A randomized controlled trial of family therapy and cognitive behavior guided self-care for adolescents with bulimia nervosa and related disorders

Schmidt, Ulrike and Lee, Sally and Beecham, Jennifer and Perkins, Sarah and Treasure, Janet and Yi, Irene and Winn, Suzanne and Robinson, Paul and Murphy, Rebecca and Keville, Saskia and Johnson-Sabine, Eric and Jenkins, Mari (2007) A randomized controlled trial of family therapy and cognitive behavior guided self-care for adolescents with bulimia nervosa and related disorders. American Journal of Psychiatry, 164 (4). pp. 591-598. ISSN 0002-953X. (The full text of this publication is not available from this repository)

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Official URL
http://dx.doi.org/10.1176/appi.ajp.164.4.591

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 bingeeating 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. Results: Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories. Conclusions: Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified. (Am J Psychiatry 2007; 164:591–598) Some 4%–7% of young females in Western countries suffer from full or partial bulimia nervosa (1). Typically, bulimia develops in adolescence, and individuals with a partial syndrome are at risk of developing the full syndrome. Without treatment, bulimia nervosa tends to persist into adulthood. The disorder is associated with secondary physical and mental disorders and imposes a major burden on families (1). Although numerous randomized controlled trials have been conducted with adults with bulimia nervosa (2), none have been conducted with adolescents. U.K. guidelines on eating disorders (2) have identified treatment of adolescent eating disorders as a research priority. The guidelines also noted that little is known about the health service utilization costs associated with these disorders. Family-based treatment produces excellent outcomes in adolescents with anorexia nervosa (2), and it has been adapted for adolescents with bulimia nervosa (3). Cognitive behavior therapy (CBT) is the treatment of choice for adults with bulimia nervosa (2). Self-care formats of CBT for bulimia nervosa can be as effective as therapist-delivered CBT if guided by a therapist (4). Guided self-care was recommended as a first-line intervention for adults with bulimia nervosa in the U.K. guidelines (2), and it may be a useful early intervention for bulimia in adolescents. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and CBT guided selfcare in adolescents with bulimia nervosa or eating disorder not otherwise specified. Our primary hypothesis was that in adolescents with bulimia nervosa or eating disorder not otherwise specified, family therapy would produce higher rates of abstinence from binge-eating and vomiting, both at completion of treatment and at follow-up. Our secondary hypothesis was that guided self-care would be less costly than family therapy.

Item Type: Article
Subjects: B Philosophy. Psychology. Religion > BF Psychology
H Social Sciences > HV Social pathology. Social and public welfare
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Personal Social Services Research Unit
Depositing User: Rosalyn Bass
Date Deposited: 25 Apr 2008 14:34
Last Modified: 08 May 2014 15:10
Resource URI: http://kar.kent.ac.uk/id/eprint/2906 (The current URI for this page, for reference purposes)
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