Cognitive-behavioral treatment of bulimia nervosa: A controlled evaluation

Psychotherapy Outcome Research with Bulimia nervosa

“…A controlled study by Wilson et al [ 1986] supported the view that behavioral instruc tions which promote exposure to feared situ ations are vital for durable symptom change. These investigators found that cognitive re structuring (CR) alone was less effective in reducing bingeing than CR plus exposure with vomiting prevention.…”

“…Ordman and Kirschenbaum [1985] did not find that any of the measures in their extensive psy chometric battery correlated with improve ment in bingeing and vomiting. Similarly, Wilson et al [1986] did not find any differ ences between responders and nonrespon ders on pretreatment variables. Fairburn et al [in press] reported that pretreatment level of self-esteem was the only consistent predic tor of outcome with low scores predicting a poor prognosis.…”

“…The positive findings are striking for some studies which include an adequate follow-up period of at least 1 year [ Fairburn et al, 1986;Huon and Brown, 1985;Lacey, 1983;Wilson et al, 1986;Wooley and Kearney-Cooke, 1986], Three out come studies not included in table I, because they were not controlled, also indicate a vari able outcome. Of 42 patients assessed be tween 14 and 72 months after presenting for treatment, Abraham et al [1983] found that the percentage rated as 'cured' was 40% by interview and 30% by self-report.…”

“…In contrast, Lacey [1983] in dicated that patients with a poor outcome had a history of anorexia nervosa. Wilson et al [1986] did not indicate the number of subjects with a history of anorexia nervosa; however, they did report that those with a poor outcome had significantly lower past weights compared to those with a good out come. It is not always recognized that many bulimia nervosa patients have lost as much or more weight as many anorexia nervosa patients, but have never been emaciated , It may be that the history of a low weight is somewhat less important than the magnitude of weight loss achieved over time.…”

“…Thus, Wilson et al [1986] may be correct in arguing that a critical variable in the treat ment of bulimia nervosa is exposure and vomiting prevention. However, the conclu sion that CR is ineffective may reflect an overly narrow view, since few CB theorists would assume that cognitive therapy in volves CR in the absence of specific behav ioral (and cognitive) strategies designed to encourage exposure and vomiting pre vention.…”