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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 ,
C. B. Peterson ,
R. D. Crosby ,
T. L. Smith ,
M. H. Klein ,
J. E. Mitchell  and
S. J. Crow
S. A. Wonderlich*
Affiliation:
Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
C. B. Peterson
Affiliation:
Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
R. D. Crosby
Affiliation:
Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
T. L. Smith
Affiliation:
Department of Psychiatry, University of Wisconsin, Madison, WI, USA
M. H. Klein
Affiliation:
Department of Psychiatry, University of Wisconsin, Madison, WI, USA
J. E. Mitchell
Affiliation:
Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
S. J. Crow
Affiliation:
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: swonderlich@nrifargo.com)
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Abstract

Background

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).

Method

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).

Results

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.

Conclusions

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.

Keywords

Bulimia nervosapsychotherapytreatment
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 3 , February 2014 , pp. 543 - 553
Copyright
Copyright © Cambridge University Press 2013 

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Footnotes

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.

References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Benjamin, LS (1974). Structural analysis of social behavior. Psychological Review 81, 392–425.CrossRefGoogle Scholar
Benjamin, LS (1993). Interpersonal Treatment of Personality Disorders. Guilford Press: New York.Google Scholar
Berg, KC, Peterson, CB, Frazier, P, Crow, SC (2012). Psychometric evaluation of the Eating Disorder Examination and Eating Disorder Examination-Questionnaire: a systematic review of the literature. International Journal of Eating Disorders 45, 428–438.Google Scholar
Crow, SJ, Agras, WS, Halmi, K, Mitchell, JE, Kraemer, HC (2012). Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa, and binge eating disorder: a multicenter study. International Journal of Eating Disorders 302, 309–318.Google Scholar
Crow, SJ, Peterson, CB (2003). The economic and social burden of eating disorders. In WPA Series Evidence and Experience in Psychiatry, vol. 6. Eating Disorders (ed. Maj, M., Halmi, K. A., Lopez-Ibor, J. J. and Sartorius, N.), pp. 383–397. John Wiley: New York.Google Scholar
Crow, SJ, Peterson, CB, Swanson, SA, Raymond, NC, Specker, S, Eckert, ED, Mitchell, JE (2009). Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry 166, 1342–1346.Google Scholar
Fairburn, CG (2008). Cognitive Behavior Therapy and Eating Disorders. Guilford Press: New York.Google ScholarPubMed
Fairburn, CG, Cooper, Z, Doll, H, O'Connor, ME, Bohn, K, Hawker, DM, Wales, JA, Palmer, RL (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry 166, 311–319.Google Scholar
Fairburn, CG, Marcus, MD, Wilson, GT (1993). Binge eating: nature, assessment, and treatment. In Cognitive-Behavioral Therapy for Binge Eating and Bulimia Nervosa: A Comprehensive Treatment Manual (ed. Fairburn, C. G. and Wilson, G. T.), pp. 361–404. Guilford Press: New York.Google Scholar
Fichter, MM, Quadflieg, N, Hedlund, S (2008). Long term course of binge eating disorder and bulimia nervosa: relevance for nosology and diagnostic criteria. International Journal of Eating Disorders 41, 577–586.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV Axis I Disorders. Patient Version (SCID-I/P). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Gratz, KL, Roemer, L (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavior Assessment 26, 41–54.Google Scholar
Haedt-Matt, A, Keel, PK (2011). Revisiting the affect regulation model of binge eating: a meta-analysis of studies using ecological momentary assessment. Psychological Bulletin 137, 660–681.Google Scholar
Hedeker, D, Gibbons, RD, Waternaux, C (1999). Sample size estimation for longitudinal designs with attrition: comparing time-related contrasts between two groups. Journal of Educational and Behavioral Statistics 24, 70–93.CrossRefGoogle Scholar
Higgins, ET, Bond, RN, Klein, R, Strauman, TJ (1986). Self-discrepancies and emotional vulnerability: how magnitude, accessibility and type of discrepancy influence affect. Journal of Personality and Social Psychology 51, 5–15.CrossRefGoogle ScholarPubMed
