Hostname: page-component-f554764f5-8cg97 Total loading time: 0 Render date: 2025-04-12T07:14:16.368Z Has data issue: false hasContentIssue false
  • English
  • Français

Five-year outcome of cognitive behavioral therapy and exposure with response prevention for bulimia nervosa

Published online by Cambridge University Press:  02 September 2010

V. V. W. McIntosh ,
F. A. Carter ,
C. M. Bulik ,
C. M. A. Frampton  and
P. R. Joyce
V. V. W. McIntosh*
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
F. A. Carter
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
C. M. Bulik
Affiliation:
Departments of Psychiatry and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
C. M. A. Frampton
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
P. R. Joyce
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
*
*Address for correspondence: V. V. W. McIntosh, Ph.D., Dip.Clin.Psych., Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, 4 Oxford Terrace, Christchurch 8140, New Zealand. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Few data exist examining the longer-term outcome of bulimia nervosa (BN) following treatment with cognitive behavioral therapy (CBT) and exposure with response prevention (ERP).

Method

One hundred and thirty-five women with purging BN received eight sessions of individual CBT and were then randomly assigned to either relaxation training (RELAX) or one of two ERP treatments, pre-binge (B-ERP) or pre-purge cues (P-ERP). Participants were assessed yearly following treatment and follow-up data were recorded.

Results

Eighty-one per cent of the total sample attended long-term follow-up. At 5 years, abstinence rates from binging were significantly higher for the two exposure treatments (43% and 54%) than for relaxation (27%), with no difference between the two forms of exposure. Over 5 years, the frequency of purging was lower for the exposure treatments than for relaxation training. Rates of recovery varied according to definition of recovery. Recovery continued to increase to 5 years. At 5 years, 83% no longer met DSM-III-R criteria for BN, 65% received no eating disorder diagnosis, but only 36% had been abstinent from bulimic behaviors for the past year.

Conclusions

This study provides possible evidence of a conditioned inoculation from exposure treatment compared with relaxation training in long-term abstinence from binge eating at 5 years, and the frequency of purging over 5 years, but not for other features of BN. Differences among the groups were not found prior to 5 years. CBT is effective for BN, yet a substantial group remains unwell in the long term. Definition of recovery impacts markedly on recovery rates.

