Five-year outcome of cognitive behavioral therapy and exposure with response prevention for bulimia nervosa

• Published in: Psychological medicine 2011-05, Vol.41 (5), p.1061-1071
• Main Authors: McIntosh, V. V. W., Carter, F. A., Bulik, C. M., Frampton, C. M. A., Joyce, P. R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Behavior modification; Behavior therapy. Cognitive therapy; Biological and medical sciences; Bulimia; Bulimia nervosa; Bulimia Nervosa - therapy; Cognitive behaviour therapy; Cognitive Therapy; Female; Humans; Implosive Therapy; Linear Models; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Prevention; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Purging; Recovery; Relaxation Therapy; Relaxation training; Treatments; United States
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291710001583

Few data exist examining the longer-term outcome of bulimia nervosa (BN) following treatment with cognitive behavioral therapy (CBT) and exposure with response prevention (ERP). One hundred and thirty-five women with purging BN received eight sessions of individual CBT and were then randomly assigned to either relaxation training (RELAX) or one of two ERP treatments, pre-binge (B-ERP) or pre-purge cues (P-ERP). Participants were assessed yearly following treatment and follow-up data were recorded. Eighty-one per cent of the total sample attended long-term follow-up. At 5 years, abstinence rates from binging were significantly higher for the two exposure treatments (43% and 54%) than for relaxation (27%), with no difference between the two forms of exposure. Over 5 years, the frequency of purging was lower for the exposure treatments than for relaxation training. Rates of recovery varied according to definition of recovery. Recovery continued to increase to 5 years. At 5 years, 83% no longer met DSM-III-R criteria for BN, 65% received no eating disorder diagnosis, but only 36% had been abstinent from bulimic behaviors for the past year. This study provides possible evidence of a conditioned inoculation from exposure treatment compared with relaxation training in long-term abstinence from binge eating at 5 years, and the frequency of purging over 5 years, but not for other features of BN. Differences among the groups were not found prior to 5 years. CBT is effective for BN, yet a substantial group remains unwell in the long term. Definition of recovery impacts markedly on recovery rates.