Sequencing of cognitive-behavioral treatments for bulimia nervosa.
OBJECTIVE
This study investigated the efficacy of a stepped-care trial of brief group psychoeducation (PE) followed by individual cognitive-behavioral therapy (CBT) in the treatment of bulimia nervosa.


METHODS
Fifty-six subjects first completed PE and were then randomly assigned to either a 16-week trial of CBT (PE + CBT) or to no further treatment follow-up (PE-alone).


RESULTS
Compared to PE-alone, PE + CBT produced significantly greater reductions in the specific eating symptoms of binging and purging and significantly higher remission rates that were maintained over a 16-week follow-up. However, there were no differential treatment effects on measures of nonspecific psychopathology. Among PE + CBT subjects, remission in specific eating symptoms was associated with greatest improvements in non-specific psychopathology. The outcome of nonremitted PE + CBT subjects and PE-alone subjects was no different at posttreatment or follow-up.


CONCLUSIONS
These results provide limited support for offering individual CBT to subjects once they have completed an initial trial of group PE.
Davis
R
R
Department of Psychology, Lakehead University, Thunder Bay, Canada.
McVey
G
G
Heinmaa
M
M
Rockert
W
W
Kennedy
S
S
D000293:Adolescent; D000328:Adult; D002032:Bulimia / Q000175:diagnosis / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011569:Psychiatric Status Rating Scales; D013997:Time Factors