Cognitive-behavioral guided self-help for eating disorders: Effectiveness and scalability

Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
Clinical psychology review (Impact Factor: 7.18). 03/2012; 32(4):343-57. DOI: 10.1016/j.cpr.2012.03.001
Source: PubMed

ABSTRACT Given the well-documented shortage of cognitive-behavioral therapy (CBT) for eating disorders, there is a compelling need for advances in dissemination. Guided self-help based on cognitive-behavioral principles (CBTgsh) provides a robust means of improving implementation and scalability of evidence-based treatment for eating disorders. It is a brief, cost-effective treatment that can be implemented by a wide range of mental health providers, including non-specialists, via face-to-face contact and internet-based technology. Controlled studies have shown that CBTgsh can be an effective treatment for binge eating disorder and bulimia nervosa, although it is contraindicated for anorexia nervosa. Several studies have shown that CBTgsh can be as effective as more complex specialty therapies and that it is not necessarily contraindicated for patients with comorbid conditions. Mental health providers with relatively minimal professional credentials have in some studies obtained results comparable to specialized clinicians. Establishing the nature of optimal "guidance" in CBTgsh and the level of expertise and training required for effective implementation is a research priority. Existing manuals used in CBTgsh are outdated and can be improved by incorporating the principles of enhanced transdiagnostic CBT. Obstacles to wider adoption of CBTgsh are identified.

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    • "Yet, findings have been mixed, with some trials suggesting that bibliotherapy is as efficacious as alternative interventions (Grilo & Masheb, 2005; Schmidt et al., 2007; Wilson, 2010), others producing small effects (Mitchell et al., 2011; Thiels, Schmidt, Treasure, Garthe, & Troop, 1998), and still others finding virtually no effects (Steele & Wade, 2008; Walsh, Fairburn, Mickley, Sysko, & Parides, 2004). Plus, bibliotherapy has only received support for bulimia nervosa and binge eating disorder , not other eating disorders (Wilson & Zandberg, 2012). Another limitation of extant treatments is that individuals often report continued pursuit of the thin ideal and body dissatisfaction after termination, which often leads to relapse (Bardone-Cone et al., 2010). "
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    ABSTRACT: The authors conducted a pilot trial of a new dissonance-based group eating disorder treatment designed to be a cost-effective front-line transdiagnostic treatment that could be more widely disseminated than extant individual or family treatments that are more expensive and difficult to deliver. Young women with a DSM-5 eating disorder (N = 72) were randomized to an 8-week dissonance-based Counter Attitudinal Therapy group treatment or a usual care control condition, completing diagnostic interviews and questionnaires at pre, post, and 2-month follow-up. Intent-to-treat analyses revealed that intervention participants showed greater reductions in outcomes than usual care controls in a multivariate multilevel model (χ2[6] = 34.1, p < .001), producing large effects for thin-ideal internalization (d = .79), body dissatisfaction (d = 1.14), and blinded interview-assessed eating disorder symptoms (d = .95), and medium effects for dissonance regarding perpetuating the thin ideal (d = .65) and negative affect (d = .55). Midway through this pilot we refined engagement procedures, which was associated with increased effect sizes (e.g., the d for eating disorder symptoms increased from .51 to 2.30). This new group treatment produced large reductions in eating disorder symptoms, which is encouraging because it requires about 1/20th the therapist time necessary for extant individual and family treatments, and has the potential to provide a cost-effective and efficacious approach to reaching the majority of individuals with eating disorders who do not presently received treatment.
    Behaviour Research and Therapy 12/2014; 65. DOI:10.1016/j.brat.2014.12.012 · 3.85 Impact Factor
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    • "There is strong evidence that self-management tools are of benefit for bulimia nervosa (Perkins, Murphy, Schmidt, & Williams, 2006; Thiels, Schmidt, Treasure, & Garthe, 2003) and that they provide a cost-effective form of management (Crow, Agras, Fairburn, Mitchell, & Nyman, 2013), but there is less evidence supporting self-management tools for AN. In fact, one review suggested that self-help is contraindicated for this particular illness (Wilson & Zandberg, 2012), and it has been argued that individuals with AN require such a high level of intensive, specialized, and ongoing professional treatment that the lower levels of stepped care models (which involve guided self-help) would not be applicable for AN (Wilson, Vitousek, & Loeb, 2000). However, one study found that a 6-week preadmission manual guided self-help intervention reduced the duration of inpatient stay relative to a waitlist control condition (Fichter, Cebulla, Quadflieg, & Naab, 2008). "
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    ABSTRACT: Recent advances in the availability of mobile applications and Internet-based programs for eating disorder treatment call for a discussion of the acceptability, efficacy, and implications of these tools, as well as the practicality of using them to augment treatment as usual. The authors review and critically evaluate several conceptual, ethical, and pragmatic issues associated with employing a mobile-guided self-help intervention for anorexia nervosa (AN). The authors then describe the development of a mobile guided self-help intervention currently under evaluation among inpatients and outpatients with AN. We delineate ways in which these tools can enhance the accuracy of assessment, increase access to psychotherapy (such as by facilitating motivation and confidence to change), and complement the efficacy of adjunct treatments for eating disorders. Moreover, the portability of mobile-guided self-help is particularly appealing given the range of precipitating and maintaining factors that individuals with eating disorders face in their natural environments. We describe preliminary feedback from pilot research investigating the acceptability and feasibility of a mobile-guided self-help intervention for inpatients and outpatients with AN. We conclude by offering practical suggestions for clinicians who seek to incorporate aspects of mobile-guided self-help in their daily practice for people with eating disorders.
    Professional Psychology Research and Practice 06/2014; 45(5). DOI:10.1037/a0036203 · 1.34 Impact Factor
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    • "to suggest that this kind of approach is as credible to patients and at least as effective as therapistdelivered approaches and can be significantly less costly (Crow et al., 2013; Mitchell et al., 2011; Schmidt et al., 2007). Moreover, the potential of manual-based guided self-care for easy and widespread dissemination of specialist care is now widely recognized (Wilson & Zandberg, 2012). It is with these considerations in mind that we developed MANTRA as a manual-based approach. "
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    ABSTRACT: Anorexia nervosa (AN) is a severe mental disorder that affects mainly young females. In adults with a well-established form of the illness, it is hard to treat. In 2006, we proposed a maintenance model of AN, combining intra- and interpersonal factors and we have recently refined this model. The model encompasses four main maintaining factors (a thinking style characterized by rigidity, detail focus, and a fear of making mistakes; an avoidant emotion processing and relational style; positive beliefs about the use of anorexia for the person [ pro-anorexia beliefs]; and a response of close others to the illness characterized by high expressed emotion and enabling of and accommodation to the illness). In this article, we describe how the model has been translated into a novel treatment for AN and the preliminary evidence supporting this. Implications for clinical practice and research are discussed.
    Journal of Cognitive Psychotherapy 02/2014; DOI:10.1891/0889-8391.28.1.48
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