Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa.
OBJECTIVE
There is a paucity of randomized clinical trials (RCTs) for adolescents with bulimia nervosa (BN). Prior studies suggest cognitive-behavioral therapy adapted for adolescents (CBT-A) and family-based treatment for adolescent bulimia nervosa (FBT-BN) could be effective for this patient population. The objective of this study was to compare the relative efficacy of these 2 specific therapies, FBT-BN and CBT-A. In addition, a smaller participant group was randomized to a nonspecific treatment (supportive psychotherapy [SPT]), whose data were to be used if there were no differences between FBT-BN and CBT-A at end of treatment.


METHODS
This 2-site (Chicago and Stanford) randomized controlled trial included 130 participants (aged 12-18 years) meeting DSM-IV criteria for BN or partial BN (binge eating and purging once or more per week for 6 months). Outcomes were assessed at baseline, end of treatment, and 6 and 12 months posttreatment. Treatments involved 18 outpatient sessions over 6 months. The primary outcome was defined as abstinence from binge eating and purging for 4 weeks before assessment, using the Eating Disorder Examination.


RESULTS
Participants in FBT-BN achieved higher abstinence rates than in CBT-A at end of treatment (39% versus 20%; p = .040, number needed to treat [NNT] = 5) and at 6-month follow-up (44% versus 25%; p = .030, NNT = 5). Abstinence rates between these 2 groups did not differ statistically at 12-month follow-up (49% versus 32%; p = .130, NNT = 6).


CONCLUSIONS
In this study, FBT-BN was more effective in promoting abstinence from binge eating and purging than CBT-A in adolescent BN at end of treatment and 6-month follow-up. By 12-month follow-up, there were no statistically significant differences between the 2 treatments.


BACKGROUND
Study of Treatment for Adolescents With Bulimia Nervosa; http://clinicaltrials.gov/; NCT00879151.
University of California, San Francisco and The University of Chicago, IL (Emeritus). Electronic address: daniel.legrange@ucsf.edu.
Daniel
D
Le Grange
Stanford University School of Medicine, Stanford, CA.
James
J
Lock
Stanford University School of Medicine, Stanford, CA.
W Stewart
WS
Agras
Stanford University School of Medicine, Stanford, CA.
Susan W
SW
Bryson
Stanford University School of Medicine, Stanford, CA.
Booil
B
Jo
D000293:Adolescent; D002032:Bulimia; D052018:Bulimia Nervosa / Q000628:therapy*; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014481:United States
adolescent medicine; bulimia nervosa; cognitive-behavioral therapy; eating disorders; family-based treatment