Evaluating Accessible Treatments for Bulimic Eating Disorders in Primary Care

1998 ◽  
Vol 4 (3) ◽  
pp. 147 ◽  
Author(s):  
Susan J Banasiak ◽  
Susan J Paxton ◽  
Phillipa J Hay
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Bulimia Nervosa ◽  
Primary Care Settings ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Evidence Based Treatments ◽  
Potential Benefits ◽  
Common Problems ◽  
Treatment Manuals

Bulimic Eating Disorders (including bulimia nervosa and binge eating disorder) are unfortunately common problems among Australian females. The scope, morbidity and chronicity of these disorders combine to make them important women's health problems. Surprisingly, while these are distressing and disruptive conditions, research suggests many sufferers are not receiving treatment despite the existence of effective psychosocial treatments. Therefore, increasing access to care is a critical contemporary issue in improving health outcomes for sufferers of these conditions. This paper discusses identified barriers to the receipt of treatment and recent refinements to existing evidence based treatments, namely, the development of Cognitive-Behavioural self-help treatment manuals and their application in the treatment of Bulimic Eating Disorders. The potential benefits of Guided and Unguided Self-Help in overcoming barriers to care are outlined and research examining the efficacy of these approaches for the treatment of Bulimic Eating Disorders reviewed. Methodological limitations of previous research indicate that the clinical utility of these approaches, particularly for bulimia nervosa, are unclear. However, previous encouraging findings and the potential benefits of these approaches support further research into the wider evaluation of these approaches particularly in primary care settings. A trial in progress is outlined and the implications of positive findings for major stakeholders discussed.

Perceptions of Cognitive Behavioural Guided Self-Help Treatment for Bulimia Nervosa in Primary Care

2007 ◽  
Vol 15 (1) ◽  
pp. 23-40 ◽  
Author(s):  
Susan J. Banasiak ◽  
Susan J. Paxton ◽  
Phillipa J. Hay
Keyword(s):  
Primary Care ◽  
Bulimia Nervosa ◽  
Self Help ◽  
Cognitive Behavioural

scholarly journals Treatments for bulimia nervosa: a network meta-analysis

2018 ◽  
Vol 48 (16) ◽  
pp. 2629-2636 ◽  
Author(s):  
Eric Slade ◽  
Edna Keeney ◽  
Ifigeneia Mavranezouli ◽  
Sofia Dias ◽  
Linyun Fou ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Bulimia Nervosa ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Evidence Base ◽  
Wait List ◽  
Full Remission ◽  
Self Help ◽  
Cognitive Behavioural ◽  
End Of Treatment

AbstractBackgroundBulimia nervosa (BN) is a severe eating disorder that can be managed using a variety of treatments including pharmacological, psychological, and combination treatments. We aimed to compare their effectiveness and to identify the most effective for the treatment of BN in adults.MethodsA search was conducted in Embase, Medline, PsycINFO, and Central from their inception to July 2016. Studies were included if they reported on treatments for adults who fulfilled diagnostic criteria for BN. Only randomised controlled trials (RCTs) that examined available psychological, pharmacological, or combination therapies licensed in the UK were included. We conducted a network meta-analysis (NMA) of RCTs. The outcome analysed was full remission at the end of treatment.ResultsWe identified 21 eligible trials with 1828 participants involving 12 treatments, including wait list. The results of the NMA suggested that individual cognitive behavioural therapy (CBT) (specific to eating disorders) was most effective in achieving remission at the end of treatment compared with wait list (OR 3.89, 95% CrI 1.19–14.02), followed by guided cognitive behavioural self-help (OR 3.81, 95% CrI 1.51–10.90). Inconsistency checks did not identify any significant inconsistency between the direct and indirect evidence.ConclusionsThe analysis suggested that the treatments that are most likely to achieve full remission are individual CBT (specific to eating disorders) and guided cognitive behavioural self-help, although no firm conclusions could be drawn due to the limited evidence base. There is a need for further research on the maintenance of treatment effects and the mediators of treatment outcome.

