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Unformatted text preview: Module 5 --- Article 4 TREATMENT HIGHLIGHTS FAMILY THERAPY FOR BULIMIA NERVOSA In adolescents with bulimia nervosa, family-based treatment is found to be effective. In an outpatient setting, 80 adolescents (aged 12 to 19) with bulimia nervosa1 were randomly assigned to receive 20 sessions of either family-based treatment [see box below] or supportive psychotherapy for a 6-month period. Followup assessments were conducted 6 months after the end of treatment. The primary outcome measure was abstinence from binge-and-purge episodes. This and other (secondary) measures of eating disorder were assessed by the Eating Disorder Examination (EDE). Also measured were depressive symptoms (Beck Depression Inventory) and self-esteem (Rosenberg Self-Esteem Scale). At the end of treatment, patients receiving family-based treatment were more likely to be abstinent from binge eating and purging (16 of 41, or 39%), compared to patients receiving supportive psychotherapy (7 of 39, or 18%). They also had, on average, larger decreases in the following eating disorder categories: dietary restraint and compensatory behaviors (and vomiting, a type of compensatory behavior).2 At the 6-month posttreatment followup, fewer patients were abstinent from binge eating and purging, but the group difference was still statistically significant in favor of family-based treatment (12, or 29% vs 4, or 10%). None of the secondary measures of eating disorder significantly differed at the 6-month followup, the supportive psychotherapy patients having “caught up.” Also, the groups were not found to differ in self-esteem or depressive symptoms at either the end of treatment or 6 months later. The authors conclude that this study’s “results suggest that FBT-BN [family-based treatment for bulimia nervosa] is promising in the amelioration of symptomatic behavior for this disorder. . . . However, we do not know whether it is family involvement or the focus on eating behavior that is key to good treatment outcome. Moreover, abstinence rates between 30% and 40% leave considerable room for improvement.” The authors recommend that research be conducted comparing the outcomes of family-based treatment and cognitive-behavioral therapy, perhaps utilizing a model that incorporates parents in treatment.
1 Patients who did not meet the full criteria for binge and purge frequency were included if, during the past 6 months, they had binged or purged at least once each week and met all other diagnostic criteria for bulimia nervosa. Patients who were taking antidepressant medication were allowed to participate in the study if they had been on a stable dose for at least 4 weeks. Patients taking 50 mg or more of fl uoxetine (eg, Prozac) were excluded due to its established antibulimic effects. At the mid-treatment assessment, the 2 groups differed on even more of the secondary eating disorder measures in favor of the family-based treatment. The authors state that “this fi nding is of interest given the adult literature on early treatment response.” (The authors cite a study indicating that early improvement is found to be a predictor of successful outcome. [A description of that study appears in the Feb 2005 issue of The Complete Practitioner, accessible in the Subscribers’ Area by entering <Fairburn> in a search box.]) 2 Le Grange D [Dept of Psychiatry, University of Chicago, 5841 S Maryland Ave, MC3077, Chicago, IL 60637; email: [email protected]], Crosby RD, Rathouz PJ, & Leventhal BL. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Archives of General Psychiatry, 64:1049-1056, 2007. Support: National Institute of Mental Health. Family Therapy for Bulimia Nervosa
Family-based treatment for bulimia nervosa includes 3 phases. In phase 1 (lasting 2 to 3 months), weekly treatment sessions focus on “empowering the parents to disrupt binge eating, purging, restrictive dieting, and any other pathological weight control behaviors.” To lessen the adolescent’s resistance to parental assistance, the treatment attempts to externalize and separate the disordered behaviors from the adolescent. The second phase begins when there has been substantial progress towards abstinence from disordered eating and related behaviors. Sessions are held every 2 weeks. In this phase, “parents transition control over eating issues back to the adolescent.” The third phase, consisting of monthly sessions, focuses on “the ways the family can help to address the effects of BN [bulimia nervosa] on adolescent developmental processes.” © Copyright 2011 MWK Publishing LLC; from The Complete Practitioner: Mental Health Applications (Vol. 10, No. 11 -- November 2007) 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.
- Spring '09