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


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 Existing manuals used in CBTgsh are outdated and can be improved by incorporating the principles of enhanced transdiagnostic CBT.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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    • "Half the patients were randomized to shCBT and were given Overcoming Binge Eating (Fairburn, 1995), a self-help book used in numerous controlled trials (Wilson & Zandberg, 2012). Primary-care physicians, without training in mental health or BED, instructed patients to read the book and focus on the self-help program in " Part 2: Medication (Sibutramine or Placebo). "
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    ABSTRACT: Objective: We examined rapid response among obese patients with binge-eating disorder (BED) in a randomized clinical trial testing antiobesity medication and self-help cognitive-behavioral therapy (shCBT), alone and in combination, in primary-care settings. Method: One hundred four obese patients with BED were randomly assigned to 1 of 4 treatments: sibutramine, placebo, shCBT + sibutramine, or shCBT + placebo. Treatments were delivered by generalist primary-care physicians and the medications were given double-blind. Independent assessments were performed by trained and monitored doctoral research clinicians monthly throughout treatment, posttreatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months after randomization). Rapid response, defined as ≥65% reduction in binge eating by the fourth treatment week, was used to predict outcomes. Results: Rapid response characterized 47% of patients, was unrelated to demographic and baseline clinical characteristics, and was significantly associated, prospectively, with remission from binge eating at posttreatment (51% vs. 9% for nonrapid responders), 6-month (53% vs. 23.6%), and 12-month (46.9% vs. 23.6%) follow-ups. Mixed-effects model analyses revealed that rapid response was significantly associated with greater decreases in binge-eating or eating-disorder psychopathology, depression, and percent weight loss. Discussion: Our findings, based on a diverse obese patient group receiving medication and shCBT for BED in primary-care settings, indicate that patients who have a rapid response achieve good clinical outcomes through 12-month follow-ups after ending treatment. Rapid response represents a strong prognostic indicator of clinically meaningful outcomes, even in low-intensity medication and self-help interventions. Rapid response has important clinical implications for stepped-care treatment models for BED. Clinical trial registration: NCT00537810 (PsycINFO Database Record
    Journal of Consulting and Clinical Psychology 01/2015; 83(2). DOI:10.1037/a0038635 · 4.85 Impact Factor
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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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    • "In order to reduce barriers (e.g., transportation, child care), we conducted all assessments and support sessions by phone and therefore did not have the opportunity to collect physiological measures. Lack of a control group is typical for feasibility studies (Arain, Campbell, Cooper, & Lancaster , 2010), and although we cannot conclude cause and effect, our outcome results (e.g., abstinence rate of 35.5%) are comparable to similar data from existing randomized control trial studies (Wilson & Zandberg, 2012). While we were able to interview some individuals who dropped out, those who refused participation often simply did not engage (e.g., would not answer phone calls), so we were not able to systematically examine reasons for refusal. "
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    ABSTRACT: Objective was to test feasibility and preliminary efficacy of a culturally adapted cognitive-behavioral self-help program to treat binge eating and related problems in Mexican Americans. Participants were 31 women recruited from the Los Angeles area and diagnosed with binge eating disorder, recurrent binge eating, or bulimia nervosa. Participants completed a culturally adapted version of a CBT-based self-help program with 8 guidance sessions over a 3-month period. Treatment efficacy was evaluated in terms of binge eating, psychological functioning, and weight loss. Intent-to-treat analyses revealed 35.5% abstinence from binge eating at posttreatment and 38.7% diagnostic remission. Results indicated significant pretreatment to posttreatment improvement on distress level, BMI, eating disorder psychopathology, and self-esteem. Satisfaction with the program was high. Findings demonstrate that the program is acceptable, feasible, and efficacious in reducing binge eating and associated symptoms for Mexican American women. Study provides "proof of concept" for implementation of culturally adapted forms of evidence-based programs. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Cultural Diversity and Ethnic Minority Psychology 07/2014; 20(3):449-457. DOI:10.1037/a0035345 · 1.36 Impact Factor
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