Academic journal article Journal of Eating Disorders

Empirically-Supported and Non-Empirically Supported Therapies for Bulimia Nervosa: Retrospective Patient Ratings

Academic journal article Journal of Eating Disorders

Empirically-Supported and Non-Empirically Supported Therapies for Bulimia Nervosa: Retrospective Patient Ratings

Article excerpt

Author(s): Lucy Serpell[sup.1,2], Blake Stobie[sup.3], Christopher G Fairburn[sup.4] and Rachel van Schaick[sup.1,5]

Background

Treatment guidelines for the United Kingdom recommend that individuals with BN should be offered 16-20 sessions of a specialist form of Cognitive Behaviour Therapy (CBT) called CBT-BN. If clients do not want or do not respond to CBT-BN, Interpersonal Psychotherapy (IPT) should be offered. For clients with Eating Disorder Not Otherwise Specified (EDNOS), the specified approach for the most similar eating disorder should be followed[1]. Similar treatment guidelines exist in the US[2].

Despite this guidance, a large proportion of sufferers of BN are not receiving the recommended treatment[3-5]. Studies surveying clinicians have found that they tend to apply a range of psychodynamic and cognitive-behavioural interventions to work with people with eating disorders[6, 7]. Only a minority of clinicians use CBT as their primary approach to eating disorders and fewer than 4% of general practitioners use national guidelines to inform their treatment decisions[8]. The lack of availability of IPT is more pronounced than that of CBT. Currently there are only six centres for professional IPT training in the UK, compared to numerous CBT training centres[9].

A further concern regarding treatment for people with BN is that some sufferers may be receiving psychological therapy that is labelled as CBT but does not include the core components of the treatment which have been evaluated in research trials. In the treatment of anxiety disorders, similar 'off-model' CBT is associated with poorer treatment outcomes[10, 11].

The majority of research investigating treatment for BN has utilised outcome measures which measure eating disorder symptom levels but has neglected to evaluate clients' perspectives on the helpfulness of treatments. Users of mental health services commonly complain that they are given inadequate information and excluded from treatment decisions[12]. In response to this, there has been an increasing focus on taking account of the views of clients in developing and evaluating treatments[13, 14]. It is important to investigate the views of clients so that they can be combined with research evidence and clinical expertise, in order to develop treatments that are effective and acceptable to clients[15]. This is arguably particularly important in the field of eating disorders where clients are often ambivalent about receiving treatment[16-19]. No research to date has analysed the specific components of psychological therapy and related self-rated treatment outcomes in clients with BN.

This study aimed to investigate whether receiving ESTs, as they have been evaluated in randomised controlled trials (RCTs), is associated with superior treatment outcomes from the clients' perspective compared to psychological therapies which currently have less empirical support. It was expected that, given the lack of training opportunities for IPT in the UK, only a minority of patients would report receiving this approach. It was hypothesised that participants who recalled having received ESTs for BN (CBT or IPT), particularly CBT-BN, would report greater self-rated treatment gains than those who recalled having received non-ESTs.

Methods

Design

An on-line questionnaire was designed to retrospectively assess the specific contents of participants' most recent set of psychological therapy for BN (The Bulimia Treatment History Questionnaire; BTHQ). The BTHQ also included a measure of symptom severity at the time participants commenced the therapy. Potential participants from across the United Kingdom were made aware of the study through a number of strategies (see Procedure). If interested in the study, potential participants could access an on-line information sheet, consent form and BTHQ.

Participants

Participants were eighteen or over and recalled having received psychological therapy for BN or EDNOS BN-Subtype. …

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