Self-help for bulimic disorders: a randomised controlled trial comparing minimal guidance with face-to-face or telephone guidance.
BACKGROUND
There is great potential demand for treatment of bulimia nervosa and binge eating disorder. Skilled therapists are in short supply. Self-help and guided self-help based upon books have shown some promise as an economical alternative to full therapy in some cases.


OBJECTIVE
To investigate the efficacy and effectiveness of self-help with and without guidance in a specialist secondary service.


METHODS
A randomised controlled trial comparing three forms of self-help over 4 months with a waiting-list comparison group and measurement of service consumption over the subsequent 8 months.


RESULTS
Self-help delivered with four sessions of face-to-face guidance led to improved outcome over 4 months. There is also some evidence to support the use of telephone guidance. A minority of participants achieved lasting remission of their disorder in relation to self-help, but there was no significant difference in final outcome between the groups after they had progressed through the stepped care programme. Patients initially offered guided self-help had a lower long-term drop-out rate.


CONCLUSIONS
Guided self-help is a worthwhile initial response to bulimia nervosa and binge eating disorder. It is a treatment that could be delivered in primary care and in other non-specialist settings.
Department of Psychiatry, Brandon Unit, General Hospital, Leicester Warwick Medical School, Leicester LE5 4PW, UK. dkb5@le.ac.uk
Robert L
RL
Palmer
Helen
H
Birchall
Lesley
L
McGrain
Victoria
V
Sullivan
D000328:Adult; D000465:Algorithms; D002032:Bulimia / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010352:Patient Dropouts; D011613:Psychotherapy / Q000379:methods; D012648:Self Care / Q000379:methods*; D017216:Telemedicine; D016896:Treatment Outcome; D014850:Waiting Lists