Schmidt Ulrike, Lee Sally, Beecham Jennifer, Perkins Sarah, Treasure Janet, Yi Irene, Winn Suzanne, Robinson Paul, Murphy Rebecca, Keville Saskia, Johnson-Sabine Eric, Jenkins Mari, Frost Susie, Dodge Liz, Berelowitz Mark, Eisler Ivan
Section of Eating Disorders, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
Am J Psychiatry. 2007 Apr;164(4):591-8. doi: 10.1176/ajp.2007.164.4.591.
To date no trial has focused on the treatment of adolescents with bulimia nervosa. The aim of this study was to compare the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy (CBT) guided self-care in adolescents with bulimia nervosa or eating disorder not otherwise specified.
Eighty-five adolescents with bulimia nervosa or eating disorder not otherwise specified were recruited from eating disorder services in the United Kingdom. Participants were randomly assigned to family therapy for bulimia nervosa or individual CBT guided self-care supported by a health professional. The primary outcome measures were abstinence from binge-eating and vomiting, as assessed by interview at end of treatment (6 months) and again at 12 months. Secondary outcome measures included other bulimic symptoms and cost of care.
Of the 85 study participants, 41 were assigned to family therapy and 44 to CBT guided self-care. At 6 months, bingeing had undergone a significantly greater reduction in the guided self-care group than in the family therapy group; however, this difference disappeared at 12 months. There were no other differences between groups in behavioral or attitudinal eating disorder symptoms. The direct cost of treatment was lower for guided self-care than for family therapy. The two treatments did not differ in other cost categories.
Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.
迄今为止，尚无试验聚焦于神经性贪食症青少年的治疗。本研究的目的是比较家庭治疗与认知行为疗法（CBT）引导的自我护理对神经性贪食症或未另行规定的饮食失调青少年的疗效和成本效益。
从英国的饮食失调服务机构招募了85名患有神经性贪食症或未另行规定的饮食失调的青少年。参与者被随机分配接受神经性贪食症家庭治疗或由健康专业人员支持的个体CBT引导的自我护理。主要结局指标是治疗结束时（6个月）及12个月时通过访谈评估的停止暴饮暴食和呕吐情况。次要结局指标包括其他贪食症状和护理成本。
85名研究参与者中，41人被分配接受家庭治疗，44人被分配接受CBT引导的自我护理。在6个月时，引导自我护理组的暴饮暴食减少幅度明显大于家庭治疗组；然而，这种差异在12个月时消失。两组在行为或态度性饮食失调症状方面没有其他差异。引导自我护理的治疗直接成本低于家庭治疗。两种治疗在其他成本类别上没有差异。
与家庭治疗相比，CBT引导的自我护理具有轻微优势，即能更快减少暴饮暴食、成本更低，且对于患有神经性贪食症或未另行规定的饮食失调的青少年具有更高的可接受性。
