Experimental Methodologies Bulimia Nervosa Annotated Bibliography in Annotated Bibliography

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Experimental Methodologies: Bulimia Nervosa

Annotated Bibliography in Abnormal Psychology

Bara-Carril, Nuria, Williams, Christopher J., Pombo-Carril, Maria G., Reid, Yael, Murray, Kathryn, Aubin, Susan et al. (2004). A preliminary investigation into the feasibility and efficacy of a CD-ROM-based cognitive-behavioral self-help intervention for bulimia nervosa. International Journal of Eating Disorders, 35(4), 538-548.

A quasi-experimental study was carried out to test the efficacy of a CD-ROM-based CBT self-help intervention for bulimia. Subjects with a diagnosis of bulimia (N = 36) or eating disorder not otherwise specified (EDNOS; N = 9) were recruited as they presented at an eating disorders clinic in South London. The EDNOS patients met all the criteria for bulimia except for the frequency of binge eating and purging behavior. The exclusion criteria included an inability to understand English, anorexia nervosa, psychosis, acutely suicidal, current substance abuse, severe learning disability, and an inability to attend sessions. Treatment consisted of eight sessions interacting with the CBT material on the CD-ROM. Motivational and educational strategies were also incorporated into the material. The outcome measure was the Short Evaluation of Eating Disorders Symptoms.

Of the 39 subjects for which outcome data was available, a significant reduction in binging and purging occurred with treatment. The decrease in over-exercise was not statistically significant, but the sample size very small. Decreases were also noted for laxative/diuretic use and food restriction. The main limitations of the study were small sample size and the use of antidepressant medications by many of the test subjects. The authors also discussed their concern that a CD-ROM treatment modality may not be widely accepted by patients, especially those who prefer to interact with a therapist. The dropout and compliance rate was also high, with only 19 subjects completing all eight sessions.

Hay, Phillipa P.J., Bacaltchuk, Josue, Stefano, Sergio, and Kashyap, Priyanka. (2009). Psychological treatments for bulimia nervosa and binging. Cochrane Database of Systematic Reviews, Issue 4, Article No. CD000562.

Hay and colleagues sought to determine the relative efficacy of a number of different psychological approaches to treating the eating disorders, bulimia nervosa and binge eating, by using a meta-analysis approach. The meta-analysis included 3,054 study participants from 48 separate studies. The inclusion criteria were adults above the age of 16, males and females, patients, and healthy controls. The diagnoses included purging and non-purging bulimia, binge eating disorder, and EDNOS. The treatments modalities included in this study were cognitive-behavioral therapy (CBT), cognitive-behavioral therapy for bulimia nervosa (CBT-BN), nutritional counseling, interpersonal therapy, hypnotherapy, psychoanalytic/psychodynamic, self-help, and several others.

The primary result from the meta-analysis is that CBT generally, and CBT-BN specifically, was shown to be an effective treatment for bulimia and related eating disorders. Interpersonal psychotherapy and other forms of psychotherapy were found to be effective, but these treatment modalities took longer to achieve statistically significant remission rates. However, psychotherapy alone was found to be insufficient to achieve significant results. The authors concluded that larger and better-controlled studies are needed to discriminate between the relative efficacy of each treatment approach. In addition, despite the large collective patient population examined in the…

Sources Used in Document:

Schapman-Williams, Ann M. And Lock, James. (2007). Using cognitive-behavioral therapy to treat adolescent-onset bulimia nervosa: A case study. Clinical Case Studies, 6(6), 508-524.

In an effort to provide a rationale for future large studies, Schapman-Williams and Lock presented a case study of a 16-year-old female Caucasian with bulimia being treated with CBT. The symptoms began 18 months prior to appearing at the clinic, starting with a concern about the need to lose weight. Food restriction and over-exercise was followed by purging through vomiting. Body image distortion and binge eating also developed. By the time she presented at the clinic, the binge-purge cycle was occurring 2-3 times per day. When given a choice between CBT and interpersonal therapy, the patient and parent chose CBT. A standard course of 20 therapy sessions for treating bulimia was prescribed.

By the second therapy session the eating pattern had begun to normalize, a process that was completed by session 12. The binge-purge cycles ended immediately, with only one relapse reported at session 13. Although the patient experienced a slight weight gain between sessions 5 and 6, weight was stable throughout treatment. Self-reports of eating associated distress declined rapidly and was gone by session 9. The study limitations mentioned by the authors included the use of a treatment protocol intended for adults, but the treating therapists were able to adapt by involving the patient's mother, in an effort to make the home environment more conducive to treatment goals. The results of this study suggest that treating adolescent-onset bulimia using CBT for adults is effective.

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