Loeb, KL, Wilson, GT, Labouvie, E, Pratt, EM, Hayaki, J, Walsh, BT, Agras, WS, Fairburn, CG (2005). Therapeutic alliance and treatment adherence in two interventions for bulimia nervosa: a study of process and outcome. Journal of Consulting and Clinical Psychology 73, 1097–1107.Google Scholar
Mehler, P (2011). Medical complications of bulimia nervosa and their treatments. International Journal of Eating Disorders 44, 95–104.Google Scholar
Miller, WR, Rollnick, S (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. Guilford Press: New York.Google Scholar
Mitchell, JE, Agras, WS, Crow, S, Halmi, K, Fairburn, CG, Bryson, S, Kraemer, H (2011). Stepped care and cognitive-behavioural therapy for bulimia nervosa: randomised trial. British Journal of Psychiatry 185, 391–397.Google Scholar
Mitchell, JE, de Zwaan, M, Roerig, JL (2003). Drug therapy for patients with eating disorders. Current Drug Targets. CNS Neurological Disorders 2, 17–29.Google Scholar
Mitchell, JE, Hoberman, HN, Peterson, CB, Mussell, M, Pyle, RL (1996). Research on the psychotherapy of bulimia nervosa: half empty or half full. International Journal of Eating Disorders 20, 219–229.Google Scholar
Mussell, MP, Crosby, RD, Crow, SJ, Knopke, AJ, Peterson, CB, Wonderlich, SA, Mitchell, JE (2000). Utilization of empirically supported psychotherapy treatments for individuals with eating disorders: a survey of psychologists. International Journal of Eating Disorders 27, 230–237.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
NICE (2004). Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. NICE Clinical Guideline No. 9. National Institute for Clinical Excellence: London.Google Scholar
Rieger, E, Van Buren, DJ, Bishop, M, Tanofsky-Kraff, M, Welch, R, Wilfley, DE (2010). An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): casual pathways and treatment implications. Clinical Psychology Review 30, 400–410.CrossRefGoogle Scholar
Rosenberg, M (1979). Conceiving the Self. Basic Books: New York.Google Scholar
Rubin, DB (1987). Multiple Imputation for Nonresponse in Surveys. Wiley: New York.Google Scholar
Schafer, JL (1987). Analysis of Incomplete Multivariate Data. Chapman & Hall: London.Google Scholar
Shapiro, JR, Berkman, ND, Brownley, KA, Sedway, JA, Lohr, KN, Bulik, CM (2007). Bulimia nervosa treatment: a systematic review of randomized controlled trials. International Journal of Eating Disorders 40, 321–336.Google Scholar
Smyth, JM, Wonderlich, SA, Heron, KE, Sliwinski, MJ, Crosby, RD, Mitchell, JE, Engel, SG (2007). Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. Journal of Consulting and Clinical Psychology 75, 629–638.CrossRefGoogle ScholarPubMed
Spielberger, CD, Gorsuch, RL, Lushene, RE (1970). Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press: Palo Alto, CA.Google Scholar
Strauman, TJ, Vookles, J, Barenstein, V, Chaiken, S, Higgins, ET (1991). Self-discrepancies and vulnerability to body dissatisfaction and disordered eating. Journal of Personality and Social Psychology 61, 946–956.CrossRefGoogle ScholarPubMed
Wallace, LM, von Ranson, KM (2011). Treatment manuals: use in the treatment of bulimia nervosa. Behavior Research and Therapy 49, 815–820.Google Scholar
Wilson, GT (2005). Psychological treatment of eating disorders. Annual Review of Psychology 1, 439–465.Google Scholar
Wilson, GT, Grilo, CM, Vitousek, KM (2007). Psychological treatments of eating disorders. American Psychologist 62, 199–216.Google Scholar
Wonderlich, SA, Engel, SG, Peterson, CB, Robinson, MD, Crosby, RD, Mitchell, JE, Smith, T, Klein, M, Lysne, C, Crow, S, Strauman, T, Simonich, H (2008). Examining the conceptual model of integrative cognitive-affective therapy for BN: two assessment studies. International Journal of Eating Disorders 41, 748–754.Google Scholar
Wonderlich, SA, Mitchell, JE (1997). Eating disorders and comorbidity: empirical, conceptual and clinical implications. Psychopharmacology Bulletin 33, 381–390.Google Scholar
Wonderlich, SA, Peterson, CB, Smith, TL, Klein, M, Mitchell, JE, Crow, SJ, Engel, SG (2010). Integrative cognitive-affective therapy for bulimia nervosa. In The Treatment of Eating Disorders: A Clinical Handbook (ed. , G. Grilo, G. and , J. Mitchell, E.), pp. 317–338. Guilford Press: New York.Google Scholar
Zeger, SL, Liang, KY (1986). The analysis of discrete and continuous longitudinal data. Biometrics 42, 121–130.Google Scholar