Guided self-change for bulimia nervosa incorporating use of a self-care manual.
OBJECTIVE
The aim of this study was to evaluate the effectiveness of guided self-change for bulimia nervosa.


METHODS
Sixty-two patients with DSM-III-R-defined bulimia nervosa were randomly assigned to 1) use of a self-care manual plus eight fortnightly sessions of cognitive behavior therapy (guided self-change) or 2) 16 sessions of weekly cognitive behavior therapy.


RESULTS
At the end of treatment and at follow-up an average of 43 weeks after the end of therapy, substantial improvements had been achieved in both groups on the main outcome measures: eating disorder symptoms according to experts' ratings (Eating Disorder Examination subscores on overeating, vomiting, dietary restraint, and shape and weight concerns), self-reports (Bulimic Investigatory Test Edinburgh), and a 5-point severity scale. Also, improvement was seen on the subsidiary outcome measures: the Beck Depression Inventory, the Self-Concept Questionnaire, and knowledge of nutrition, weight, and shape. At follow-up, 71% of the cognitive behavior therapy group had not binged or vomited during the week preceding. In the guided self-change group, 70% had not binged and 61% had not vomited during the week before follow-up.


CONCLUSIONS
Guided self-change incorporating use of a self-care manual offers an approach that can be as effective as standard cognitive behavior therapy in the long term and can considerably reduce the amount of therapist contact required.
Thiels
C
C
Bielefeld Polytechnic, Germany.
Schmidt
U
U
Treasure
J
J
Garthe
R
R
Troop
N
N
D000328:Adult; D001835:Body Weight; D002032:Bulimia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008370:Manuals as Topic; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D012648:Self Care; D012720:Severity of Illness Index; D016896:Treatment Outcome