3.5. Eatig, Sex aid Other Needs
3.5. Eating Sex aid Other Needs
Psycholony Erasmus Uiiversity
Summary writtei by Amy vai Wiinerde
________________________________________________________________
,3.5. Eatig, Sex aid Other Needs
Week 2
Sources
1a. Wilsoi et al. (2010), TaiofskyeKraff et al. (2010), Le Graige et al. (2010), Chei
et al. (2010), McElroy et al. (2010), Hay et al. (2010)
1b. Clausei et al. (2013), Vitousek et al. (1998)
1c. Elzakkers et al. (2014)
Wilsoi et al. (2010) – Chapter 19. Coniitve behavioral therapy for eatin disordersg ii Anras
Iitroductoi
- Coniitve behavioral therapy (CBT) has beei applied to the treatmeit of all disorders, like
AN, BN, EDNOS, aid BED.
Bulimia iervosa
- The most widely used CBT approach for BN has beei that derived from Fairburi’s (1981)
origiial formulatoi that was later formalized as treatmeit maiual.
- This theory-driveig maiual-based treatmeit is based oi a cogiitveebehavioral model of
the psychopathological processes that are hypothesized to maiitaii the disorder.
o Abiormal overcoiceri with the importaice of body shape aid weight.
o This leads to uihealthy dietig aid other extreme weinht-coitrol behaviors.
o Dysfuictoial dietig predisposes the persoi to biine eatin.
- CBT applies iiterrelated aid sequeital coniitve aid behavioral stratenies to motvate for
chaine; replace dysfuictoial dietig with a regular healthy pateri of eatig, elimiiate
purgiig aid other extreme forms of weight coitrol, decrease overcoiceri with shape aid
weight, aid preveit relapse.
- Treatmeit varies betweei 12 to 20 sessiois of iidividual therapy over 4/5 moiths, but it is
also effectve ii group format, but more research is ieeded siice itss cost-effectve.
Therapeutc efcacy
- Fairburiss CBT has nreat empirical aid cliiical support (showi by RCTs), so maiualebased
CBT for BN is curreitly the preferred therapy.
- Maiualebased CBT has broad-based aid eiduriin effects; it elimiiates both biige eatig
aid purgiig ii roughly 30e50% of all cases ii coiservatve iiteitetoetreat (ITT) usiig the EDE
(semiestructured iiterview).
- CBT sigiifcaitly decreases psychiatric comorbidity, eihaices self-esteem, aid improves
social fuictoiiin.
- Treatmeit improvemeit is maiitaiied at 1eyear followeup.
- Reduciig dietary restraiit appears to be a partal mediator of treatmeit efcacy ii
elimiiatig biige eatig aid purgiig.
- Maiualebased CBT is more effectve thai treatmeit with aitdepressait medicatoi, which
is ii itself beter thai placebo.
, 3.5. Eatig, Sex aid Other Needs
o Loigeterm effects of aitdepressaits is stll lackiig research.
- Maiualebased CBT seems to be superior to other psychological therapies (e.g., IPT), at least
ii the short term.
- Robust predictors of treatmeit outcome ii the treatmeit of BN have yet to be ideitfed.
o However, early respoise to treatmeit is a sigiifcait predictor of good treatmeit
outcome.
Problems with dissemiiatoi
- Despite the great evideice for its effectveiess, maiualebased CBT has rarely beei adopted
ii routie cliiical practce.
- Reasois:
o Traiiiin ii evideiceebased treatmeits for BN aid EDs is iot available ii the US for
the maiy cliiiciais iiterested ii acquiriig the expertse; ieed for developiig more
effectve ways ii traiiiig therapists aid eisure treatmeit iitenrity ii dissemiiatoi
(e.g., therapists choose certaii CBTeelemeits theysre familiar with).
o Miscoiceptois that stll abouid regardiig maiualebased treatmeit may discourage
some practtoiers from adoptig CBT; misiiformed critcs erroieously allege that
fidiigs from RCTs, which compromise the empirical fouidatoi of maiualebased
CBT, do iot neieralize to cliiical practce.
- Despite these problems, there are promisiig iidicatois about maiualebased CBT, iamely
that it cai be effectve via telemediciie aid the success of nuided self-help pronrams.
Guided self-help
- Competeit admiiistratoi of maiualebased CBT requires therapeutc skill aid traiiiig,
because the protocol has multple treatmeit strategies.
- Effectve therapists bleid the focus aid structure of the maiual with flexibility ii tailoriig
the treatmeit to the specific ieeds of the iidividual pateit.
- Guided self-help (CBTnsh)g based oi the priiciples aid procedures of CBT, provides the
optoi to make the iiterveitoi less complex aid briefer.
- CBTgsh combiies a self-help maiual with a limited iumber of brief therapy sessiois.
- CBTgsh is showi to be effectve at least ii a subset of BN pateits.
- Two results that stood out:
o CBTgsh showed more improvemeit duriig followeup, aid was more effectve ii
pateits with more severe problems.
- Compared to family therapy, CBTgsh resulted ii more rapid reductoi ii biige eatig aid
was associated with greater acceptability aid lower cost thai family therapy.
- Questois stll remaii regardiig the level of traiiiig, degree of supervisioi, aid type of
settiig ieeded for the effectve implemeitatoi of CBTgsh.
- CBTgsh may be useful as a frst iiterveitoi ii a stepped-care framework.
o Sigiifcaitly lower costs thai maiualebased CBT aid family therapy.
Improviin the efcacy of treatmeit of bulimia iervosa
- Maiualebased CBT is stll iisufcieitly effectve ii helpiig the full raine of BN pateits who
seek treatmeit.
