title: A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa.
abstract: BACKGROUND
  The purpose of this investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, 'enhanced' cognitive-behavioral therapy (CBT-E).
  
  
  METHODS
  Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat).
  
  
  RESULTS
  Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different.
  
  
  CONCLUSIONS
  ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.
authors.affiliation: Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Wonderlich
authors.affiliation: Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Peterson
authors.affiliation: Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: Department of Psychiatry, University of Wisconsin, Madison, WI, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Department of Psychiatry, University of Wisconsin, Madison, WI, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Klein
authors.affiliation: Neuropsychiatric Research Institute/Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Mitchell
authors.affiliation: Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Crow
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000150:complications / Q000523:psychology; D002032:Bulimia / Q000523:psychology / Q000628:therapy; D052018:Bulimia Nervosa / Q000150:complications / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000150:complications / Q000523:psychology; D004644:Emotions; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis / Q000706:statistics & numerical data; D007398:Interpersonal Relations; D007406:Interview, Psychological; D008297:Male; D008960:Models, Psychological; D015233:Models, Statistical; D062405:Motivational Interviewing; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods; D012649:Self Concept; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires