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Randomized Controlled Trial
. 2015 Jun:69:48-53.
doi: 10.1016/j.brat.2015.04.002. Epub 2015 Apr 4.

Predictors and moderators of psychological changes during the treatment of adolescent bulimia nervosa

Anna C Ciao  1 , Erin C Accurso  2 , Ellen E Fitzsimmons-Craft  3 , Daniel Le Grange  4
Affiliations
Randomized Controlled Trial

Predictors and moderators of psychological changes during the treatment of adolescent bulimia nervosa

Anna C Ciao et al. Behav Res Ther. 2015 Jun.

Abstract

This study examined predictors of psychological change among 80 adolescents with bulimia nervosa (BN) participating in a randomized-controlled trial comparing family-based treatment (FBT) to supportive psychotherapy (SPT). Psychological outcomes (cognitive eating disorder pathology, depression, and self-esteem) were explored at baseline, post-treatment, and 6-month follow-up. Multi-level growth models examined predictors of rate of change in psychological outcomes and moderators of treatment effects. All psychological outcomes improved through 6-month follow-up (moderate to large effect sizes) across both treatments. Overall, few significant predictors were identified. Older adolescents had faster change in self-esteem relative to younger adolescents (p = 0.03). Adolescents taking psychotropic medication at baseline had faster change in eating concerns relative to adolescents not taking medication (p = 0.02). Age (p = 0.02) and baseline purging severity (p = 0.03) moderated the relationship between treatment condition and change in eating concerns, where younger adolescents and individuals with high baseline purging had greater change when treated with FBT relative to SPT. Age and purging did not significantly moderate change in other psychological outcomes. Bulimic symptom improvement did not predict change in psychological symptoms. Generally, FBT and SPT were equally efficacious with respect to psychological improvement, although FBT may be more efficacious in younger adolescents and those with more frequent purging.

Keywords: Adolescents; Bulimia nervosa; Family-based treatment; Supportive psychotherapy.

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Conflict of interest statement

Conflict of Interest Statement:

Dr. Le Grange receives royalties from Guilford Press and consultant fees from the Training Institute for Child and Adolescent Eating Disorders, LLC.

Figures

Figure 1
Figure 1
The effect of treatment type and age (younger = estimated slope of the value 1SD below the mean, older = estimated slope of the value 1SD above the mean) on reductions in eating concerns (p = .02).
Figure 2
Figure 2
The effect of treatment type and baseline purging frequency (lesser purging = estimated slope of the value 1SD below the mean, greater purging = estimated slope of the value 1SD above the mean) on reductions in eating concerns (p = .03).
See this image and copyright information in PMC

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