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

Camden E Matherne, Hunna Watson, Daniel B Fassnacht, Kathina Ali, Stephanie Zerwas, Christine Peat, Cristin Runfola, Michele D Levine, Marsha D Marcus, Benjamin Zimmer, Markus Moessner, Ross Crosby, Cynthia M Bulik

Journal: European eating disorders review : the journal of the Eating Disorders Association 2022;30(4):373-387

PMID: 35474624

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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.

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

DOI: 10.1002/erv.2898

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MeSH Terms: Binge-Eating Disorder, Bulimia, Bulimia Nervosa, Cognitive Behavioral Therapy, Female, Humans, Male, Quality of Life, Treatment Outcome