title: Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change.
abstract: This article extends the acute outcome findings from a study comparing psychological and pharmacological interventions for bulimia nervosa (B.T. Walsh et al., 1997) by examining 3 additional domains: predictive factors, therapeutic alliance, and time course of change. One hundred twenty women were randomized to cognitive-behavioral therapy (CBT), supportive psychotherapy (SPT) plus antidepressant medication or a placebo, or a medication-alone condition. Results indicate that high baseline frequencies of binge eating and vomiting, as well as a positive history of substance abuse or dependence, are negative prognostic indicators. Although a greater overall therapeutic alliance may increase the likelihood of remission, symptom change over the course of treatment may have as much of an impact on patient ratings of alliance as the reverse. CBT was significantly more rapid than SPT in reducing binge eating and vomiting frequencies.
authors.affiliation: Eating Disorders Clinic, Rutgers, State University of New Jersey, Piscataway 08854, USA. tewilson@rci.rutgers.edu
authors.forename: G T
authors.initials: GT
authors.lastname: Wilson
authors.forename: K L
authors.initials: KL
authors.lastname: Loeb
authors.forename: B T
authors.initials: BT
authors.lastname: Walsh
authors.forename: E
authors.initials: E
authors.lastname: Labouvie
authors.forename: E
authors.initials: E
authors.lastname: Petkova
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.forename: C
authors.initials: C
authors.lastname: Waternaux
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage*; D002032:Bulimia / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003891:Desipramine / Q000008:administration & dosage; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D011369:Professional-Patient Relations; D011379:Prognosis; D011614:Psychotherapy, Brief; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D005473:Fluoxetine; D003891:Desipramine