Cognitive behaviour therapy for eating disorders

2012 ◽  
pp. 1298-1304
Author(s):  
Zafra Cooper ◽  
Rebecca Murphy ◽  
Christopher G. Fairburn
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Cognitive Behaviour Therapy ◽  
Behaviour Therapy ◽  
General Management ◽  
Not Otherwise Specified ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour

The eating disorders provide one of the strongest indications for cognitive behaviour therapy. This bold claim arises from the demonstrated effectiveness of cognitive behaviour therapy in the treatment of bulimia nervosa and the widespread acceptance that cognitive behaviour therapy is the treatment of choice. Cognitive behaviour therapy is also widely used to treat anorexia nervosa although this application has not been adequately evaluated. Recently its use has been extended to ‘eating disorder not otherwise specified’ (eating disorder NOS), a diagnosis that applies to over 50 per cent of cases, and emerging evidence suggests that it is just as effective with these cases as it is with cases of bulimia nervosa. In this chapter the cognitive behavioural approach to the understanding and treatment of eating disorders will be described. The data on the efficacy and effectiveness of the treatment are considered in the chapters on anorexia nervosa and bulimia nervosa (see Chapters 4.10.1 and 4.10.2 respectively), as is their general management.

scholarly journals Stepped care and cognitive–behavioural therapy for bulimia nervosa: randomised trial

2011 ◽  
Vol 198 (5) ◽  
pp. 391-397 ◽  
Author(s):  
James E. Mitchell ◽  
Stewart Agras ◽  
Scott Crow ◽  
Katherine Halmi ◽  
Christopher G. Fairburn ◽  
...  
Keyword(s):  
Bulimia Nervosa ◽  
Cognitive Behavioural Therapy ◽  
Relative Effectiveness ◽  
Randomised Trial ◽  
Behavioural Therapy ◽  
Individual Therapy ◽  
Stepped Care ◽  
Self Help ◽  
Treatment Conditions ◽  
Cognitive Behavioural

BackgroundThis study compared the best available treatment for bulimia nervosa, cognitive–behavioural therapy (CBT) augmented by fluoxetine if indicated, with a stepped-care treatment approach in order to enhance treatment effectiveness.AimsTo establish the relative effectiveness of these two approaches.MethodThis was a randomised trial conducted at four clinical centres (Clinicaltrials.gov registration number: NCT00733525). A total of 293 participants with bulimia nervosa were randomised to one of two treatment conditions: manual-based CBT delivered in an individual therapy format involving 20 sessions over 18 weeks and participants who were predicted to be non-responders after 6 sessions of CBT had fluoxetine added to treatment; or a stepped-care approach that began with supervised self-help, with the addition of fluoxetine in participants who were predicted to be non-responders after six sessions, followed by CBT for those who failed to achieve abstinence with self-help and medication management.ResultsBoth in the intent-to-treat and completer samples, there were no differences between the two treatment conditions in inducing recovery (no binge eating or purging behaviours for 28 days) or remission (no longer meeting DSM–IV criteria). At the end of 1-year follow-up, the stepped-care condition was significantly superior to CBT.ConclusionsTherapist-assisted self-help was an effective first-level treatment in the stepped-care sequence, and the full sequence was more effective than CBT suggesting that treatment is enhanced with a more individualised approach.

Integrated Care for Binge Eating and Other Eating Disorders

2017 ◽  
Author(s):  
Joel Yager ◽  
Philip S. Mehler ◽  
Eileen D. Yager ◽  
Alison R. Yager
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Adolescent Medicine ◽  
Care Practice ◽  
Levels Of Care

Binge eating disorder, bulimia nervosa, and anorexia nervosa, particularly milder cases, often go unrecognized and untreated in primary care practice settings. Eating disorders are frequently associated with shame, and masked by other prominent physical and psychiatric conditions that demand attention. Among adults, binge eating disorder, the most prevalent of the eating disorders, occurs with increasing frequency, in tandem with higher rates and degrees of obesity, across all age ranges, and in both genders. Bulimia nervosa and anorexia nervosa are more common in females, and although they are most often seen in pediatric and adolescent medicine practices cases, they are also seen in adult practice populations. This chapter describes pathways by which primary care practices can implement integrated and collaborative care treatment programs, likely to benefit large numbers of patients, and effectively coordinate with specialist levels of care, as necessary.

scholarly journals Advances in Diagnosis and Treatment of Anorexia Nervosa and Bulimia Nervosa*

1992 ◽  
Vol 37 (5) ◽  
pp. 309-315 ◽  
Author(s):  
Sidney H. Kennedy ◽  
Paul E. Garfinkel
Keyword(s):  
Substance Abuse ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Psychiatric Comorbidity ◽  
High Rate ◽  
Obsessive Compulsive ◽  
Related Disorder ◽  
Compulsive Disorder ◽  
Cognitive Behavioural

