Study design: Randomized controlled trial
Study grouping:
Open Label:
Cluster RCT:
Baseline Characteristics
Group therapy
-
Frequency: 19 gange på 4,5 mdr. 90 minute sessions.
-
Content: The GCBT treatment was adapted from the Oxford manual (Fairburn et al., 1993) and reviewed by Fairburn. The handouts, session schedule, and content were identical to ICBT. At the beginning of each stage, the agenda for the following sessions in the stage was established and revised at the start of each session. During the first 30–40 minutes of each session, the therapist reviewed each individual’s self-monitoring while the rest of the group read material, reviewed strategies, or participated in a structured activity (e.g., listing the negative effects of BN). Like ICBT patients, group patients were given the option to have a family and friends information evening that was only conducted if all members desired it.
Individual therapy
-
Frequency: nineteen 50-min sessions spread over 4.5 months
-
Content: The ICBT treatment followed the semistructured, three-stage program of nineteen 50-min sessions spread over 4.5 months (Fairburn et al., 1993). Patients had access to the self-help book published by Fairburn (1995). Stage 1 patients were given the option of an information session with friends or family
Included criteria: female, 18 years or older, met BN criteria in the4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; AmericanPsychiatric Association, 1994), had a body mass index (BMI) between 19 and 27, and gaveinformed consent.
Excluded criteria: Patients were excluded if they were currently receiving treatment forBN, were a suicide risk or were medically compromised, met diagnosis for other mentalillnesses (this was later dropped) or were unable to be present for the study, or lived more than 1.5 hr away fromthe University of Sydney.
Intervention Characteristics
Group therapy
-
Age (SD): no info
-
BN/BN-like (% of sample (N)): 100 (30)
-
Sex (female % of sample (N)): 100 (30)
-
BMI (SD): no info
Individual therapy
-
Age (SD): no info
-
BN/BN-like (% of sample (N)): 100 (30)
-
Sex (female % of sample (N)): 100 (30)
-
BMI (SD): no info
Continuous:
- EDI body dissatisfaction
- EDE weight concern
- EDI drive for thinness
- EDI bulimia
- EDE eating concern
- EDE restraint
- Binges/week
- Binges/month
- Purges/month
- Vomiting/month
- EDE global
- EDE shape concern
- Livskvalitet
- Funktionsevne
- Vomiting/week
Dichotomous:
- Dropout
- Remission of ED
- Remission of ED
- Binge eating abstinence
- Vomiting abstinence
Sponsorship source: This study was supported by a small Australian Research Council grant and EC wassupported by an Australian Postgraduate Award. CGF is supported by a Principal ResearchFellowship award from the Wellcome Trust (046386).
Country: Australia
Setting: outpatient
Comments:
Authors name: Eunice Chen
Institution: Yale Center of Eating and Weight Disorders, Department of Psychology, Yale University, New Haven, Connecticut
Email: echen@u.washington.edu
Address: Department of Psychology, Yale University, P.O. Box 208205, New Haven,CT 06520-8205.
Identification:
Participants:
Study design:
Baseline characteristics:
Intervention characteristics:
Pretreatment:
Continuous outcomes:
Dichotomous outcomes:
Adverse outcomes:
Study design: Randomized controlled trial
Study grouping:
Open Label:
Cluster RCT:
Baseline Characteristics
Group therapy
-
Frequency: Phase 2 consisted of eight sessions of individual or group CBT. Group sessions lasted 90 minutes, had between six to eight participants, and were moderated by two therapists.
-
Content: four individual sessions of manualized individual MET. In contrast to the well-known CBT-BN program of Fairburn and colleagues (2), the group treatment used here (19,21) is briefer (8 versus 19 sessions) and emphasized women’s development of interpersonal competencies. In both conditions, patients worked with the manual, “You Can’t Have Your Cake and Eat It Too: A Progam for Controlling Bulimia” (19). The structure of Phase 2 sessions followed the chapter topics of the book. Each week included discussion and exercises to educate women about the physical and psychological hazards of eating disorders, challenging myths, and identifying ways women might undermine their own success. During weekly sessions, therapists integrated nutritional information (realistic caloric consumption, meal planning, etc.) and methods to modify extreme, unhelpful thinking. Perfectionist ideas about one’s body and behavior were identified and ways to assert one’s feelings and express anger were reviewed.
Individual therapy
-
Frequency: Phase 2 consisted of eight sessions of individual or group CBT. Individual sessions lasted 50 minutes.
-
Content: four individual sessions of manualized individual MET. In both conditions, patients worked with the manual, “You Can’t Have Your Cake and Eat It Too: A Progam for Controlling Bulimia” (19). The structure of Phase 2 sessions followed the chapter topics of the book. Each week included discussion and exercises to educate women about the physical and psychological hazards of eating disorders, challenging myths, and identifying ways women might undermine their own success. During weekly sessions, therapists integrated nutritional information (realistic caloric consumption, meal planning, etc.) and methods to modify extreme, unhelpful thinking. Perfectionist ideas about one’s body and behavior were identified and ways to assert one’s feelings and express anger were reviewed.
Included criteria: All patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for BN or EDNOS were eligible for the study. We defined EDNOS as subthreshold BN—a clinically relevant eating disorder (i.e., significant impairment of physical health or psychosocial functioning) where the patient met the criteria for BN except that the binge eating and/or inappropriate compensatory behaviors occurred at a frequency of less than twice a week or for a duration of 3 months.
Excluded criteria: The exclusion criteria were pregnancy, diabetes mellitus, severe mental illness (such as schizophrenia or bipolar illness), severe learning disability, inability to commit to treatment from the outset, or referral for assessment only.
