title: The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self-directed behavior, and self-discrepancy within the mediation model.
abstract: The purpose of this investigation was to examine the indirect effects of Integrative Cognitive-Affective Therapy (ICAT-BN) and Cognitive-Behavioral Therapy-Enhanced (CBT-E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self-directed behavior, and self-discrepancy.
  
  
  
  Eighty adults with BN were randomized to 21 sessions of ICAT-BN or CBT-E. A regression-based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self-directed behavior measured at mid-treatment, as well as the indirect effects of treatment at follow-up through emotion regulation, self-directed behavior, and self-discrepancy measured at end of treatment.
  
  
  
  No significant differences in outcome between treatment conditions were observed, and no significant direct or indirect effects were found. Examination of the individual paths within the indirect effects models revealed comparable treatment effects. Across treatments, improvements in emotion regulation and self-directed behavior between baseline and mid-treatment predicted improvements in global eating disorder scores but not binge eating and purging frequency at end of treatment. Baseline to end of treatment improvements in emotion regulation and self-directed behavior also predicted improvements in global eating disorder scores at follow-up. Baseline to end of treatment improvements in emotion regulation predicted improvements in binge eating and baseline to end of treatment increases in positive self-directed behavior predicted improvements in purging at follow-up.
  
  
  
  These findings suggest that emotion regulation and self-directed behavior are important treatment targets and that ICAT-BN and CBT-E are comparable in modifying these psychological processes among individuals with BN.
authors.affiliation: Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota.|The Emily Program, St. Paul, Minnesota.
authors.forename: Carol B
authors.identifier: 0000-0001-9152-4552
authors.initials: CB
authors.lastname: Peterson
authors.affiliation: Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Berg
authors.affiliation: Department of Clinical Research, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.|Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: Department of Clinical Research, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.|Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Lavender
authors.affiliation: Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, California.
authors.forename: Erin C
authors.identifier: 0000-0002-5521-6381
authors.initials: EC
authors.lastname: Accurso
authors.affiliation: Department of Psychology, Western Washington University, Bellingham, Washington.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Ciao
authors.affiliation: VA South Central Mental Illness Research, Education and Clinical Center at the Center for Innovations in Quality, Effectiveness and Safety (IQuEST; CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, Texas.|Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Smith
authors.affiliation: Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Klein
authors.affiliation: Department of Clinical Research, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.|Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
authors.forename: James E
authors.initials: JE
authors.lastname: Mitchell
authors.affiliation: Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota.|The Emily Program, St. Paul, Minnesota.
authors.forename: Scott J
authors.identifier: 0000-0002-1827-5075
authors.initials: SJ
authors.lastname: Crow
authors.affiliation: Department of Clinical Research, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.|Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wonderlich
mesh_terms: D000328:Adult; D056912:Binge-Eating Disorder / Q000523:psychology; D052018:Bulimia Nervosa / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D017008:Negotiating / Q000379:methods*; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome
keywords: bulimia nervosa; cognitive-behavioral therapy; emotion regulation; emotion-focused therapy; integrative cognitive-affective therapy