title: Four-year follow-up of guided self-change for bulimia nervosa.
abstract: The aim of this follow-up study was to evaluate the longer-term effectiveness of guided self-care for bulimia nervosa. In the original trial, 62 patients with DSM-III-R bulimia nervosa were randomly assigned to: a) a self-care manual plus eight fortnightly sessions of cognitive behavioural therapy (guided self-change); or b) 16 weekly sessions of cognitive behavioural therapy (CBT). Twenty-eight of these patients (45% of the original cohort) were involved in this follow-up study based on personal interviews by experts and self-rated instruments; the majority of the others could not be traced, but their pre- and post-treatment variables were not different from those of the follow-up patients. After an average follow-up of 54.2 months (SD 5.8), significant improvements were achieved or maintained in both groups in terms of the main outcome measures: eating disorder symptoms based on expert ratings (Eating Disorder Examination sub-scores for overeating, vomiting, dietary restraint, and shape and weight concerns), self report (Bulimic Investigatory Test Edinburgh), and a global five-point severity scale. There was also an improvement in the subsidiary outcome variables: Beck's Depression Inventory, the Self-concept Questionnaire, and knowledge of nutrition, weight and shape. During the week before the follow-up examination, 66.7% of the patients in the guided self-change group and 61.5% of those in the CBT group had not binged, vomited or abused laxatives. Guided self-change incorporating a self-care manual is an approach that can be as effective as standard cognitive behavioural therapy in the long-term, and can reduce the amount of therapist contact required.
authors.affiliation: Department of Social Studies, Bielefeld University of Applied Sciences, Bielefeld, Germany. cornelia.thiels@-online.de
authors.forename: C
authors.initials: C
authors.lastname: Thiels
authors.forename: U
authors.initials: U
authors.lastname: Schmidt
authors.forename: J
authors.initials: J
authors.lastname: Treasure
authors.forename: R
authors.initials: R
authors.lastname: Garthe
mesh_terms: D000704:Analysis of Variance; D001294:Attitude to Health; D002032:Bulimia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D008370:Manuals as Topic; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods*; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D012648:Self Care / Q000379:methods* / Q000523:psychology; D012649:Self Concept; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome