Department of Psychology, Wesleyan University, Middletown, CT 06459, USA.
J Consult Clin Psychol. 2010 Jun;78(3):312-21. doi: 10.1037/a0018915.
Despite proven efficacy of cognitive behavioral therapy (CBT) for treating eating disorders with binge eating as the core symptom, few patients receive CBT in clinical practice. Our blended efficacy-effectiveness study sought to evaluate whether a manual-based guided self-help form of CBT (CBT-GSH), delivered in 8 sessions in a health maintenance organization setting over a 12-week period by master's-level interventionists, is more effective than treatment as usual (TAU).
In all, 123 individuals (mean age = 37.2; 91.9% female, 96.7% non-Hispanic White) were randomized, including 10.6% with bulimia nervosa (BN), 48% with binge eating disorder (BED), and 41.4% with recurrent binge eating in the absence of BN or BED. Baseline, posttreatment, and 6- and 12-month follow-up data were used in intent-to-treat analyses.
At 12-month follow-up, CBT-GSH resulted in greater abstinence from binge eating (64.2%) than TAU (44.6%; number needed to treat = 5), as measured by the Eating Disorder Examination (EDE). Secondary outcomes reflected greater improvements in the CBT-GSH group in dietary restraint (d = 0.30); eating, shape, and weight concern (ds = 0.54, 1.01, 0.49, respectively; measured by the EDE Questionnaire); depression (d = 0.56; Beck Depression Inventory); and social adjustment (d = 0.58; Work and Social Adjustment Scale), but not weight change.
CBT-GSH is a viable first-line treatment option for the majority of patients with recurrent binge eating who do not meet diagnostic criteria for BN or anorexia nervosa.
尽管认知行为疗法（CBT）已被证明对以暴食为核心症状的进食障碍有效，但在临床实践中，很少有患者接受 CBT。我们的混合有效性-效果研究旨在评估基于手册的引导式自助 CBT（CBT-GSH）是否比常规治疗（TAU）更有效，该方法由硕士水平的干预者在健康维护组织环境中以 8 次疗程、为期 12 周的方式提供。
共有 123 名参与者（平均年龄=37.2；91.9%为女性，96.7%为非西班牙裔白人）被随机分配，其中 10.6%患有神经性贪食症（BN），48%患有暴食障碍（BED），41.4%患有反复发作的暴食症，但无 BN 或 BED。意向治疗分析使用了基线、治疗后以及 6 个月和 12 个月的随访数据。
在 12 个月的随访中，CBT-GSH 组在 EDE 评估中，暴食症的戒除率（64.2%）高于 TAU 组（44.6%；需要治疗的人数=5）。次要结局反映 CBT-GSH 组在饮食控制（d=0.30）、进食、体型和体重担忧（EDE 问卷评估，ds=0.54、1.01、0.49）、抑郁（d=0.56；贝克抑郁量表）和社会适应（d=0.58；工作和社会适应量表）方面的改善更大，但体重变化没有差异。
对于大多数不符合 BN 或神经性厌食症诊断标准的反复发作暴食症患者，CBT-GSH 是一种可行的一线治疗选择。
