Peterson Carol B, Berg Kelly C, Crosby Ross D, Lavender Jason M, Accurso Erin C, Ciao Anna C, Smith Tracey L, Klein Marjorie, Mitchell James E, Crow Scott J, Wonderlich Stephen A
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota.
The Emily Program, St. Paul, Minnesota.
Int J Eat Disord. 2017 Jun;50(6):636-647. doi: 10.1002/eat.22669. Epub 2017 Jan 24.
The purpose of this investigation was to examine the indirect effects of Integrative Cognitive-Affective Therapy (ICAT-BN) and Cognitive-Behavioral Therapy-Enhanced (CBT-E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self-directed behavior, and self-discrepancy.
Eighty adults with BN were randomized to 21 sessions of ICAT-BN or CBT-E. A regression-based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self-directed behavior measured at mid-treatment, as well as the indirect effects of treatment at follow-up through emotion regulation, self-directed behavior, and self-discrepancy measured at end of treatment.
No significant differences in outcome between treatment conditions were observed, and no significant direct or indirect effects were found. Examination of the individual paths within the indirect effects models revealed comparable treatment effects. Across treatments, improvements in emotion regulation and self-directed behavior between baseline and mid-treatment predicted improvements in global eating disorder scores but not binge eating and purging frequency at end of treatment. Baseline to end of treatment improvements in emotion regulation and self-directed behavior also predicted improvements in global eating disorder scores at follow-up. Baseline to end of treatment improvements in emotion regulation predicted improvements in binge eating and baseline to end of treatment increases in positive self-directed behavior predicted improvements in purging at follow-up.
These findings suggest that emotion regulation and self-directed behavior are important treatment targets and that ICAT-BN and CBT-E are comparable in modifying these psychological processes among individuals with BN.
本研究旨在通过三个假设的维持变量——情绪调节、自我导向行为和自我差异，检验综合认知-情感疗法（ICAT-BN）和强化认知行为疗法（CBT-E）对神经性贪食症（BN）治疗结果的间接影响。
80名患有BN的成年人被随机分配接受21次ICAT-BN或CBT-E治疗。采用基于回归的自抽样法，检验治疗在治疗结束时通过治疗中期测量的情绪调节和自我导向行为对结果的间接影响，以及在随访时通过治疗结束时测量的情绪调节、自我导向行为和自我差异对结果的间接影响。
未观察到治疗条件之间在结果上有显著差异，也未发现显著的直接或间接影响。对间接效应模型中的个体路径进行检验，发现治疗效果相当。在所有治疗中，基线与治疗中期之间情绪调节和自我导向行为的改善预测了总体饮食失调评分的改善，但未预测治疗结束时的暴饮暴食和清除频率。基线至治疗结束时情绪调节和自我导向行为的改善也预测了随访时总体饮食失调评分的改善。基线至治疗结束时情绪调节的改善预测了暴饮暴食的改善，而基线至治疗结束时积极自我导向行为的增加预测了随访时清除行为的改善。
这些发现表明，情绪调节和自我导向行为是重要的治疗靶点，并且ICAT-BN和CBT-E在改善BN患者的这些心理过程方面具有可比性。
