bulimia nervosa

“…Compared with studies using group CBT (Blouin et al, 1994;Jacobi et al, 2002;Mitchell et al, 1993), the results in our CBT group are poor, with a recovery rate of 12% and a remisson rate of 36% in the completer sample at the end of treatment. Others report recovery rates of 28% (Blouin et al, 1994) to 45% (Jacobi et al, 2002) for binging and 30-63 % for vomiting in completer samples. The reasons for the comparably poor results in our CBT group may be manifold.…”

Guided self‐help versus cognitive‐behavioral group therapy in the treatment of bulimia nervosa

“…Compared with studies using group CBT (Blouin et al, 1994;Jacobi et al, 2002;Mitchell et al, 1993), the results in our CBT group are poor, with a recovery rate of 12% and a remisson rate of 36% in the completer sample at the end of treatment. Others report recovery rates of 28% (Blouin et al, 1994) to 45% (Jacobi et al, 2002) for binging and 30-63 % for vomiting in completer samples. The reasons for the comparably poor results in our CBT group may be manifold.…”

Emotionally focused family therapy for bulimia: Changing attachment patterns.

“…Further analyses were conducted on the EFFT group data to determine the extent to which EFFT was effective in treating bulimia. EFFT reduced bulimic symptomatology to an extent comparable to group CBT (Blouin et al, 1994). In particular, binge frequency was reduced by 52% with total remission observed in 44.4% of the clients, and vomiting was reduced by 65% with complete remission of symptoms in 66.6% of patients.…”

“…It has been suggested that behavioral self-help might be the first line of treatment (Cooper, Coker, & Fleming, 1996), followed by individual, group or, when appropriate, family therapy. If adolescents view their families as conflicted and controlling, family therapy may be a particularly crucial part of the treatment package, since these adolescents do not seem to respond as well to group psychoeducational approaches (Blouin et al, 1994).…”

Synthesis of Research Findings

“…There is evidence that initial elevations in body dissatisfaction attenuate the effects of cognitive behavioral therapy for bulimia nervosa [68] -the current treatment of choice for this disorder. However, this finding has not replicated in other investigations [69,70]. Regardless, testing whether elevations in a factor impede the effects of a treatment program is not isomorphic with testing whether elevations in this factor predict persistence of pathology in a community sample of individuals afflicted with the disorder.…”

Guided self‐help versus cognitive‐behavioral group therapy in the treatment of bulimia nervosa

“…Compared with studies using group CBT (Blouin et al, 1994;Jacobi et al, 2002;Mitchell et al, 1993), the results in our CBT group are poor, with a recovery rate of 12% and a remisson rate of 36% in the completer sample at the end of treatment. Others report recovery rates of 28% (Blouin et al, 1994) to 45% (Jacobi et al, 2002) for binging and 30-63 % for vomiting in completer samples. The reasons for the comparably poor results in our CBT group may be manifold.…”

Emotionally focused family therapy for bulimia: Changing attachment patterns.

“…Further analyses were conducted on the EFFT group data to determine the extent to which EFFT was effective in treating bulimia. EFFT reduced bulimic symptomatology to an extent comparable to group CBT (Blouin et al, 1994). In particular, binge frequency was reduced by 52% with total remission observed in 44.4% of the clients, and vomiting was reduced by 65% with complete remission of symptoms in 66.6% of patients.…”

“…It has been suggested that behavioral self-help might be the first line of treatment (Cooper, Coker, & Fleming, 1996), followed by individual, group or, when appropriate, family therapy. If adolescents view their families as conflicted and controlling, family therapy may be a particularly crucial part of the treatment package, since these adolescents do not seem to respond as well to group psychoeducational approaches (Blouin et al, 1994).…”

Synthesis of Research Findings

“…There is evidence that initial elevations in body dissatisfaction attenuate the effects of cognitive behavioral therapy for bulimia nervosa [68] -the current treatment of choice for this disorder. However, this finding has not replicated in other investigations [69,70]. Regardless, testing whether elevations in a factor impede the effects of a treatment program is not isomorphic with testing whether elevations in this factor predict persistence of pathology in a community sample of individuals afflicted with the disorder.…”

Guided self‐help versus cognitive‐behavioral group therapy in the treatment of bulimia nervosa

“…Compared with studies using group CBT (Blouin et al, 1994;Jacobi et al, 2002;Mitchell et al, 1993), the results in our CBT group are poor, with a recovery rate of 12% and a remisson rate of 36% in the completer sample at the end of treatment. Others report recovery rates of 28% (Blouin et al, 1994) to 45% (Jacobi et al, 2002) for binging and 30-63 % for vomiting in completer samples. The reasons for the comparably poor results in our CBT group may be manifold.…”

Emotionally focused family therapy for bulimia: Changing attachment patterns.

“…Further analyses were conducted on the EFFT group data to determine the extent to which EFFT was effective in treating bulimia. EFFT reduced bulimic symptomatology to an extent comparable to group CBT (Blouin et al, 1994). In particular, binge frequency was reduced by 52% with total remission observed in 44.4% of the clients, and vomiting was reduced by 65% with complete remission of symptoms in 66.6% of patients.…”

“…It has been suggested that behavioral self-help might be the first line of treatment (Cooper, Coker, & Fleming, 1996), followed by individual, group or, when appropriate, family therapy. If adolescents view their families as conflicted and controlling, family therapy may be a particularly crucial part of the treatment package, since these adolescents do not seem to respond as well to group psychoeducational approaches (Blouin et al, 1994).…”

Synthesis of Research Findings

“…There is evidence that initial elevations in body dissatisfaction attenuate the effects of cognitive behavioral therapy for bulimia nervosa [68] -the current treatment of choice for this disorder. However, this finding has not replicated in other investigations [69,70]. Regardless, testing whether elevations in a factor impede the effects of a treatment program is not isomorphic with testing whether elevations in this factor predict persistence of pathology in a community sample of individuals afflicted with the disorder.…”