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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: virginia.mcintosh@otago.ac.nz)
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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

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