Mod1 Art5 - Module 1 --- Article 5 TREATMENT HIGHLIGHTS...

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Unformatted text preview: Module 1 --- Article 5 TREATMENT HIGHLIGHTS TREATMENTS FOR BINGE EATING DISORDER Interpersonal psychotherapy and guided self-help based on cognitive-behavioral therapy are both found to be effective in the treatment of binge eating disorder. This study sought to determine the relative benefits of 3 different treatments for binge eating disorder (BED). The participants were 205 overweight or obese adults (mostly women). They were randomly assigned to receive 1 of the following 3 treatments: (1) behavioral weight loss treatment (BWL), (2) interpersonal psychotherapy (IPT), or (3) guided self-help based on cognitive-behavioral therapy (CBTgsh) [see box below for treatment descriptions]. The primary outcome measure was binge eating as assessed by the Eating Disorder Examination (EDE). The assessments occurred at the start of the study and every 6 months for 2 years after treatment had ended. The findings were based on intent-to-treat analyses, in which the last available data from the noncompleters were carried forward and used in place of missing data. At the end of treatment, the outcome was similar among the 3 groups, with most participants no longer binge eating. However, at the followup conducted 2 years after the end of treatment, only IPT and CBTgsh were associated with maintaining improvement. IPT and CBTgsh were more likely (2.6 and 2.3 times more likely, respectively) to be associated with cessation of binge eating than was BWL. The efficacy of the treatments was affected by certain participant factors, such as self-esteem level (based on the Rosenberg Self-Esteem Scale) and severity of eating disorder (based on a global EDE score that measures binge eating, dietary constraint, and concerns about one’s eating, weight, and shape). Low (vs high) self-esteem was associated with poorer outcome among those receiving BWL. In contrast, low self-esteem did not, overall, negatively impact the outcome of those receiving IPT. Among those receiving CBTgsh, low self-esteem had only a negative impact on outcome in participants who had a greater eating disorder severity at the start of the study. Attrition rates were lowest with IPT. The authors comment that CBTgsh is a relatively brief and cost-effective treatment. They conclude that “the findings suggest that CBTgsh be considered a first-line treatment for most patients with BED. Interpersonal psychotherapy (or perhaps another specialty therapy such as CBT) should be recommended as the treatment of choice for that subset of individuals with BED (30% of the sample in this study) with low self-esteem and a high level of specific eating disorder psychopathology.” Wilson GT, Wilfley DE, Agras WS, & Bryson SW. Psychological treatments of binge eating disorder. Archives of General Psychiatry, 67:94-101, 2010. Support: Natl Institutes of Health. Treatments for Binge Eating Disorder In this study, each of the 3 treatments were conducted during a 24-week period. A description of each treatment follows. Behavioral Weight Loss Treatment (BWL): An essential part of this program is the self-monitoring of fat intake, exercise, and, for some, caloric intake. Moderate caloric restriction and exercise are used to attempt to meet a weight loss goal of 7%. First, participants are instructed to reduce their fat intake to 25% of calories from fat. A calorie goal based on initial weight is set if weight loss is not occurring to a satisfactory extent. The weekly exercise goal is 2.5 hours of moderate exercise. There are 16 individual 50-minute weekly sessions. These are followed by 4 individual sessions, occurring every 2 weeks, for the purpose of “continuing weight loss and enhancing maintenance of such losses.” [The program is adapted from the National Institutes of Diabetes and Digestive and Kidney Disease’s Prevention Program’s manual, described in Diabetes Care, 25:2165-2171, 2002.] Interpersonal Psychotherapy (IPT): This program consists of 3 phases divided among a total of 19 individual sessions, all of which are 50-60 minutes long, except for the 2-hour initial session. The first 3 sessions occur during the first 2 weeks, followed by 12 weekly sessions, followed by the final four sessions occurring every other week. The first phase entails conducting a “detailed analysis of the interpersonal context within which the eating disorder developed and was maintained.” Through this analysis, a formulation of the current interpersonal problem areas is developed. The second phase focuses on “helping the patient make interpersonal changes in the specific area or areas identified” during the first phase. The third phase entails “a review of the patient’s progress and an exploration of ways to handle future interpersonal difficulties.” [The program was developed by 1 of the study’s authors (Wilfley) and based on the work of Klerman et al (Interpersonal Psychology of Depression. New York, NY: Basic Books, 1984) and Fairburn (Interpersonal psychotherapy for bulimia nervosa. In: Garner & Finkel, eds. Handbook of Treatment for Eating Disorders. New York, NY: Guilford Press, 1997).] Guided Self-help Based on CBT (CBTgsh): This self-help program is guided by a therapist (meeting individually with the patient) during an initial 60-minute session and 9 additional 25-minute sessions. The sessions are conducted weekly, then every other week, and then every 4 weeks. “The primary focus is developing a regular pattern of moderate eating using self-monitoring, self-control strategies, and problem-solving. Relapse prevention is emphasized to promote maintenance of behavioral change.” The roles of the therapist are to (a) “explain the rationale for the use of the self-help manual,” (b) “generate a reasonable expectancy for a successful outcome,” and (c) “motivate the patient to focus on using the manual.” [The program is based on Fairburn’s Overcoming Binge Eating. New York, NY: Guilford Press, 1995.] ©Copyright 2011 MWK Publishing LLC; from The Complete Practitioner: Mental Health Applications (Vol. 13, No. 5 -- May 2010) For next article, go to next page. ...
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This note was uploaded on 02/10/2011 for the course PCO 4930 taught by Professor Neimeyer during the Spring '09 term at University of Florida.

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