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Am J Psychiatry 1993; 150:37-46
Copyright © 1993 by American Psychiatric Association
Comparison of cognitive-behavioral and supportive-expressive therapy for bulimia nervosa
DM Garner, W Rockert, R Davis, MV Garner, MP Olmsted and M Eagle
Department of Psychiatry, Toronto General Hospital.
OBJECTIVE: The authors compared the effectiveness of 4 months (18 sessions)
of cognitive-behavioral and supportive-expressive therapy for bulimia.
METHOD: Sixty patients obtained from clinical referrals to an eating
disorders program who met modified DSM-III-R criteria for bulimia nervosa
were randomly assigned to the two conditions. Treatments were delivered in
an individual format, on an outpatient basis, by experienced therapists
using treatment manuals. The primary outcome measures were self-induced
vomiting, binge eating, and attitudes toward body weight and shape, which
were assessed by self- report and structured interview. RESULTS: Fifty
patients completed treatment, 25 in each condition. Both treatments led to
significant improvements in specific eating disorder symptoms and in
psychosocial disturbances. Supportive-expressive therapy was just as
effective as cognitive-behavioral therapy in reducing binge eating. Where
treatment differences were found, they favored cognitive-behavioral
therapy. Cognitive-behavioral therapy was marginally superior in reducing
the frequency of self-induced vomiting; 36% of the patients who received
cognitive-behavioral therapy and 12% of those who received supportive-
expressive therapy abstained from vomiting in the last month of treatment.
Cognitive-behavioral therapy was significantly more effective in
ameloriating disturbed attitudes toward eating and weight, depression, poor
self-esteem, general psychological distress, and certain personality
traits. CONCLUSIONS: These results moderately favor cognitive-behavioral
therapy over supportive-expressive therapy for bulimia nervosa, but
follow-up is required to determine the durability of outcome with both
modalities. The findings must be interpreted with caution since the
selected clinical sample in this study may not represent the bulimia
nervosa population.
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