Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, Germany.
King's College London, Institute of Psychiatry, Box P059, De Crespigny Park, London SE5 8AF, UK.
Clin Psychol Rev. 2014 Mar;34(2):158-76. doi: 10.1016/j.cpr.2014.01.003. Epub 2014 Jan 23.
There is a growing body of research on manualized self-help interventions for bulimia nervosa (BN) and binge eating disorder (BED). Study and treatment dropout and adherence represent particular challenges in these studies. However, systematic investigations of the relationship between study, intervention and patient characteristics, participation, and intervention outcomes are lacking. We conducted a systematic literature review using electronic databases and hand searches of relevant journals. In metaregression analyses, we analyzed study dropout as well as more specific measures of treatment participation in manualized self-help interventions, their association with intervention characteristics (e.g. duration, guidance, intervention type [bibliotherapy, CD-ROM or Internet based intervention]) and their association with treatment outcomes. Seventy-three publications reporting on 50 different trials of manualized self-help interventions for binge eating and bulimia nervosa published through July 9th 2012 were identified. Across studies, dropout rates ranged from 1% to 88%. Study dropout rates were highest in CD-ROM interventions and lowest in Internet-based interventions. They were higher in samples of BN patients, samples of patients with higher degrees of dietary restraint at baseline, lower age, and lower body mass index. Between 6% and 88% of patients completed the intervention to which they had been assigned. None of the patient, study and intervention characteristics predicted intervention completion rates. Intervention outcomes were moderated by the provision of personal guidance by a health professional, the number of guidance sessions as well as participants' age, BMI, and eating disorder related attitudes (Restraint, Eating, Weight and Shape Concerns) at baseline (after adjusting for study dropout and intervention completion rates). Guidance particularly improved adherence and outcomes in samples of patients with bulimia nervosa; specialist guidance led to higher intervention completion rates and larger intervention effects on some outcomes than non-specialist guidance. Self-help interventions have a place in the treatment of BN and BED, especially if the features of their delivery and indications are considered carefully. To better determine who benefits most from what kind and "dosage" of self-help interventions, we recommend the use of consistent terminology as well as uniform standards for reporting adherence and participation in future self-help trials.
越来越多的研究关注手动自助干预暴食症（BN）和暴食障碍（BED）。在这些研究中，研究和治疗脱落以及依从性是特别的挑战。然而，系统地调查研究、干预和患者特征、参与以及干预结果之间的关系还很缺乏。我们使用电子数据库和相关期刊的手工搜索进行了系统文献回顾。在荟萃回归分析中，我们分析了手动自助干预研究脱落以及更具体的治疗参与措施，以及它们与干预特征（如持续时间、指导、干预类型[自助阅读、光盘或基于互联网的干预]）的关系以及与治疗结果的关系。通过 2012 年 7 月 9 日之前发表的针对暴食和 BN 的手动自助干预的 50 项不同试验的 73 篇出版物被确定。在所有研究中，脱落率范围从 1%到 88%。光盘干预的脱落率最高，基于互联网的干预最低。在 BN 患者样本、基线时饮食抑制程度较高的患者样本、年龄较低和 BMI 较低的患者样本中，脱落率较高。完成分配的干预的患者比例在 6%到 88%之间。患者、研究和干预特征均不能预测干预完成率。干预结果受健康专业人员提供的个人指导、指导次数以及参与者的年龄、BMI 和饮食障碍相关态度（约束、进食、体重和体型关注）的影响（在调整研究脱落和干预完成率后）。指导特别是在 BN 患者样本中提高了依从性和结果；专业指导导致更高的干预完成率和对一些结果的更大干预效果，而非专业指导则导致更高的干预完成率和对一些结果的更大干预效果。自助干预在 BN 和 BED 的治疗中占有一席之地，特别是如果仔细考虑其提供方式和适应症。为了更好地确定谁从何种自助干预以及“剂量”中获益最大，我们建议在未来的自助试验中使用一致的术语以及一致的报告依从性和参与的标准。
