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

  • V. V. W. McIntosh (a1), F. A. Carter (a1), C. M. Bulik (a2), C. M. A. Frampton (a1) and P. R. Joyce (a1)...

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.

Copyright

Corresponding author

*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)

References

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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