Predicting cognitive-behavioral therapy outcomes for bulimia nervosa patients based on skill use during treatment

ObjectiveEmerging research indicates that skills acquisition may be important to behavior change in cognitive behavior therapy (CBT) for eating disorders. This study investigated whether skills use assessed in real time during the initial 4 weeks of CBT‐based day treatment was associated with momentary eating disorder behavior change and rapid response to treatment.MethodsParticipants with DSM‐5 bulimia nervosa or purging disorder (N = 58) completed ecological momentary assessments (EMA) several times daily for the first 28 days of treatment. EMA assessed skills use, the occurrence of binge eating and/or purging, and state negative affect. Rapid response was defined as abstinence from binge eating and/or purging in the first 4 weeks of treatment.ResultsGreater real‐time skills use overall, and use of “planning ahead,” “distraction,” “social support,” and “mechanical eating” skills in particular, were associated with a lower likelihood of engaging in binge eating or purging during the same period. After controlling for baseline group differences in overall difficulties with emotion regulation, rapid and non‐rapid responders did not differ in overall skills use, or skills use at times of higher negative affect, during the EMA period.DiscussionMomentary use of skills appears to play an important role in preventing binge eating and purging, and certain skills appear to be particularly helpful. These findings contribute to the literature elucidating the processes by which CBT treatments for eating disorders work by providing empirical evidence that skills use helps to prevent binge eating and purging behaviors.Public SignificanceIndividuals with eating disorders learn new skills during treatment to help them improve their symptoms. This study shows that for people with eating disorders, using skills helps prevent eating disorder behaviors in the moment. Certain skills may be particularly helpful, including planning ahead, distracting activities, support from others, and focusing on eating meals and snacks regardless of how one is feeling. These findings help us better understand how treatments work.

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Momentary skills use predicts decreased binge eating and purging early in day treatment: An ecological momentary assessment study

MacDonald,

Trottier,

Cao

et al. 2024

“…A growing body of research supports this theory, as compliance with regular eating has been associated with treatment outcomes in several studies (Barakat et al, 2017; Zendegui et al, 2014). A recent study from our team found that clinicians' reports of their patients' use of the six skills described above were prospectively associated with improvements in ED pathology at posttreatment and follow‐up (Clancy et al, 2023). In studies on CBTs for depression, therapeutic skills acquisition and use is consistently associated with greater symptom improvement during (Camacho et al, 2021) and after treatment (Boswell et al, 2014; Jarrett et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…Examining relations between skills use and symptom change on a weekly basis during treatment could elucidate whether patients would benefit from additional treatment strategies and allow for timely intervention that is tailored to their treatment response patterns. Based on evidence that CBT‐E skills use predicts better ED treatment outcomes (Clancy et al, 2023), it is plausible that higher skills use in 1 week is associated with symptom improvement or stabilization (e.g., if a patient has already shown significant symptom improvement) that week and the following week. A bidirectional relationship between symptom change and skills use may also exist, such that patients who show symptom improvement subsequently show greater adoption and use of skills (e.g., due to increased self‐efficacy or motivation).…”

Section: Introductionmentioning

confidence: 99%

Trajectories of therapeutic skills use and their dynamic relations to symptom change during cognitive‐behavioral therapy for bulimia nervosa

D'Adamo,

Linardon,

Manasse

et al. 2023

Self Cite

ObjectiveTo examine trajectories of therapeutic skills use and weekly relations between skills use and symptom change during the enhanced version of cognitive‐behavioral therapy (CBT‐E) for bulimia nervosa (BN).MethodFifty‐five adults (M age: 39.0 ± 14.1; 83.9% female; 64.3% White, 93.6% non‐Hispanic/Latino) receiving CBT‐E for BN‐spectrum eating disorders (EDs) self‐monitored their use of five therapeutic skills (i.e., regular eating, eating enough to prevent excessive hunger and eating a range of macronutrients, breaking dietary rules, urge management strategies, and mood management strategies) several times per day during treatment. Patients also self‐reported their ED symptoms (i.e., frequency of binge eating, compensatory behaviors, and dietary restraint) weekly. We examined trajectories of use of each CBT‐E skill and temporal relations between skills use and ED symptoms from week‐to‐week during treatment.ResultsParticipants showed significant increases in eating enough to prevent excessive hunger and eating a range of macronutrients from week‐to‐week (p < .05). Regular eating, eating enough to prevent excessive hunger, and eating a range of macronutrients 1 week predicted lower binge eating and compensatory behaviors the same week and the following week, and urge management strategy use predicted greater binge eating the same week and the following week (p < .05).ConclusionsResults showed temporal relationships between therapeutic skills use and symptom change on a weekly level, with evidence that using skills targeting dietary restraint was associated with lower BN symptoms. Findings highlight the promise of future work to elucidate the most potent CBT‐E skills for symptom improvement and inform more targeted interventions.Public SignificanceFindings showed weekly relationships between therapeutic skills use and symptom change during treatment, with evidence that using CBT‐E skills aimed to reduce dietary restraint (i.e., regular eating, eating enough to prevent excessive hunger, and eating a range of macronutrients) was associated with lower BN symptoms. Future work has the potential to identify the most potent CBT‐E skills for symptom improvement and inform more targeted interventions.

Patients' perceptions of post‐treatment factors that influenced skill use after cognitive‐behavioral therapy for bulimia nervosa spectrum disorders

Liu,

Wang,

Wetherall

et al. 2024

ObjectiveDeterioration rate among patients with bulimia‐spectrum eating disorders (BN‐EDs) after receiving enhanced cognitive‐behavioral therapy (CBT‐E) remains high. Previous studies identified body image concerns, environmental triggers, lack of social support, lack of resources, comorbidity, and discontinued skill use as predictors of deterioration. However, no studies have qualitatively explored patients' perceptions of how these factors influenced their skill use and led to deterioration after receiving outpatient CBT.MethodsThis study aimed to qualitatively explore (1) what post‐treatment factors patients believe contributed to deterioration, and (2) whether patients continued to practice the CBT skills they learned from treatment and identify motivators and barriers to post‐treatment skill use. Twelve participants who had previously completed 16 sessions of CBT for their BN‐EDs and experienced at least modest treatment responses participated in the qualitative interviews.ResultsFour themes were identified from the qualitative interviews. Post‐treatment deterioration was primarily driven by decreased skill use due to a perceived sudden loss of accountability and continued body dissatisfaction after treatment ended. Discontinued practice of binge analysis led to decreased awareness of the relationship between poor skill use and ED behaviors. Difficulty accessing resources impeded participants from receiving external help to address challenges in skill practice, thus also contributing to deterioration.DiscussionFindings suggested that outpatient treatment for BN‐EDs patients should emphasize more on body image concern, and deterioration prevention for outpatient CBT‐E should focus on building self‐accountability to keep practicing skills after treatment ends.Public significanceThis study was the first to qualitatively explore post‐treatment factors influencing skill use and deterioration in patients with bulimia‐spectrum eating disorders after they completed outpatient CBT. Findings indicated that decreased skill use was a primary driver of post‐treatment deterioration, and that relapse prevention for outpatient CBT for BN‐EDs should focus on enhancing patients' self‐accountability to continue practicing therapeutic skills independently after treatment ended.