Intervention Characteristics
Group therapy
-
Age (SD): 28.9 (8.1)
-
BN/BN-like (% of sample (N)): 100 (73)
-
Sex (female % of sample (N)): no info
-
BMI (SD): 23.5 (5.9)
Individual therapy
-
Age (SD): 31 (7.7)
-
BN/BN-like (% of sample (N)): 100 (79)
-
Sex (female % of sample (N)): no info
-
BMI (SD): 25.1 (7.7)
Continuous:
- EDI body dissatisfaction
- EDE weight concern
- EDI drive for thinness
- EDI bulimia
- EDE eating concern
- EDE restraint
- Binges/week
- Binges/month
- Purges/month
- Vomiting/month
- EDE global
- EDE shape concern
- Livskvalitet
- Funktionsevne
- Vomiting/week
Dichotomous:
- Dropout
- Remission of ED
- Remission of ED
- Binge eating abstinence
- Vomiting abstinence
Sponsorship source: The authors have not disclosed any potential conflicts of interest.
Country: USA
Setting: busy outpatient setting
Comments:
Authors name: MELANIE A. KATZMAN
Institution: Department of Psychiatry (M.A.K.), Weill Cornell Medical Center, New York
Email: mkatzman@katzmanconsulting.com
Address: Melanie A. Katzman, 10East 78th Street, Suite 4A, New York, NY 10075.
Identification:
Participants:
Study design:
Baseline characteristics:
Intervention characteristics:
Pretreatment:
Continuous outcomes:
Dichotomous outcomes:
Adverse outcomes:
Study design: Randomized controlled trial
Study grouping:
Open Label:
Cluster RCT:
Baseline Characteristics
Group therapy
-
Frequency: 23 sessions over a period of 20 weeks. Group sessions were 2 hr in the evening between 5 p.m. and 7 p.m., and occurred twice weekly for the first 3 weeks, and weekly thereafter for 17 weeks. The first phase, of 10 sessions, is symptom focused and based on CBT techniques, whereas the second phase, of 13 sessions, is interpersonally focused and based on IPT techniques.
-
Content: GRP is based on a detailed treatment manual,21 previously tested in our pilot study, which is based on published CBT22 and IPT23 manuals.
Individual therapy
-
Frequency: 50–60 min weekly for 23 weeks. The first phase, of 10 sessions, is symptom focused and based on CBT techniques, whereas the second phase, of 13 sessions, is interpersonally focused and based on IPT techniques.
-
Content: CBT used in the current study is a concise treatment including key elements (e.g., cognitive view, homework with self-monitoring sheets, dysfunctional eating patterns, identification of binge eating, information about self-esteem, dieting, body/weight/shape, binge eating, compensatory behaviors and physical consequences, shape/weight and cognitive distortions, coping strategies, and relapse prevention) of CBT. If interpersonal problems arose during the CBT treatment, therapists referred the subjects to the upcoming IPT. IPT24 was adapted for eating disorders by Fairburn13 and focuses on current interpersonal problem areas (grief, interpersonal disputes, role transitions, and interpersonal deficits) in an eating disorder context. Participants are encouraged to recognize, accept, and express their interpersonal experience and attempt other ways of functioning. The IPT used in the current study was of shorter duration compared with what has been described elsewhere.13 The sequenced treatment is divided into two phases.
Included criteria: inclusioncriteria: (a) being of female gender, (b) being 18–24years of age, (c) meeting DSM-IV criteria for BN, (d)accepting both IND and GRP, and (e) having a bodymass index (BMI) > 18 kg/m2.
Excluded criteria: Exclusion criteria were(a) current alcohol and/or drug abuse, (b) current psychoticdisorder, (c) current receipt of psychopharmacologicmedication and/or psychotherapy, and (d) suicidalbehavior.
Intervention Characteristics
Group therapy
-
Age (SD): 21.1 (2.0)
-
BN/BN-like (% of sample (N)): 100 (44)
-
Sex (female % of sample (N)): 100 (44)
-
BMI (SD): 21.5 (2.1)
Individual therapy
-
Age (SD): 20.3 (2.0)
-
BN/BN-like (% of sample (N)): 100 (42)
-
Sex (female % of sample (N)): 100 (42)
-
BMI (SD): 21.9 (2.1)
Continuous:
- EDI body dissatisfaction
- EDE weight concern
- EDI drive for thinness
- EDI bulimia
- EDE eating concern
- EDE restraint
- Binges/week
- Binges/month
- Purges/month
- Vomiting/month
- EDE global
- EDE shape concern
- Livskvalitet
- Funktionsevne
- Vomiting/week
- Purges/week
- Binges/days pr week
- Purges/days pr week
- EDI subscales 1-3
Dichotomous:
- Dropout
- Remission of ED
- Remission of ED
- Binge eating abstinence
- Vomiting abstinence
Sponsorship source: Supported by a grant from the Vårdal Foundation, Sweden
Country: Sweden
Setting: outpatient
Comments:
Authors name: Lauri Nevonen
Institution: Anorexia-Bulimia Unit, Queen Silvia Children’s Hospital, Child and Adolescent Psychiatry Center
Email: Lauri.Nevonen@vgregion.se
Address: Anorexia-Bulimia Unit, Queen Silvia Children’s Hospital, Child and Adolescent Psychiatry Center, s-461 85 Göteborg, Sweden.
Identification:
Participants:
Study design:
Baseline characteristics:
Intervention characteristics:
Pretreatment:
Continuous outcomes:
Dichotomous outcomes:
Adverse outcomes: