Banasiak Susan J, Paxton Susan J, Hay Phillipa
Psychology Department, University of Melbourne, Australia.
Psychol Med. 2005 Sep;35(9):1283-94. doi: 10.1017/S0033291705004769.
To increase access to cognitive behavioural therapy for bulimia nervosa new delivery modes are being examined. Guided Self-Help (GSH) in primary care is potentially valuable in this respect. This research aimed to compare outcomes following GSH delivered by general practitioners (GPs) in the normal course of their practice to a delayed treatment control (DTC) condition, and to examine the maintenance of treatment gains at 3 and 6 months following completion of GSH.
Participants were 109 women with full syndrome or sub-threshold bulimia nervosa, randomly allocated to GSH ( n = 54) and DTC ( n = 55). The GSH group received direction and support from a GP over a 17-week period while working through the manual in Bulimia Nervosa and Binge-Eating: A Guide to Recovery by P. J. Cooper (1995). GSH and DTC groups were assessed pre-treatment and 1 week following the 17-week intervention or waiting interval. The GSH group was reassessed at 3- and 6-month follow-up.
Intention-to-treat analyses at end of treatment revealed significant improvements in bulimic and psychological symptoms in GSH compared with DTC, reduction in mean frequency of binge-eating episodes by 60% in GSH and 6% in DTC, and remission from all binge-eating and compensatory behaviours in 28% of the GSH and 11% of the DTC sample. Treatment gains were maintained at 3- and 6-month follow-up.
Outcomes in GSH compare favourably with those of specialist-delivered psychological treatments. These findings are considered in light of the nature of the therapy offered and the primary care context.
为了增加神经性贪食症患者获得认知行为疗法的机会，正在探索新的治疗模式。在这方面，初级保健中的引导式自助（GSH）可能具有重要价值。本研究旨在比较全科医生（GP）在日常诊疗过程中提供的GSH与延迟治疗对照（DTC）条件下的治疗效果，并考察GSH完成后3个月和6个月时治疗效果的维持情况。
109名患有完全型或亚阈值神经性贪食症的女性参与研究，她们被随机分配到GSH组（n = 54）和DTC组（n = 55）。GSH组在17周的时间里，在阅读P. J. 库珀（1995年）所著的《神经性贪食症与暴饮暴食：康复指南》手册的过程中，接受全科医生的指导和支持。在治疗前以及17周干预期或等待期结束后的1周，对GSH组和DTC组进行评估。对GSH组在3个月和6个月的随访时再次进行评估。
治疗结束时的意向性分析显示，与DTC组相比，GSH组的贪食和心理症状有显著改善，GSH组暴饮暴食发作的平均频率降低了60%而DTC组降低了6%，GSH组样本中有28%、DTC组样本中有11%的患者所有暴饮暴食和代偿行为均消失。在3个月和6个月的随访中，治疗效果得以维持。
GSH的治疗效果与专科提供的心理治疗效果相当。根据所提供治疗方法的性质和初级保健环境对这些发现进行了考量。
