Journal Article

A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa

Wonderlich, S. A., Crosby, R. D., Crow, S. J., Smith, T. L., Mitchell, J. E., Peterson, C. B., Klein, M. H.

2014

Overview

The purpose of this investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, 'enhanced' cognitive-behavioral therapy (CBT-E). Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat). Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different. ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.

• Publisher: Cambridge University Press
• Subject: Adaptation, Psychological / Adult / Adult and adolescent clinical studies / Adults / Anxiety / Anxiety - complications / Anxiety - psychology / Anxiety-Depression / Behavior therapy. Cognitive therapy / Behavioral psychology / Binge eating / Biological and medical sciences / Bulimia / Bulimia - psychology / Bulimia - therapy / Bulimia nervosa / Bulimia Nervosa - complications / Bulimia Nervosa - psychology / Bulimia Nervosa - therapy / Clinical trials / Cognition / Cognitive behavioral therapy / Cognitive Behavioral Therapy - methods / Cognitive behaviour therapy / Cognitive therapy / Cognitive-behavioral factors / Comparative studies / Depression - complications / Depression - psychology / Eating behavior disorders / Eating disorders / Emotional regulation / Emotions / Evidence-Based Practice / Female / Humans / Individual psychotherapy / Intention to Treat Analysis - statistics & numerical data / Interpersonal Relations / Interview, Psychological / Linear analysis / Male / Medical sciences / Medical treatment / Mental depression / Models, Psychological / Models, Statistical / Motivational Interviewing / Original Articles / Outcome Assessment, Health Care - statistics & numerical data / Patient Education as Topic - methods / Psychology. Psychoanalysis. Psychiatry / Psychopathology. Psychiatry / Psychotherapy / Purging / Rehabilitation / Self Concept / Self control / Self esteem / Severity of Illness Index / Surveys and Questionnaires / Symptoms / Treatment methods / Treatments