Adjusting cognitive behavior therapy for adolescents with bulimia nervosa: Results of case series

Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
American journal of psychotherapy 02/2005; 59(3):267-81.
Source: PubMed


This article reviews the types of adjustments needed to an adult protocol of cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) to make it more acceptable to an adolescent population. Employing developmental principles as well as clinical experience as guidelines, these modifications include the involvement of parents, recognition of the interaction of treatment with normal adolescent developmental tasks, and allowances for typical cognitive and emotional immaturity on treatment procedures. Outcomes from a series of adolescents with BN who were treated with this modified-CBT approach show results similar to those expected in adult populations treated using CBT.

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    • "FBT for ED posits that the adolescent has regressed in terms of managing food and eating and that they are not able to recover without significant support from their family. This novel case study was aimed to further assess the suggestion by Lock (2005) that CBT for BN would be enhanced by the inclusion of families. The first participant and her family recived the manualized version of FBT-BN and the second had a combination of FBT-BN and CBT-E. "
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    ABSTRACT: Enhanced cognitive behaviour therapy (CBT-E) is the first-line treatment for bulimia nervosa (BN) in adulthood. There is limited evidence for therapies for children and adolescents with BN; however family-based treatment (FBT) is being increasingly used. This case study contrasts the delivery of FBT with an augmented version (CBT-E) in two adolescents presenting with BN. In both cases, the adolescents achieved remission from BN symptoms, (cessation of bingeing and compensatory behaviour) at the end of treatment. The families reported that FBT provided a platform for them to work together and view BN as a family issue, rather than leaving the onus on the young person to recover independently. The addition of CBT-E strategies assisted with managing cognitions associated with bodyweight and shape concerns and appeared to be useful in a more complex presentation with comorbidities. Future research should examine the effectiveness of augmenting CBT-E strategies to FBT using larger samples and more rigorous research designs.Practitioner pointsInvolving families in the treatment of adolescent BN is both effective and acceptable to young people and their families.Two promising treatment approaches, FBT-BN and CBT-E, can effectively be combined to provide a therapy which has the strengths of both modalities alone.Adolescents with comorbidities or complex presentations may benefit most from combining the two modalities to develop additional skills and strategies.
    Full-text · Article · Sep 2015 · Journal of Family Therapy
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    • "Eisler et al. (2000) AN N ¼ 40 females 12–18 FT-B conjoint or separated RCT No difference in MRS between groups; family with high EE improve more in Separate FBT (p < .05) Lock et al. (2005) "
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    ABSTRACT: Eating disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology methodological review criteria, family treatment-behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family treatment-systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted.
    Preview · Article · Jan 2015 · Journal of Clinical Child & Adolescent Psychology
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    • "Table 1 summarises baseline demographic and clinical presen - tation variables of this patient . The treatment with this patient was 16 sessions of manualised CBT adjusted for adolescents ( Fairburn , Marcus , & Wilson , 1993 ; Lock , 2005 ) over 6 months . "
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    ABSTRACT: Objective: Daily food monitoring is central to most treatment approaches for eating disorders (ED) but adherence to self-monitoring is often challenging for patients. A potentially helpful strategy to improve the adherence to self-monitoring is the use of smartphone applications (apps); however, there are no clinical data describing their use. This study explores the potential of a smartphone app to support ED treatment. Methods: Naturalistic clinical observation, usability and acceptability data were collected from five patients representing the full diagnostic spectrum for ED. Participants included 2 males and 3 females, ages 16–64 years, and their clinicians. Results: As hypothesised, the app resulted in increased frequency of food recording over conventional paper and was generally well-received though usage varied widely. We describe patient and clinician utilisation, including specific adaptations by clinical presentation. Discussion: This proof-of-concept study provides clinical illustration of the potential benefits of a self-monitoring smartphone app for transdiagnostic clinical use. Considerations for the adoption and use of mobile apps in everyday clinical practice are provided.
    Full-text · Article · Aug 2014
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