Attrition and outcome in self-help treatment for bulimia nervosa and binge eating disorder: a constructive replication.
ABSTRACT 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.
- SourceAvailable from: Kelly J. Duncan[Show abstract] [Hide abstract]
ABSTRACT: This meta‐analysis included 111 clinical trials exploring the effectiveness of counseling/psychotherapy and guided self‐help approaches in the treatment of bulimia nervosa. In general, single‐group studies supported higher efficacy of counseling/psychotherapy, whereas wait‐list, treatment‐as‐usual, and placebo studies indicated both approaches were equally effective at termination (posttest) and follow‐up in altering binging, purging, laxative use, and self‐reported bulimia or body dissatisfaction perceptions in nearly all comparisons.Journal of counseling and development: JCD 04/2013; 91(2). · 0.62 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Psychological research has emphasized the importance of narrative for a person's sense of self. Building a coherent narrative of past events is one objective of psychotherapy. However, in guided self-help therapy the patient has to develop this narrative autonomously. Identifying patients’ narrative skills in relation to psychological distress could provide useful information about their suitability for self-help. The aim of this study was to explore whether the syntactic integration of clauses into narrative in texts written by prospective psychotherapy patients was related to mild to moderate psychological distress. Cross-clausal syntax of texts by 97 people who had contacted a primary care mental health service was analyzed. Severity of symptoms associated with mental health difficulties was assessed by a standardized scale (Clinical Outcomes in Routine Evaluation outcome measure). Cross-clausal syntactic integration was negatively correlated with the severity of symptoms. A multiple regression analysis confirmed that the use of simple sentences, finite complement clauses, and coordinated clauses was associated with symptoms (R2 = .26). The results suggest that the analysis of cross-clausal syntax can provide information on patients’ narrative skills in relation to distressing events and can therefore provide additional information to support treatment decisions.Applied Psycholinguistics 04/2011; 32(02). · 1.39 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: There is a growing body of research on manualized self-help interventions for bulimia nervosa (BN) and binge eating disorder (BED). Study and treatment dropout and adherence represent particular challenges in these studies. However, systematic investigations of the relationship between study, intervention and patient characteristics, participation, and intervention outcomes are lacking. We conducted a systematic literature review using electronic databases and hand searches of relevant journals. In metaregression analyses, we analyzed study dropout as well as more specific measures of treatment participation in manualized self-help interventions, their association with intervention characteristics (e.g. duration, guidance, intervention type [bibliotherapy, CD-ROM or Internet based intervention]) and their association with treatment outcomes. Seventy-three publications reporting on 50 different trials of manualized self-help interventions for binge eating and bulimia nervosa published through July 9th 2012 were identified. Across studies, dropout rates ranged from 1% to 88%. Study dropout rates were highest in CD-ROM interventions and lowest in Internet-based interventions. They were higher in samples of BN patients, samples of patients with higher degrees of dietary restraint at baseline, lower age, and lower body mass index. Between 6% and 88% of patients completed the intervention to which they had been assigned. None of the patient, study and intervention characteristics predicted intervention completion rates. Intervention outcomes were moderated by the provision of personal guidance by a health professional, the number of guidance sessions as well as participants' age, BMI, and eating disorder related attitudes (Restraint, Eating, Weight and Shape Concerns) at baseline (after adjusting for study dropout and intervention completion rates). Guidance particularly improved adherence and outcomes in samples of patients with bulimia nervosa; specialist guidance led to higher intervention completion rates and larger intervention effects on some outcomes than non-specialist guidance. Self-help interventions have a place in the treatment of BN and BED, especially if the features of their delivery and indications are considered carefully. To better determine who benefits most from what kind and "dosage" of self-help interventions, we recommend the use of consistent terminology as well as uniform standards for reporting adherence and participation in future self-help trials.Clinical Psychology Review 01/2014; · 7.18 Impact Factor