Hsu L K, Rand W, Sullivan S, Liu D W, Mulliken B, McDonagh B, Kaye W H
Department of Psychiatry New England Medical Center and Tufts School of Medicine, Boston, MA 02111, USA.
Psychol Med. 2001 Jul;31(5):871-9. doi: 10.1017/s003329170100410x.
This study compared the effectiveness of cognitive therapy (CT), nutritional therapy (NT), the combination of cognitive and nutritional therapy (CNT), against a control condition of support group (SG) in the treatment of bulimia nervosa.
One hundred female out-patients who fulfilled DSM-III-R criteria for bulimia nervosa were randomized to the four treatment groups. NT and CT were designed to cover different areas with minimal overlap, and CNT provided all of the features of both of these treatments. The control condition was conducted in a group self-help format. Each of the treatments lasted 14 weeks.
All three active treatments as well as SG produced significant decreases in binge/vomit episodes. Intent-to-treat analysis found CNT and CT to be significantly more effective than SG in retaining subjects in treatment and completion of study, as well as in producing greater improvements in dysfunctional attitudes and self-control. CNT was superior to SG in achieving abstinence from bulimic behaviour. NT was superior to SG only in increase of self-control. Logistic regression found that the cognitive component, whether given alone or in conjunction with NT, and higher pre-treatment self-control scores were significant predictors for both completion of study and abstinence.
CT (either alone, or in combination with nutritional therapy) remains the treatment of choice for bulimia nervosa. A treatment escalation approach should be tested for the treatment of bulimia with the more intensive and less widely available CT (with or without nutritional counselling) offered after patients have failed the less intensive and more widely available support group treatment.
本研究比较了认知疗法（CT）、营养疗法（NT）、认知与营养联合疗法（CNT），与支持小组（SG）对照条件在治疗神经性贪食症中的有效性。
100名符合神经性贪食症DSM-III-R标准的女性门诊患者被随机分为四个治疗组。NT和CT的设计旨在覆盖不同领域且重叠最小，CNT则具备这两种治疗的所有特征。对照条件以小组自助形式进行。每种治疗持续14周。
所有三种积极治疗以及SG组的暴饮暴食/呕吐发作次数均显著减少。意向性分析发现，CNT和CT在使受试者坚持治疗并完成研究方面，以及在改善功能失调态度和自我控制方面，比SG显著更有效。CNT在实现戒除贪食行为方面优于SG。NT仅在自我控制增强方面优于SG。逻辑回归分析发现，认知成分，无论单独给予还是与NT联合给予，以及治疗前较高的自我控制分数，都是研究完成和戒除的显著预测因素。
CT（单独使用或与营养疗法联合使用）仍然是神经性贪食症的首选治疗方法。对于神经性贪食症的治疗，应测试一种治疗升级方法，即在患者未能从强度较低且应用更广泛的支持小组治疗中获益后，提供强度更高且应用不太广泛的CT（有或没有营养咨询）。
