title: Predictors and moderators of treatment outcome in a randomized clinical trial for adults with symptoms of bulimia nervosa.
abstract: OBJECTIVE
  This study examined predictors and moderators of outcome in 2 treatments for bulimia nervosa (BN).
  
  
  METHODS
  Eighty adults with BN symptoms at 1 of 2 sites were randomized to 21 sessions of integrative cognitive-affective therapy for BN (ICAT-BN) or enhanced cognitive behavior therapy (CBT-E). Generalized linear models examined predictors and moderators of improvements in bulimic behavior and eating disorder psychopathology at end of treatment (EOT) and 4-month follow-up (FU).
  
  
  RESULTS
  At EOT, individuals with higher dietary restraint had greater reductions in bulimic behavior. At FU, individuals with higher weight and shape concern had greater reductions in bulimic behavior, whereas those with greater baseline depression had less improvement in eating disorder psychopathology. Individuals higher in stimulus seeking had greater reductions in bulimic behavior and eating disorder psychopathology at follow up in ICAT-BN than in CBT-E, whereas individuals lower in stimulus seeking had greater reductions in bulimic behavior in CBT-E than in ICAT-BN. Finally, individuals with higher affective lability had greater reductions in eating disorder psychopathology in ICAT-BN than in CBT-E, whereas improvements were comparable across treatments for individuals with lower affective lability.
  
  
  CONCLUSIONS
  This study identified 3 nonspecific predictors of outcome (i.e., dietary restraint, weight and shape concern, and depression) and 2 moderators (i.e., affective lability and stimulus seeking). All moderator effects emerged at FU rather than at EOT, suggesting that the moderating effects of treatment were not immediately apparent. These results suggest that individuals with higher affective lability and stimulus seeking may benefit more from treatment with a greater focus on affective states and self-regulation.
authors.affiliation: Department of Psychiatry, University of California, San Francisco.
authors.forename: Erin C
authors.initials: EC
authors.lastname: Accurso
authors.affiliation: Neuropsychiatric Research Institute.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wonderlich
authors.affiliation: Neuropsychiatric Research Institute.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: Baylor College of Medicine.
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Department of Psychiatry, University of Wisconsin, Madison.
authors.forename: Marjorie H
authors.initials: MH
authors.lastname: Klein
authors.affiliation: Neuropsychiatric Research Institute.
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.affiliation: University of Minnesota Medical School.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Crow
authors.affiliation: University of Minnesota Medical School.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Berg
authors.affiliation: University of Minnesota Medical School.
authors.forename: Carol B
authors.initials: CB
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D001828:Body Image / Q000523:psychology; D052018:Bulimia Nervosa / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*