This paper reviews four areas of research into anorexia nervosa (AN) and bulimia nervosa (BN). First, in terms of diagnosis, the psychological concerns about weight and shape are now addressed in BN, bringing it more in line with the related disorder, anorexia nervosa. Second, studies of psychiatric comorbidity confirm the overlap between eating disorders and depression, obsessive compulsive disorder, substance abuse, and personality disorder. Nevertheless, there are reasons to accept the distinct qualities of each syndrome, and eating disorders are not merely a variant of these other conditions. Third, treatment advances in BN involve mainly cognitive-behavioural or interpersonal psycho-therapies and pharmacotherapies primarily with antidepressants. The effect of combining more than one approach is beginning to be addressed. Finally, outcome studies involving people with both AN and BN have shown that the disorders “cross over” and that both conditions have a high rate of relapse. A renewed interest in the treatment of AN is needed.

Walk Free: A Service for Panic and Phobia Sufferers

1995 ◽  
Vol 23 (2) ◽  
pp. 187-191
Author(s):  
Ian Hughes ◽  
Ken Russell ◽  
Steve Rollnick
Keyword(s):  
Social Phobia ◽  
Support Groups ◽  
Home Visiting ◽  
Behavioural Interventions ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Comprehensive Service ◽  
Common Problems ◽  
Cognitive Behavioural Interventions

Panic, social phobia and agoraphobia are common problems, for which cognitive-behavioural interventions are particularly suitable. Walk Free is a comprehensive service for such sufferers, incorporating assessment by psychologists, home visiting, self-help activities, and support groups. It has expanded rapidly within Cardiff, where there are now four Walk Free centres, and it has seen over 300 sufferers over a three-year period.

scholarly journals Formative Evaluation Prior to Implementation of a Brief Treatment for Posttraumatic Stress Disorder in Primary Care

2021 ◽  
Author(s):  
Sarah E. Valentine ◽  
Cara Fuchs ◽  
Natalya Sarkisova ◽  
Elyse A. Olesinski ◽  
A. Rani Elwy
Keyword(s):  
Primary Care ◽  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Formative Evaluation ◽  
Stress Disorder ◽  
Safety Net ◽  
Successful Implementation ◽  
Evidence Based ◽  
Primary Care Settings ◽  
Evidence Based Treatments

Abstract Background Successful implementation of evidence-based treatments for posttraumatic stress disorder (PTSD) in primary care may address treatment access and quality gaps by providing care in novel and less stigmatized settings. Yet, PTSD treatments are largely unavailable safety net primary care settings. We aimed to collect data on four potential influences on implementation, including the degree of less-than-best practices, determinants of the current practice, potential barriers and facilitators of implementation, and the feasibility of a proposed strategy for implementing a brief treatment for PTSD. Methods Our mixed-methods developmental formative evaluation (Stetler et al., 2006) was guided by the Consolidated Framework for Implementation Research (CFIR), including a) surveys assessing implementation climate and attitudes towards evidence-based treatments and behavioral health integration and b) semi-structured interviews to identify barriers and facilitators to implementation and need for intervention and system augmentation. Participants were hospital employee stakeholders (N = 22), including primary care physicians, integrated behavioral health clinicians, community wellness advocates, and clinic leadership. We examined frequency and descriptive data from surveys and conducted directed content analysis of interviews. We used a concurrent mixed-methods approach, integrating survey and interview data collected simultaneously using a joint display approach to inform implementation efforts. We utilized a primary care community advisory board (CAB) comprised of employee stakeholders to refine interview guides, and apply findings to the specification of a revised implementation plan. Results Stakeholders described strong attitudinal support, yet therapist time and capacity restraints are major PTSD treatment implementation barriers. Patient engagement barriers such as stigma, mistrust, and care preferences were also noted. Recommendations based on findings included tailoring the intervention to meet existing workflows, system alignment efforts focused on improving detection, referral, and care coordination processes, protecting clinician time for training and consultation, and embedding a researcher in the practice. Conclusions Our evaluation identified key factors to be considered when preparing for implementation of PTSD treatments in safety net integrated primary care settings. Our project also demonstrated that successful implementation of EBTs for PTSD in safety net hospitals necessitates strong stakeholder engagement to identify and mitigate barriers to implementation.

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