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. 2022 Aug;27(6):2257-2264.
doi: 10.1007/s40519-021-01348-5. Epub 2022 Jan 4.

Latent trajectories of symptom change during cognitive-behavior therapy predict post-treatment worsening of symptoms: a preliminary examination among outpatients with bulimia-spectrum eating disorders

Emily K Presseller  1   2 , Elizabeth W Lampe  3   4 , Megan L Michael  3   4 , Claire Trainor  3   4 , Stephanie C Fan  4 , Adrienne S Juarascio  3   4
Affiliations

Latent trajectories of symptom change during cognitive-behavior therapy predict post-treatment worsening of symptoms: a preliminary examination among outpatients with bulimia-spectrum eating disorders

Emily K Presseller et al. Eat Weight Disord. 2022 Aug.

Abstract

Purpose: Up to 44% of individuals with bulimia nervosa (BN) experience worsening of symptoms after cognitive behavior therapy (CBT). Identifying risk for post-treatment worsening of symptoms using latent trajectories of change in eating disorder (ED) symptoms during treatment could allow for personalization of treatment to improve long-term outcomes METHODS: Participants (N = 56) with BN-spectrum EDs received 16 sessions of CBT and completed digital self-monitoring of eating episodes and ED behaviors. The Eating Disorder Examination was used to measured ED symptoms at post-treatment and 3-month follow-up. Latent growth mixture modeling of digital self-monitoring data identified latent growth classes. Kruskal-Wallis H tests examined effect of trajectory of change in ED symptoms on post-treatment to follow-up symptom change.

Results: Multi-class models of change in binge eating, compensatory behaviors, and regular eating improved fit over one-class models. Individuals with high frequency-rapid response in binge eating (H(1) = 10.68, p =0 .001, η2 = 0.24) had greater recurrence of compensatory behaviors compared to individuals with low frequency-static response. Individuals with static change in regular eating exhibited greater recurrence of binge eating than individuals with moderate response (H(1) = 8.99, p = 0.003, η2 = 0.20).

Conclusion: Trajectories of change in ED symptoms predict post-treatment worsening of symptoms. Personalized treatment approaches should be evaluated among individuals at risk of poor long-term outcomes.

Level of evidence: IV, evidence obtained from multiple time series.

Trial registration: ClinicalTrials.gov registration number NCT03673540, registration date: September 17, 2018.

Keywords: Binge eating; Bulimia nervosa; Cognitive-behavior therapy; Compensatory behaviors; Treatment outcome.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Latent trajectories of change in eating disorder symptoms across 16 sessions of CBT. Lines designate individual participants’ symptom trajectories. Individual participant data are color-coded by latent class membership
See this image and copyright information in PMC

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