Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial.

Hunna J Watson, Michele D Levine, Stephanie C Zerwas, Robert M Hamer, Ross D Crosby, Caroline S Sprecher, Amy O'Brien, Benjamin Zimmer, Sara M Hofmeier, Hans Kordy, Markus Moessner, Christine M Peat, Cristin D Runfola, Marsha D Marcus, Cynthia M Bulik

Journal: The International journal of eating disorders 2017;50(5):569-577

PMID: 27862108

Abstract

OBJECTIVE

We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout.

METHOD

Participants (N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors.

RESULTS

Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96).

DISCUSSION

Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:569-577).

© 2016 Wiley Periodicals, Inc.

Address: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.; Eating Disorders Program, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Western, Australia.; School of Paediatrics and Child Health, The University of Western Australia, Crawley, Western Australia, Australia.; School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia.; Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.; Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.; Neuropsychiatric Research Institute, Fargo, North Dakota.; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota.; Eating Disorders Program, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Western, Australia.; Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.; Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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