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Sequential Treatment for Bulimia Nervosa Incorporating A Self-Care Manual

Published online by Cambridge University Press:  02 January 2018

Janet Treasure ,
Ulrike Schmidt ,
Nicholas Troop ,
Jane Tiller ,
Gill Todd  and
Susan Turnbull
Janet Treasure
Affiliation:
Eating Disorder Research Group
Ulrike Schmidt
Affiliation:
Psychiatry Department, St Mary's Hospital, London
Nicholas Troop
Affiliation:
Eating Disorder Research Group, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Jane Tiller
Affiliation:
Eating Disorder Research Group, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Gill Todd
Affiliation:
Eating Disorder Research Group, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Susan Turnbull
Affiliation:
Eating Disorder Research Group, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
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Abstract

Background

The aim of this study was to evaluate the effectiveness of a stepped care approach to the treatment of bulimia nervosa: a self-care manual followed, if necessary, by a course of attenuated cognitive behavioural treatment (CBT) in comparison with standard CBT.

Method

One hundred and ten patients, presenting at a tertiary referral centre with ICD–10 bulimia nervosa or atypical bulimia nervosa, were randomly assigned to one of two treatment conditions; a) a sequential treatment group: 8 weeks with a self-care manual followed by up to eight sessions of CBT (if still symptomatic) or b) 16 sessions of CBT.

Results

Bulimic symptoms improved significantly in both groups with no significant differences between the two groups on any of the measures at the end of treatment or at 18 months follow-up. At end of treatment 30% (95% CI: 18–46%) of the sequential group and 30% (95% CI: 17–47%) of the standard treatment group were free from all bulimic symptoms. Sixteen of those in the sequential group improved significantly with self-care and did not require additional treatment. The median number of sessions taken by the sequential group was three (95% CI: 0–6). At 18 months follow-up 40% (95% CI: 23–59%) of the sequential group and 41% (95% CI: 25–59%) of the CBT group were symptom free.

Conclusions

A sequential approach to the treatment of bulimia may be as effective as standard CBT and can considerably reduce the amount of therapist contact required.

Type
Papers
Information
The British Journal of Psychiatry , Volume 168 , Issue 1 , January 1996 , pp. 94 - 98
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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