Attrition and outcome in self-help treatment for bulimia nervosa and binge eating disorder: A constructive replication

Department of Psychology, Uppsala University, Uppsala, Sweden.
Eating Behaviors (Impact Factor: 1.58). 12/2006; 7(4):300-8. DOI: 10.1016/j.eatbeh.2005.11.002
Source: PubMed


The aim of the study was to assess the efficacy of a 12-week CBT-based pure and guided self-help among 29 patients with full and subthreshold bulimia nervosa, and binge eating disorder. In the intention-to-treat analyses, self-help had a moderately positive and sustained effect on the patients' eating problems. The patients reduced their mean number of objective bulimic episodes and purging behavior by 26% and 22% over the course of treatment. The corresponding reduction levels for the treatment completers (n=21) were 41% and 34%, respectively. As in the previous study, there were no significant differences between the pure and guided self-help mode in terms of outcome, and the results were sustained 6 months after the end of the treatment. The findings are discussed in relation to the shorter duration of the self-help, the lower rate of attrition, and the characteristics of the sample compared to the earlier trial.

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    • "The purpose of these meetings is to support the patient's motivation for continuing the selfhelp , and not to provide counselling care. Success rates for guided self-help vary greatly, partly due to completion rates often being low (e.g., Gellatly et al., 2007; Ghaderi, 2006). However, it is generally accepted that self-help can be used successfully compared to waiting list controls (although not always, see Mead et al, 2005) but less so when compared to therapist-led treatment (e.g., Gregory et al., 2004; Menchola et al., 2007). "
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    ABSTRACT: This study investigated whether an analysis of narrative style (word use and cross-clausal syntax) of patients with symptoms of generalised anxiety and depression disorders can help predict the likelihood of successful participation in guided self-help. Texts by 97 people who had made contact with a primary care mental health service were analysed. Outcome measures were completion of the guided self-help programme, and change in symptoms assessed by a standardised scale (CORE-OM). Regression analyses indicated that some aspects of participants' syntax helped to predict completion of the programme, and that aspects of syntax and word use helped to predict improvement of symptoms. Participants using non-finite complement clauses with above-average frequency were four times more likely to complete the programme (95% confidence interval 1.4 to 11.7) than other participants. Among those who completed, the use of causation words and complex syntax (adverbial clauses) predicted improvement, accounting for 50% of the variation in well-being benefit. These results suggest that the analysis of narrative style can provide useful information for assessing the likelihood of success of individuals participating in a mental health guided self-help programme.
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    ABSTRACT: This chapter defines bibliotherapy as psychotherapeutic programs presented in a written self-help format as opposed to fictional stories or religious texts. It outlines the research literature regarding the clinical effectiveness and cost-effectiveness of bibliotherapy for a wide variety of problems. It discusses the literature on process variables leading to therapeutic change in patients utilizing bibliotherapy. It addresses the role of bibliotherapy within the context of a stepped care and integrated care environment. It proposes adjunctive treatment as a research and dissemination agenda for the use of bibliotherapy. There are many obvious advantages to bibliotherapy over traditional psychotherapy such as the ability to self-pace, allowing individuals who are unable to receive mental health services due to geographical or transportational barriers receive treatment and providing cost-effectiveness for those who cannot afford psychotherapy or pharmacotherapy, privacy that can lessen stigmatization or labeling, and coping skills for life after treatment has ended. Despite these benefits, there are still many unknowns in the area of bibliotherapy such as for whom it is effective, for which psychological problems it is effective, what degree of adjunctive professional or nonprofessional help is needed, and what role bibliotherapy can play in integrated health care systems.
    Evidence-Based Adjunctive Treatments, 01/2008: pages 7-39; , ISBN: 9780120885206

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