University Hospital of Heidelberg, Germany.
Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August-University, Goettingen, Germany; International Psychoanalytic University (IPU), Berlin, Germany.
J Am Acad Child Adolesc Psychiatry. 2017 Apr;56(4):329-335. doi: 10.1016/j.jaac.2017.01.019. Epub 2017 Feb 11.
The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents.
In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder-oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated.
The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35-2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT (d = 0.51-0.82) and PDT (d = 0.24-1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favor of CBT and for eating concern (d = -0.35) in favor of PDT.
CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information-Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095.
作者比较了认知行为疗法（CBT）和心理动力学疗法（PDT）治疗女性青少年神经性贪食症（BN）的效果。
在这项随机对照试验中，81 名符合 DSM-IV 标准的 BN 或部分 BN 女性青少年接受了平均 36.6 节基于手册的以疾病为导向的 PDT 或 CBT。接受过培训的心理学家在基线、治疗期间、治疗结束时和治疗结束后 12 个月对治疗条件进行了盲法评估，以评估治疗结果。主要结局是缓解率，定义为治疗结束时缺乏 BN 或部分 BN 的 DSM-IV 诊断。评估了几个次要结局。
CBT 和 PDT 的缓解率分别为 33.3%和 31.0%，两者之间无显著差异（优势比[OR] = 0.90，95%置信区间[CI] = 0.35-2.28，p = 0.82）。CBT 和 PDT 的组内效应大小分别为 h = 1.22 和 h = 1.18。CBT（d = 0.51-0.82）和 PDT（d = 0.24-1.10）均显著改善了所有次要结局。两组在 12 个月随访时均保持稳定的改善。CBT 在暴食（d = 0.23）和催吐（d = 0.26）方面和 PDT 在进食关注（d = -0.35）方面的改善效果优于 PDT。
CBT 和 PDT 均有效促进女性青少年 BN 的康复。两种疗法的缓解率与其他评估 CBT 的研究相似。这项试验发现了在暴食、催吐和进食关注方面存在差异，但其影响较小。
临床试验注册信息-用认知行为疗法（CBT）或心理动力学疗法（PDT）治疗女性青少年神经性贪食症。http://isrctn.com/；ISRCTN14806095。
