University of Ottawa, School of Psychology and The Ottawa Hospital Research Institute,Clinical Epidemiology Program, Ottawa,Canada.
University of Ottawa, Faculty of Education and Institut du savoir Montfort,Department of Psychiatry,Ottawa,Canada.
Psychol Med. 2019 Mar;49(4):598-606. doi: 10.1017/S0033291718001277. Epub 2018 May 24.
A stepped care approach involves patients first receiving low-intensity treatment followed by higher intensity treatment. This two-step randomized controlled trial investigated the efficacy of a sequential stepped care approach for the psychological treatment of binge-eating disorder (BED).
In the first step, all participants with BED (n = 135) received unguided self-help (USH) based on a cognitive-behavioral therapy model. In the second step, participants who remained in the trial were randomized either to 16 weeks of group psychodynamic-interpersonal psychotherapy (GPIP) (n = 39) or to a no-treatment control condition (n = 46). Outcomes were assessed for USH in step 1, and then for step 2 up to 6-months post-treatment using multilevel regression slope discontinuity models.
In the first step, USH resulted in large and statistically significant reductions in the frequency of binge eating. Statistically significant moderate to large reductions in eating disorder cognitions were also noted. In the second step, there was no difference in change in frequency of binge eating between GPIP and the control condition. Compared with controls, GPIP resulted in significant and large improvement in attachment avoidance and interpersonal problems.
The findings indicated that a second step of a stepped care approach did not significantly reduce binge-eating symptoms beyond the effects of USH alone. The study provided some evidence for the second step potentially to reduce factors known to maintain binge eating in the long run, such as attachment avoidance and interpersonal problems.
阶梯式护理方法涉及患者首先接受低强度治疗，然后接受高强度治疗。这项两阶段随机对照试验研究了序贯阶梯式护理方法对暴食障碍（BED）的心理治疗效果。
在第一阶段，所有 BED 患者（n=135）都接受了基于认知行为治疗模型的非指导性自助（USH）。在第二阶段，继续参与试验的患者被随机分配到 16 周的团体心理动力人际治疗（GPIP）（n=39）或无治疗对照组（n=46）。使用多层次回归斜率不连续模型，在第一阶段评估 USH 的结果，然后在治疗后 6 个月评估第二阶段的结果。
在第一阶段，USH 导致暴食频率显著且具有统计学意义的减少。饮食障碍认知也有显著的中度到大幅度减少。在第二阶段，GPIP 和对照组之间在暴食频率的变化上没有差异。与对照组相比，GPIP 显著改善了回避依恋和人际问题。
研究结果表明，阶梯式护理方法的第二阶段并不能显著减少暴食症状，超过单独使用 USH 的效果。该研究提供了一些证据表明，第二阶段可能会减少长期维持暴食的因素，如回避依恋和人际问题。
