title: Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial.
abstract: We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout.
  
  
  
  Participants (N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors.
  
  
  
  Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96).
  
  
  
  Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:569-577).
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|Eating Disorders Program, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Western, Australia.|School of Paediatrics and Child Health, The University of Western Australia, Crawley, Western Australia, Australia.|School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia.
authors.forename: Hunna J
authors.identifier: 0000-0001-8405-381X
authors.initials: HJ
authors.lastname: Watson
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Michele D
authors.initials: MD
authors.lastname: Levine
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Zerwas
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hamer
authors.affiliation: Neuropsychiatric Research Institute, Fargo, North Dakota.|Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Sprecher
authors.affiliation: Eating Disorders Program, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Western, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: O'Brien
authors.affiliation: Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zimmer
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Hofmeier
authors.affiliation: Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Kordy
authors.affiliation: Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Moessner
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Peat
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Cristin D
authors.identifier: 0000-0001-5841-1556
authors.initials: CD
authors.lastname: Runfola
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Marsha D
authors.initials: MD
authors.lastname: Marcus
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Bulik
mesh_terms: D000328:Adult; D052018:Bulimia Nervosa / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D010352:Patient Dropouts / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome
keywords: bulimia nervosa; cognitive-behavioral therapy; dropout; failure to engage; randomized controlled trial