An exploratory investigation of predictors of outcome in face-to-face and online cognitive-behavioural therapy for bulimia nervosa

Camden E Matherne¹, Hunna Watson^{1

2

3}, Daniel B Fassnacht^{4

5}, Kathina Ali^{4

5}, Stephanie Zerwas¹, Christine Peat¹, Cristin Runfola^{1

6}, Michele D Levine⁷, Marsha D Marcus⁷, Benjamin Zimmer⁸, Markus Moessner⁸, Ross Crosby^{9

10}, Cynthia M Bulik^{1

11

12}

Affiliations

¹ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
² School of Psychology, Curtin University, Bentley, Western Australia, Australia.
³ Division of Paediatrics, The University of Western Australia, Crawley, Western Australia, Australia.
⁴ College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.
⁵ Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.
⁶ Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.
⁷ Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁸ Center for Psychotherapy Research, University Hospital, Heidelberg, Germany.
⁹ Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.
¹⁰ Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA.
¹¹ Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹² Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

PMID: 35474624
DOI: 10.1002/erv.2898

Randomized Controlled Trial

An exploratory investigation of predictors of outcome in face-to-face and online cognitive-behavioural therapy for bulimia nervosa

Camden E Matherne et al. Eur Eat Disord Rev. 2022 Jul.

. 2022 Jul;30(4):373-387.

doi: 10.1002/erv.2898. Epub 2022 Apr 26.

Authors

Affiliations

¹ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
² School of Psychology, Curtin University, Bentley, Western Australia, Australia.
³ Division of Paediatrics, The University of Western Australia, Crawley, Western Australia, Australia.
⁴ College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.
⁵ Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.
⁶ Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.
⁷ Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁸ Center for Psychotherapy Research, University Hospital, Heidelberg, Germany.
⁹ Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.
¹⁰ Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA.
¹¹ Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹² Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

PMID: 35474624
DOI: 10.1002/erv.2898

Abstract

Objective: Cognitive-behavioural therapy (CBT) delivered face-to-face and via the internet reduces bulimia nervosa (BN) symptoms. However, our empirical understanding of factors affecting patient outcomes is limited.

Method: Using data from a randomised, controlled trial comparing internet-based (CBT4BN, n = 78) with face-to-face (CBTF2F, n = 71) group CBT (97% female, M = 28 years), we examined general treatment (across conditions) and modality-specific predictors of end-treatment and 1-year outcomes (abstinence, binge-eating frequency, purging frequency).

Results: Improved eating disorder-related quality of life (EDQOL) during treatment and follow-up predicted abstinence at end-treatment and 1-year assessments. Improved EDQOL, disordered eating cognitions, and anxiety symptoms predicted less frequent binge eating and purging. Previous CBT and being employed predicted more frequent binge eating and purging at both assessments. Higher self-transcendence and self-directedness predicted less frequent binge eating. More severe binge eating and purging at baseline and end-treatment predicted more frequent binge eating and purging at subsequent assessments. Improved EDQOL was more strongly associated with positive outcome in CBT4BN; improved depressive symptoms and health-related QOL predicted positive outcome in CBT4BN but not CBTF2F.

Discussion: Symptom improvement and certain character traits predicted positive outcome, whereas more severe presentation and prior CBT experience predicted poorer outcome. Consideration of intreatment symptom improvement may facilitate care recommendations, particularly for internet-based modalities.

Keywords: bulimia nervosa; cognitive-behavioural therapy; eating disorders; internet; randomised controlled trial; treatment outcome.

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References

REFERENCES

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An exploratory investigation of predictors of outcome in face-to-face and online cognitive-behavioural therapy for bulimia nervosa

Affiliations

An exploratory investigation of predictors of outcome in face-to-face and online cognitive-behavioural therapy for bulimia nervosa

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources