Publication
Guided self help for bulimic disorders: effectiveness, predictors of outcome and trajectories of change
| Summary: | Eating disorders are serious disorders associated with a great psychological comorbidity and with serious medical complications. Several studies have showed that Cognitive-Behavioral Treatment is effective and it is considered the first line treatment for these disorders. However, research has focus on alternative ways of delivering empirically evidence treatments. Shelf help can be an alternative to full CBT in the treatment of bulimic disorders. Research is still needed to investigate for whom this approach is efficient and how it should be implemented. The first chapter is an update of a previously paper published paper in Portuguese presenting the cognitive behavioral approach to the treatment of eating disorders. In this section are also present the main clinical characteristics of bulimic disorders and its epidemiology and provide the theoretical background for the later studies conducted. The second chapter of this dissertation describes a self help manual developed for bulimic disorders. The treatment program is based on Cognitive behavioral principles for the treatment of Eating disorders and addresses the behavioral and cognitive components of bulimic disorders. The self help manual developed was used in the later studies presented in this thesis. The third chapter of this dissertation is entitled “Guided self help CBT treatment for Bulimic Disorders: Effectiveness and clinical significant change” and aimed to test the effectiveness and clinical significant change of a guided self-help treatment program for bulimia nervosa and similar disorders. Results showed a significant reduction in eating disorders psychopathology, psychological distress and depressive symptomatology. Treatment was effective in reducing binge eating and purge frequencies. A clinically significant change occurred for the majority of participants, returning to levels of functioning within the range of normal population after treatment and at follow up. The fourth study in this dissertation “Early Change as a predictor of outcome in guided self-help treatment for bulimic disorders” addressed two main aims: to study time to achieve a significant reduction in binge eating and purge and the predictive role of early change in treatment outcome with a guided self help program. Results showed that a significant reduction of binge eating and purge frequencies occur early in treatment. On the other hand, early change was found to be the most significant predictor of binge eating remission at the end of treatment and follow up and also of binge eating frequency improvement. These results are contextualized in terms of their implications for intervention strategies, namely the implementation of stepped care models. The fifth chapter of this dissertation is entitled “Trajectories’ of change during a guided self-help program for Bulimic Disorders” and aimed to study the course of change of bulimic symptoms, such as binge eating and purge frequencies throughout a guided self help treatment. Results showed a non linear change in symptoms. Participants who remained clinical at end of treatment and follow up showed different growth curves for binge eating frequency since a deceleration at mid-treatment occurred. Baseline severity was not found to be a significant predictor of the growth curves obtained. Results are discussed regarding their implication in adopting less intensive treatment strategies as a fists step and the need to continuing monitoring symptoms during treatment as a way to inform clinical decisions regarding treatment implementation. Guided self help seems to be a valuable first step in the treatment of bulimic disorders. Models of intervention for bulimic disorders should include continued monitoring and access change during the course of treatment as way to better plan and implement individually and tailored intervention strategies that can lead to improve treatment outcome. |
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| Main Authors: | Vaz, Ana Rita Rendeiro Ribeiro |
| Year: | 2013 |
| Country: | Portugal |
| Document type: | doctoral thesis |
| Access type: | restricted access |
| Associated institution: | Universidade do Minho |
| Language: | English |
| Origin: | RepositóriUM - Universidade do Minho |
| Summary: | Eating disorders are serious disorders associated with a great psychological comorbidity and with serious medical complications. Several studies have showed that Cognitive-Behavioral Treatment is effective and it is considered the first line treatment for these disorders. However, research has focus on alternative ways of delivering empirically evidence treatments. Shelf help can be an alternative to full CBT in the treatment of bulimic disorders. Research is still needed to investigate for whom this approach is efficient and how it should be implemented. The first chapter is an update of a previously paper published paper in Portuguese presenting the cognitive behavioral approach to the treatment of eating disorders. In this section are also present the main clinical characteristics of bulimic disorders and its epidemiology and provide the theoretical background for the later studies conducted. The second chapter of this dissertation describes a self help manual developed for bulimic disorders. The treatment program is based on Cognitive behavioral principles for the treatment of Eating disorders and addresses the behavioral and cognitive components of bulimic disorders. The self help manual developed was used in the later studies presented in this thesis. The third chapter of this dissertation is entitled “Guided self help CBT treatment for Bulimic Disorders: Effectiveness and clinical significant change” and aimed to test the effectiveness and clinical significant change of a guided self-help treatment program for bulimia nervosa and similar disorders. Results showed a significant reduction in eating disorders psychopathology, psychological distress and depressive symptomatology. Treatment was effective in reducing binge eating and purge frequencies. A clinically significant change occurred for the majority of participants, returning to levels of functioning within the range of normal population after treatment and at follow up. The fourth study in this dissertation “Early Change as a predictor of outcome in guided self-help treatment for bulimic disorders” addressed two main aims: to study time to achieve a significant reduction in binge eating and purge and the predictive role of early change in treatment outcome with a guided self help program. Results showed that a significant reduction of binge eating and purge frequencies occur early in treatment. On the other hand, early change was found to be the most significant predictor of binge eating remission at the end of treatment and follow up and also of binge eating frequency improvement. These results are contextualized in terms of their implications for intervention strategies, namely the implementation of stepped care models. The fifth chapter of this dissertation is entitled “Trajectories’ of change during a guided self-help program for Bulimic Disorders” and aimed to study the course of change of bulimic symptoms, such as binge eating and purge frequencies throughout a guided self help treatment. Results showed a non linear change in symptoms. Participants who remained clinical at end of treatment and follow up showed different growth curves for binge eating frequency since a deceleration at mid-treatment occurred. Baseline severity was not found to be a significant predictor of the growth curves obtained. Results are discussed regarding their implication in adopting less intensive treatment strategies as a fists step and the need to continuing monitoring symptoms during treatment as a way to inform clinical decisions regarding treatment implementation. Guided self help seems to be a valuable first step in the treatment of bulimic disorders. Models of intervention for bulimic disorders should include continued monitoring and access change during the course of treatment as way to better plan and implement individually and tailored intervention strategies that can lead to improve treatment outcome. |
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