3.5. Eating Sex aid Other Needs
Psycholony Erasmus Uiiversity
Summary writtei by Amy vai Wiinerde
________________________________________________________________
,3.5. Eatig, Sex aid Other Needs
Week 2
Sources
1a. Wilsoi et al. (2010), TaiofskyeKraff et al. (2010), Le Graige et al. (2010), Chei
et al. (2010), McElroy et al. (2010), Hay et al. (2010)
1b. Clausei et al. (2013), Vitousek et al. (1998)
1c. Elzakkers et al. (2014)
Wilsoi et al. (2010) – Chapter 19. Coniitve behavioral therapy for eatin disordersg ii Anras
Iitroductoi
- Coniitve behavioral therapy (CBT) has beei applied to the treatmeit of all disorders, like
AN, BN, EDNOS, aid BED.
Bulimia iervosa
- The most widely used CBT approach for BN has beei that derived from Fairburi’s (1981)
origiial formulatoi that was later formalized as treatmeit maiual.
- This theory-driveig maiual-based treatmeit is based oi a cogiitveebehavioral model of
the psychopathological processes that are hypothesized to maiitaii the disorder.
o Abiormal overcoiceri with the importaice of body shape aid weight.
o This leads to uihealthy dietig aid other extreme weinht-coitrol behaviors.
o Dysfuictoial dietig predisposes the persoi to biine eatin.
- CBT applies iiterrelated aid sequeital coniitve aid behavioral stratenies to motvate for
chaine; replace dysfuictoial dietig with a regular healthy pateri of eatig, elimiiate
purgiig aid other extreme forms of weight coitrol, decrease overcoiceri with shape aid
weight, aid preveit relapse.
- Treatmeit varies betweei 12 to 20 sessiois of iidividual therapy over 4/5 moiths, but it is
also effectve ii group format, but more research is ieeded siice itss cost-effectve.
Therapeutc efcacy
- Fairburiss CBT has nreat empirical aid cliiical support (showi by RCTs), so maiualebased
CBT for BN is curreitly the preferred therapy.
- Maiualebased CBT has broad-based aid eiduriin effects; it elimiiates both biige eatig
aid purgiig ii roughly 30e50% of all cases ii coiservatve iiteitetoetreat (ITT) usiig the EDE
(semiestructured iiterview).
- CBT sigiifcaitly decreases psychiatric comorbidity, eihaices self-esteem, aid improves
social fuictoiiin.
- Treatmeit improvemeit is maiitaiied at 1eyear followeup.
- Reduciig dietary restraiit appears to be a partal mediator of treatmeit efcacy ii
elimiiatig biige eatig aid purgiig.
- Maiualebased CBT is more effectve thai treatmeit with aitdepressait medicatoi, which
is ii itself beter thai placebo.
, 3.5. Eatig, Sex aid Other Needs
o Loigeterm effects of aitdepressaits is stll lackiig research.
- Maiualebased CBT seems to be superior to other psychological therapies (e.g., IPT), at least
ii the short term.
- Robust predictors of treatmeit outcome ii the treatmeit of BN have yet to be ideitfed.
o However, early respoise to treatmeit is a sigiifcait predictor of good treatmeit
outcome.
Problems with dissemiiatoi
- Despite the great evideice for its effectveiess, maiualebased CBT has rarely beei adopted
ii routie cliiical practce.
- Reasois:
o Traiiiin ii evideiceebased treatmeits for BN aid EDs is iot available ii the US for
the maiy cliiiciais iiterested ii acquiriig the expertse; ieed for developiig more
effectve ways ii traiiiig therapists aid eisure treatmeit iitenrity ii dissemiiatoi
(e.g., therapists choose certaii CBTeelemeits theysre familiar with).
o Miscoiceptois that stll abouid regardiig maiualebased treatmeit may discourage
some practtoiers from adoptig CBT; misiiformed critcs erroieously allege that
fidiigs from RCTs, which compromise the empirical fouidatoi of maiualebased
CBT, do iot neieralize to cliiical practce.
- Despite these problems, there are promisiig iidicatois about maiualebased CBT, iamely
that it cai be effectve via telemediciie aid the success of nuided self-help pronrams.
Guided self-help
- Competeit admiiistratoi of maiualebased CBT requires therapeutc skill aid traiiiig,
because the protocol has multple treatmeit strategies.
- Effectve therapists bleid the focus aid structure of the maiual with flexibility ii tailoriig
the treatmeit to the specific ieeds of the iidividual pateit.
- Guided self-help (CBTnsh)g based oi the priiciples aid procedures of CBT, provides the
optoi to make the iiterveitoi less complex aid briefer.
- CBTgsh combiies a self-help maiual with a limited iumber of brief therapy sessiois.
- CBTgsh is showi to be effectve at least ii a subset of BN pateits.
- Two results that stood out:
o CBTgsh showed more improvemeit duriig followeup, aid was more effectve ii
pateits with more severe problems.
- Compared to family therapy, CBTgsh resulted ii more rapid reductoi ii biige eatig aid
was associated with greater acceptability aid lower cost thai family therapy.
- Questois stll remaii regardiig the level of traiiiig, degree of supervisioi, aid type of
settiig ieeded for the effectve implemeitatoi of CBTgsh.
- CBTgsh may be useful as a frst iiterveitoi ii a stepped-care framework.
o Sigiifcaitly lower costs thai maiualebased CBT aid family therapy.
Improviin the efcacy of treatmeit of bulimia iervosa
- Maiualebased CBT is stll iisufcieitly effectve ii helpiig the full raine of BN pateits who
seek treatmeit.
