A sequenced group psychotherapy model for bulimia nervosa patients: a pilot study

Integrating Cognitive-behavioural and Interpersonal Approaches in a Group Program for the Eating Disorders: Measuring Effectiveness in a Naturalistic Setting

A group treatment program, designed for post-adolescent women with a range of eating problems, was developed, implemented, evaluated and then transported to a different treatment setting to test its effectiveness. The treatment program was aimed at overcoming some of the difficulties traditionally associated with clinical trial treatment protocols. In particular, the inclusion of sub-clinical and comorbid clients, the integration of two empirically validated theoretical approaches (cognitive-behavioural therapy and interpersonal therapy), and the implementation of the program in both a generalist outpatient clinic staffed by postgraduate counselling students and a hospital specialist clinic, enabled treatment outcome to be assessed under more naturalistic conditions. Twenty-eight women (Mean age = 33 years), met in six small groups at the University clinic, and completed the 10-week group program, which incorporated both cognitive-behavioural and interpersonal components. Outcome was determined by measures of behaviour change, changes in eating psychopathology and measures of general psychopathology. In addition, treatment generalisability was assessed by running the group program in an alternative setting, with an additional 12 clients, led by two clinically trained therapists. Group data indicated improvement on most outcome measures at both posttreatment and follow-up, for treated clients (in both settings) relative to a waiting-list control group. The variables which were most affected by treatment, however, were not necessarily those specifically targeted by the intervention. The results demonstrate the need to gather empirical data on psychotherapy as it is actually practiced, with a broad range of clients, therapists and using integrated treatment approaches.

A self psychological and relational approach to group therapy for university students with bulimia

Bulimia is a complex disorder that can significantly interfere with psychosocial functioning. It is a particularly significant problem among adolescents and young women in college and university settings. The preponderance of literature on group therapeutic approaches for this disorder is from a cognitive-behavioral perspective. In this paper, we present a psychodynamic group therapy approach for female university students, informed specifically by self psychological and relational frameworks. Through clinical illustrations, we demonstrate how the group provides selfobject experiences, including mirroring, idealizing, twinship, and adversarial experiences, and how the group becomes the arena through which group members can experience, express, and understand emotions. The interpersonal context of the group uniquely provides opportunities for members to examine their bulimic symptoms in relation to interactions that take place outside of or within the group.

A comparison of sequenced individual and group psychotherapy for patients with bulimia nervosa

OBJECTIVE

The current study examined the effectiveness of individual (IND) versus group (GRP) therapy for patients with bulimia nervosa (BN), using a manual of sequenced treatment with cognitive-behavioral therapy (CBT) followed by interpersonal psychotherapy (IPT).

METHOD

Eighty-six participants with BN were matched and randomized to 23 sessions of IND or GRP. Participants were measured pretreatment and posttreatment and at 1-year and 2.5-year follow-ups using both intent-to-treat and completer samples.

RESULTS

The intent-to-treat analysis revealed that the percentage of participants recovered and remitted was equivalent between IND and GRP. Significant group differences were found between completers on binge eating and compensatory behavior with greater improvement for IND. On most measures, effect sizes were larger for IND at 1-year follow-up.

CONCLUSION

Sequencing CBT and IPT worked well in both IND and GRP formats. We found few outcome differences between IND as opposed to GRP.

An integration of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa: a case study using the case formulation method

OBJECTIVE

The current study provides an illustration of an integration of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for the treatment of bulimia nervosa (BN), based on the case formulation strategy.

METHOD

A 25-year-old Hispanic female referred herself for the treatment of eating difficulties and depressed mood. Diagnostic criteria were met for BN, major depressive episode, and alcohol abuse. Components of both CBT and IPT were utilized throughout the course of treatment.

RESULTS

CBT techniques appeared to be most effective in eliminating binge eating and binge drinking behavior, whereas IPT techniques seemed to be most effective in reducing purging behavior. Results revealed that the client was no longer experiencing clinically significant symptoms of BN, depression, or alcohol abuse at end of treatment and follow-up (18 months after treatment onset).

DISCUSSION

Findings support the integration of CBT and IPT for the treatment of BN and, potentially, other eating disorders.

Coping Strategies in Bulimia Nervosa Treatment: Impact on Outcome in Group Cognitive-Behavioral Therapy

This study's purpose was to examine the extent to which participants (N = 143) receiving cognitive-behavioral therapy for bulimia nervosa (BN) reported implementing therapeutic strategies to abstain from BN behaviors, and to assess whether use of specific strategies predicts outcome at treatment end and 1- and 6-month follow-up. Frequency of outcome expectancies (OE), stimulus-response prevention (SRP), and social support-seeking (SSS) strategies significantly increased by end of treatment. By 1-month follow-up, use of SSS, not OE or SRP, declined significantly relative to treatment end. Although frequency of coping strategy use at treatment end did not predict 1-month BN symptom remission, SSS use at 1-month follow-up predicted 6-month remission. Findings highlight the importance of social support to maintain treatment gains.