暴食障碍认知行为治疗和药物治疗反应的预测因素和调节因素。
Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder.
机构信息
Department of Psychiatry, Yale University School of Medicine, 301 Cedar Street, New Haven, CT 06519, USA.
出版信息
J Consult Clin Psychol. 2012 Oct;80(5):897-906. doi: 10.1037/a0027001. Epub 2012 Jan 30.
OBJECTIVE
To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED).
METHOD
108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors, psychiatric and personality disorder comorbidity, eating disorder psychopathology, psychological features, and 2 subtyping methods (negative affect, overvaluation of shape/weight) were tested as predictors and moderators for the primary outcome of remission from binge eating and 4 secondary dimensional outcomes (binge-eating frequency, eating disorder psychopathology, depression, and body mass index). Mixed-effects models analyzed all available data for each outcome variable. In each model, effects for baseline value and treatment were included with tests of both prediction and moderator effects.
RESULTS
Several demographic and clinical variables significantly predicted and/or moderated outcomes. One demographic variable signaled a statistical advantage for medication only (younger participants had greater binge-eating reductions), whereas several demographic and clinical variables (lower self-esteem, negative affect, and overvaluation of shape/weight) signaled better improvements if receiving CBT. Overvaluation was the most salient predictor/moderator of outcomes. Overvaluation significantly predicted binge-eating remission (29% of participants with vs. 57% of participants without overvaluation remitted). Overvaluation was especially associated with lower remission rates if receiving medication only (10% vs. 42% for participants without overvaluation). Overvaluation moderated dimensional outcomes: Participants with overvaluation had significantly greater reductions in eating disorder psychopathology and depression levels if receiving CBT. Overvaluation predictor/moderator findings persisted after controlling for negative affect.
CONCLUSIONS
Our findings have clinical utility for prescription of CBT and medication and implications for refinement of the BED diagnosis.
目的
探讨暴食障碍（BED）认知行为疗法（CBT）和药物治疗应答的预测因素和调节因素。
方法
在一项针对 CBT 和氟西汀治疗的随机双盲安慰剂对照试验中，对 108 名 BED 患者进行了评估，包括治疗前、治疗期间和治疗后。人口统计学因素、精神和人格障碍共病、饮食障碍病理心理学、心理特征以及 2 种亚型方法（负性情绪、对体型/体重的过度评价）被作为预测和调节因素，用于主要结局（暴食发作缓解）和 4 个次要维度结局（暴食发作频率、饮食障碍病理心理学、抑郁和体重指数）的预测。混合效应模型分析了每个结局变量的所有可用数据。在每个模型中，都包括了基线值和治疗的影响，并对预测和调节效应进行了检验。
结果
一些人口统计学和临床变量显著预测和/或调节了结局。一个人口统计学变量仅对药物治疗有利（年轻参与者的暴食发作减少更大），而一些人口统计学和临床变量（自尊心较低、负性情绪和对体型/体重的过度评价）则表明如果接受 CBT，改善情况更好。对体型/体重的过度评价是预测/调节结局的最重要因素。对体型/体重的过度评价显著预测暴食发作缓解（有过度评价的参与者中有 29%缓解，而无过度评价的参与者中有 57%缓解）。如果仅接受药物治疗，过度评价与较低的缓解率尤其相关（无过度评价的参与者中有 10%缓解，而有过度评价的参与者中有 42%缓解）。对体型/体重的过度评价调节了维度结局：如果接受 CBT，有过度评价的参与者在饮食障碍病理心理学和抑郁水平上的降低更为显著。在控制了负性情绪后，过度评价的预测/调节因素仍然存在。
结论
我们的研究结果对 CBT 和药物的处方具有临床实用价值，并对 BED 诊断的精细化具有启示意义。
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