Keywords

Bulimia nervosacognitive behavioral therapyexposure with response preventiontreatment outcome
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 5 , May 2011 , pp. 1061 - 1071
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Agras, WS, Schneider, JA, Arnow, B, Raeburn, SD, Telch, CF (1989 a). Cognitive-behavioral treatment with and without exposure plus response prevention in the treatment of bulimia nervosa: a reply to Leitenberg and Rosen. Journal of Consulting and Clinical Psychology 57, 778–779.CrossRefGoogle ScholarPubMed
Agras, WS, Schneider, JA, Arnow, SD, Raeburn, SD, Telch, CF (1989 b). Cognitive-behavioral and response-prevention treatments for bulimia nervosa. Journal of Consulting and Clinical Psychology 57, 215–221.CrossRefGoogle ScholarPubMed
APA (1987). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Bulik, CM, Sullivan, PF, Carter, FA, McIntosh, VV, Joyce, PR (1998 a). The role of exposure with response prevention in the cognitive-behavioural therapy for bulimia nervosa. Psychological Medicine 28, 611–623.CrossRefGoogle ScholarPubMed
Bulik, CM, Sullivan, PF, Carter, FA, McIntosh, VV, Joyce, PR (1999). Predictors of rapid and sustained response to cognitive-behavioral therapy for bulimia nervosa. International Journal of Eating Disorders 26, 137–144.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Bulik, CM, Sullivan, PF, Joyce, PR, Carter, FA, McIntosh, VV (1998 b). Predictors of 1-year treatment outcome in bulimia nervosa. Comprehensive Psychiatry 39, 206–214.CrossRefGoogle ScholarPubMed
Carter, FA, McIntosh, VVW, Joyce, PR, Sullivan, PF, Bulik, CM (2003). Role of exposure with response prevention in the cognitive behavioral therapy for bulimia nervosa: three-year follow-up results. International Journal of Eating Disorders 33, 127–135.CrossRefGoogle ScholarPubMed
Fairburn, CG, Jones, R, Peveler, RC, Carr, SJ, Solomon, RA, O'Connor, ME, Burton, J, Hope, RA (1991). Three psychological treatments for bulimia nervosa: a comparative trial. Archives of General Psychiatry 48, 463–469.CrossRefGoogle ScholarPubMed
Fairburn, CG, Marcus, MD, Wilson, GT (1993). Cognitive-behavioural therapy for binge eating and bulimia nervosa: a comprehensive treatment manual. In Binge Eating: Nature, Assessment and Treatment ( ed. Fairburn, C. G. and Wilson, G. T.), pp. 361–404. Guilford Press: New York.Google Scholar
Fairburn, CG, Norman, PA, Welch, SL, O'Connor, ME, Doll, HA, Peveler, RC (1995). A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Archives of General Psychiatry 52, 304–312.CrossRefGoogle ScholarPubMed
Garner, DM, Olmsted, MA, Polivy, J (1983 a). Development and validation of a multidimensional Eating Disorder Inventory for anorexia nervosa and bulimia nervosa. International Journal of Eating Disorders 2, 15–24.3.0.CO;2-6>CrossRefGoogle Scholar
Garner, DM, Olmsted, MP, Polivy, J (1983 b). The Eating Disorder Inventory: a measure of cognitive-behavioral dimensions of anorexia nervosa and bulimia. In Anorexia Nervosa: Recent Developments in Research (ed. Darby, P. L., Garfinkel, P. E., Garner, D. M. and Coscina, D. V.), pp. 173–184. Liss: New York.Google Scholar
Giles, TR, Young, RR, Young, DE (1985). Behavioral treatment of severe bulimia. Behavior Therapy 16, 393–405.CrossRefGoogle Scholar
Hamilton, M (1960). A rating scale for measuring depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle Scholar
Jansen, A, Klaver, J, Merckelbach, H, van den Hout, MA (1989 a). Restrained eaters are rapidly habituating sensation seekers. Behaviour Research and Therapy 27, 247–252.CrossRefGoogle ScholarPubMed
Jansen, A, van den Hout, MA, de Loof, C, Zandbergen, J, Griez, E (1989 b). A case of bulimia successfully treated by cue exposure. Journal of Behavior Therapy and Experimental Psychiatry 20, 327–332.CrossRefGoogle ScholarPubMed
Kordy, H, Kraemer, B, Palmer, RL, Papezova, H, Pellet, J, Richard, M, Treasure, J (2002). Remission, recovery, relapse and recurrence in eating disorders: conceptualization and illustration of a validation strategy. Journal of Clinical Psychology 58, 833–846.CrossRefGoogle ScholarPubMed
Leitenberg, H, Gross, J, Peterson, J, Rosen, J (1984). Analysis of an anxiety model and the process of change during exposure plus response prevention treatment of bulimia nervosa. Behavior Therapy 15, 3–20.CrossRefGoogle Scholar
Leitenberg, H, Rosen, J (1989). Cognitive-behavioral therapy with and without exposure plus response prevention in treatment of bulimia nervosa: comment on Agras, Schneider, Arnow, Raeburn, and Telch. Journal of Consulting and Clinical Psychology 57, 776–777.CrossRefGoogle ScholarPubMed
Leitenberg, H, Rosen, JC, Gross, J, Nudelman, S, Vara, LS (1988). Exposure plus response prevention treatment of bulimia nervosa. Journal of Consulting and Clinical Psychology 56, 535–541.CrossRefGoogle ScholarPubMed
Martinez-Mallén, E, Castro-Fornieles, J, Lázaro, L, Moreno, E, Morer, A, Font, E, Julien, J, Vila, M, Toro, J (2007). Cue exposure in the treatment of resistant adolescent bulimia nervosa. International Journal of Eating Disorders 40, 596–601.CrossRefGoogle ScholarPubMed
McIntosh, VVW, Jordan, J, Carter, JD, Latner, JD, Wallace, A (2007). Appetite focused CBT for binge eating. In Self-help for Obesity and Eating Disorders (ed. Wilson, G. T. and Latner, J. D.), pp. 325–346. Guilford Press: New York.Google Scholar
Rosen, JC, Leitenberg, H (1982). Bulimia nervosa: treatment with exposure and response prevention. Behaviour Research and Therapy 13, 117–124.CrossRefGoogle Scholar
Schmidt, U, Marks, I (1988). Cue exposure to food plus response prevention of bingeing vs. cue exposure plus prevention of vomiting in bulimia nervosa: a pilot study. International Journal of Eating Disorders 7, 663–672.3.0.CO;2-X>CrossRefGoogle Scholar
Schmidt, U, Marks, IM (1989). Exposure plus response prevention of binging vs. exposure plus response prevention of vomiting in bulimia nervosa. A crossover study. Journal of Nervous and Mental Disease 177, 259–266.CrossRefGoogle ScholarPubMed
Shapiro, JR, Berkman, ND, Brownley, KA, Sedway, JA, Lohr, KN, Bulik, CM (2007). Bulimia nervosa treatment: a systematic review of randomized controlled trials. International Journal of Eating Disorders 40, 321–336.CrossRefGoogle ScholarPubMed
Spitzer, RL, Williams, JB, Gibbon, M (1987). Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Spitzer, RL, Williams, JB, Gibbon, M, First, M (1990). Structured Clinical Interview for DSM-III-R – Patient Edition (With Psychotic Screen): SCID-P (PS): Version 1.0. American Psychiatric Press: Washington, DC.Google Scholar
Steiger, H, Gauvin, L, Engelberg, MJ, Ying Kin, NM, Israel, M, Wonderlich, SA, Richardson, J (2005). Mood- and restraint-based antecedents to binge episodes in bulimia nervosa: possible influences of the serotonin system. Psychological Medicine 35, 1553–1562.CrossRefGoogle ScholarPubMed
Stein, RI, Kenardy, J, Wiseman, CV, Dounchis, JZ, Arnow, BA, Wilfley, DE (2007). What's driving the binge in binge eating disorder? A prospective examination of precursors and consequences. International Journal of Eating Disorders 40, 195–203.CrossRefGoogle ScholarPubMed
Thompson-Brenner, H, Glass, S, Westen, D (2003). A multidimensional meta-analysis of psychotherapy for bulimia nervosa. Clinical Psychology: Science and Practice 10, 269–287.Google Scholar
Toro, J, Cervera, M, Feliu, MH, Garriga, N, Jou, M, Martinez, E, Toro, E (2003). Cue exposure in the treatment of resistant bulimia nervosa. International Journal of Eating Disorders 34, 227–234.CrossRefGoogle ScholarPubMed
Wilson, GT, Rossiter, E, Kleifield, EI, Lindholm, L (1986). Cognitive-behavioral treatment of bulimia nervosa: a controlled evaluation. Behaviour Research and Therapy 24, 277–288.CrossRefGoogle ScholarPubMed