A comparison of nutritional management and stress management in the treatment of bulimia nervosa

Westmead Hospital, Sydney, New South Wales, Australia
The British Journal of Psychiatry (Impact Factor: 7.99). 09/1991; 159(2):250-61. DOI: 10.1192/bjp.159.2.250
Source: PubMed


In a comparison of nutritional management (NM) and stress management (SM) for treatment of bulimia nervosa, 55 female patients were randomly assigned to either treatment. Therapy consisted of 15 sessions in a group over three months, by the end of which, patients under both treatment conditions showed a significant reduction in the frequency of binge eating and vomiting and a significant improvement in various psychopathological features such as body dissatisfaction and depression. All improvements were maintained over 12-month follow-up NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge frequency and a higher abstinence rate from binge eating. SM led to greater positive changes in certain psychopathological features such as feelings of ineffectiveness, interpersonal distrust and anxiety. NM should be regarded as a necessary first intervention in all bulimic patients. Further psychological therapy, such as SM, is indicated as well for some patients, depending on their specific psychological difficulties.

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    • "Some treatments labeled as nutritional counseling or management seem virtually identical to elements of manual-based CBT. For example, Laessle et al. (1991) compared what they called a nutritional management (NM) treatment with stress management. The former closely approximated the behavioral components (Stage 1) of manual-based CBT (Fairburn et al., 1993). "
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    ABSTRACT: The goals of manual-based cognitive-behavioral therapy (CBT) and nutritional counseling for eating disorders are similar, namely, eliminating dysfunctional patterns of eating. Modifying these behaviors requires specific therapeutic expertise in the principles and procedures of behavior change that is not typically part of the training of nutritionists and dieticians or mental health professionals without specific expertise. We discuss ways in which principles of behavior change can be applied to eating disorders by non-CBT experts. Specific nutritional rehabilitation programs have the potential to augment CBT in addressing the array of appetitive abnormalities present in eating disorder patients. The dysfunctional appetitive, hedonic, and metabolic characteristics of patients with bulimia nervosa (BN) and binge eating disorder are reviewed. These abnormalities constitute potential target areas that might be more fully addressed by nutritional interventions designed to restore normal appetitive function.
    Full-text · Article · Oct 2000 · Eating Behaviors
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    • "Antidepressant medication exerts its effect rapidly ( Devlin & Walsh, 1995 ). CBT is also comparatively quick acting ( Wilson & Fairburn, 1998 ), producing more rapid improvement than supportive—expressive psychotherapy ( Garner et al., 1993 ), stress management therapy ( Laessle et al., 1991 ), and interpersonal psychotherapy (IPT; Fairburn et al., 1993 ). "
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    ABSTRACT: This article extends the acute outcome findings from a study comparing psychological and pharmacological interventions for bulimia nervosa (B.T. Walsh et al., 1997) by examining 3 additional domains: predictive factors, therapeutic alliance, and time course of change. One hundred twenty women were randomized to cognitive-behavioral therapy (CBT), supportive psychotherapy (SPT) plus antidepressant medication or a placebo, or a medication-alone condition. Results indicate that high baseline frequencies of binge eating and vomiting, as well as a positive history of substance abuse or dependence, are negative prognostic indicators. Although a greater overall therapeutic alliance may increase the likelihood of remission, symptom change over the course of treatment may have as much of an impact on patient ratings of alliance as the reverse. CBT was significantly more rapid than SPT in reducing binge eating and vomiting frequencies.
    Full-text · Article · Sep 1999 · Journal of Consulting and Clinical Psychology

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