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A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa

Published online by Cambridge University Press:  23 May 2013

S. A. Wonderlich*
Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
C. B. Peterson
Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
R. D. Crosby
Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
T. L. Smith
Department of Psychiatry, University of Wisconsin, Madison, WI, USA
M. H. Klein
Department of Psychiatry, University of Wisconsin, Madison, WI, USA
J. E. Mitchell
Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
S. J. Crow
Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
*Address for correspondence: Dr S. A. Wonderlich, Neuropsychiatric Research Institute, 120 South 8th Street, Box 1415, Fargo, ND 58107–1415, USA. (Email:



The purpose of this investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, ‘enhanced’ cognitive-behavioral therapy (CBT-E).


Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat).


Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different.


ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.

Original Articles
Copyright © Cambridge University Press 2013 

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This paper was presented at the Eating Disorder Research Society Meeting, Porto, Portugal, 20–22 September 2012, and the International Conference on Eating Disorders, 2–4 May 2013, Montreal, Quebec.


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