title: Guided self-help as the first step for bulimic symptoms: implementation of a stepped-care model within specialized psychiatry.
abstract: OBJECTIVE
  This study describes the implementation and effectiveness of the first step, guided self-help (GSH), in a clinical setting, of a stepped-care model of cognitive behavior therapy for patients with bulimic symptoms.
  
  
  METHODS
  Eighty-nine patients participated.
  
  
  RESULTS
  In the intent to-treat analyses, the effect sizes were small to moderate (0.25-0.66). However, the effect sizes were substantially larger (0.44-1.66) for the patients who completed all the GSH sessions (45%). The majority of noncompleters stayed within psychiatric services. Supplementary treatments were mostly directed towards comorbid conditions, especially depression. Those discontinuing treatment in advance where characterized by more lifetime diagnoses and higher ratings on the restraint subscale of the EDE-Q.
  
  
  CONCLUSIONS
  GSH within specialized psychiatry might be effective for about 30% of the patients. There is no indication of patients losing their confidence in psychiatric services by being offered GSH as the first treatment.
authors.affiliation: Department of Neuroscience, Uppsala University, Uppsala, Sweden. mia.ramklint@neuro.uu.se
authors.forename: Mia
authors.initials: M
authors.lastname: Ramklint
authors.forename: Mats
authors.initials: M
authors.lastname: Jeansson
authors.forename: Sven
authors.initials: S
authors.lastname: Holmgren
authors.forename: Ata
authors.initials: A
authors.lastname: Ghaderi
mesh_terms: D000328:Adult; D002032:Bulimia / Q000628:therapy*; D052018:Bulimia Nervosa / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D015438:Health Behavior; D006801:Humans; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome