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CBT and Bulimia Nervosa

CBT and Bulimia Nervosa. Tara Weatherill. The Cognitive Model of BN (Fairburn, 1993). Five Core Domains Involved in Maintenance: 1. Negative self evaluation. 2. Extreme body image concern 3. Dietary constraint 4. Binge Eating 5. Compensatory Behaviour (Purging).

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CBT and Bulimia Nervosa

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  1. CBT and Bulimia Nervosa Tara Weatherill

  2. The Cognitive Model of BN(Fairburn, 1993) • Five Core Domains Involved in Maintenance: 1. Negative self evaluation. 2. Extreme body image concern 3. Dietary constraint 4. Binge Eating 5. Compensatory Behaviour (Purging)

  3. The Cognitive Model of BN-Revised (Fairburn, 2003) • Not used to replace old model (given all the evidence to support it) • Just used as supplement • Additional maintaining mechanisms: • 1.clinical perfectionism • 2.mood intolerance • 3.interpersonal difficulties

  4. How does it Work? • CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.   • Situation • Thoughts • Emotions • Physical feelings • Actions

  5. CBT- Overview • Helps change how you think (‘cognition’) and what you do (‘behaviour’) • The cognitive behavioral treatment of BN consists of 20 sessions. • The entire process takes about 20 weeks to complete. • Split into three stages (Fairburn, 1993) 1. Cognitive view on the maintenance of bulimia is presented, and behavioral techniques are implemented to replace binge eating with more stable eating patterns. (8 weeks) 2. Emphasis placed on the elimination of dieting . Cognitive processes are focused upon extensively; the therapist and the individual examine his/her thoughts, beliefs, and values which maintain the eating problem. (8 weeks) 3. focus on developing relapse prevention strategies. (4 weeks)

  6. CBT- Stage One 1. Orient the patient 2. Establish collaborative therapeutic relationship 3. Take individual’s history 4. Outline rationale 5. Introduce/review monitoring sheets

  7. CBT- Stage One con’t 6. Introduce weekly weighing 7. Introduce/review homework assignments 8. Educate about weight/eating 9. Advice on negative behaviour patterns 10. Joint session with friends/family

  8. CBT- Stage Two 1. continue review/monitor sheets & homework 2. reduce dieting tendency 3. enhance problem solving skills 4. address body image concerns 5. address other cognitive distortions

  9. CBT- Stage Three • Composed of three interviews. • Two week intervals. • Goal: Maintain progress once treatment is terminated in order to prevent relapse of the binge/purge cycle.

  10. Results- overview • Review of 16 studies • Based on outcome of CBT-only treatment groups • Assessed according to five core domains of cognitive model

  11. Results- Low Self Esteem • 5 studies (31%) used as outcome variable • All used Rosenberg Self Esteem Inventory (1965) • 3 reported significant findings

  12. Results- Distorted Body Image • 11 (70%) studies evaluated construct in some way • Fairburn & Cooper • Eating Disorders Examination (1993) • Body Shape Questionnaire (1987) • Efficacy varies depending on outcome measures used

  13. Results- Dietary Constraint • 2 aspects: 1. caloric restriction 2. cognitive restraint • 12 (75%) included some form of measure • evidence from mean post-treatment scores on the EDE restraint scale suggests that CBT does reduce restraint to normative levels. (Anderson & Maloney, 2001)

  14. Results- Binging • 13 (81%) used some measure as outcome variable 1. food records/self report questionnaires 2. interviews • Eating Disorders Examination • Combining all methods of assessment, CBT reduced binge eating an average of 75% (Anderson & Maloney)

  15. Results- Purging • All 16 reported some measure • Self report • food records • EDE • CBT reduced compensatory behavior an average of 78%

  16. Future CBT Outcome Studies (Anderson & Maloney) 1. Assess all core domains of the cognitive model 2. Provide pre- and post-treatment means for critical variables 3. Use the EDE as an outcome measure, but not as the only outcome measure 4. Obtain both objective and subjective measures of binge eating 5. Assess non-purging as well as purging methods of compensatory behavior 6. Assess dietary restraint using measures of both caloric restriction and cognitive restraint

  17. Other Evidence to Support CBT • Whittal, Agras, & Gould (1999) They found that CBT was associated with substantial improvements in eating disordered behaviors and eating attitudes. “Improvements with CBT were significantly larger than those for medication in terms of binge frequency, purge frequency, and eating attitudes.” • Anderson & Maloney (2001) “Cognitive behavioral therapy (CBT) is widely regarded as the treatment of choice for bulimia nervosa (BN)” • Ricca et. Al “Compared to any other psychological or pharmacological treatment for which controlled studies have been published, CBT is reported to be more effective (the majority of studies), or at least as effective.”

  18. Advantages Over Other Methods • No medication • No harmful side effects • No addiction/withdrawal • Not just treatment of symptoms • Client involved • Part of goal-making process • More likely to have long lasting effects • Educate on illness (prevention!)

  19. Disadvantages • Need specially trained professionals • Relies heavily on self-report data (valid?) • Lengthy treatment/possible relapse • Cost???

  20. Evaluation of CBT • Still research need to be done on effectiveness • Excellent alternative to medication • Learning/understanding of problem • Best available treatment

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