The Treatment of Bulimia Nervosa

1987 ◽  
Vol 21 (1) ◽  
pp. 5-15 ◽  
Author(s):  
Rosalyn A. Griffiths ◽  
Stephen W. Touyz ◽  
Philip B. Mitchell ◽  
Wendy Bacon

We review treatment approaches to bulimia nervosa, with particular emphasis on methodology and research design. The following treatments are considered: behaviour therapy, cognitive behaviour therapy, pharmacological treatment, group therapy, psychoanalytic psychotherapy, self-help and support groups, hypnosis and miscellaneous (family therapy and nutritional approaches). Several directions for future research and methodological recommendations are suggested.

Author(s):  
Nick Grey ◽  
Suzanne Byrne ◽  
Tracey Taylor ◽  
Avi Shmueli ◽  
Cathy Troupp ◽  
...  

This chapter explores goal-oriented practice across therapies: cognitive behaviour therapy (CBT), psychoanalytic psychotherapy, psychoanalytic child psychotherapy, interpersonal psychotherapy (IPT), humanistic and existential therapies, systemic family therapy, and online therapy. Each section gives an overview of the approach and sets out ways that goals are conceptualized, negotiated, and embedded. Examples are given to illustrate how goals are used. Differences are found across these approaches in the methods used to negotiate goals, and the extent that these are made explicit and embedded in the work. Greater similarities are found in the use of goals in CBT and IPT, compared with the less directive modalities of humanistic, psychodynamic, and systemic psychotherapies. Differences are also found within modalities (e.g. psychoanalytic psychotherapy for adults versus psychoanalytic child psychotherapy). However, the chapter demonstrates the many similarities in the use of goals as a common factor across these different therapeutic approaches.


Author(s):  
Zafra Cooper ◽  
Rebecca Murphy ◽  
Christopher G. Fairburn

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.


Autism ◽  
2020 ◽  
Vol 24 (4) ◽  
pp. 867-883 ◽  
Author(s):  
Sebastian B Gaigg ◽  
Paul E Flaxman ◽  
Gracie McLaven ◽  
Ritika Shah ◽  
Dermot M Bowler ◽  
...  

Anxiety in autism is an important treatment target because of its consequences for quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can ameliorate anxiety in autism but cost-effective delivery remains a challenge. This pilot randomised controlled trial examined whether online cognitive behaviour therapy and mindfulness-based therapy self-help programmes could help reduce anxiety in 54 autistic adults who were randomly allocated to either an online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme or a waitlist control group (n = 19). Primary outcome measures of anxiety, secondary outcome measures of broader well-being and potential process of change variables were collected at baseline, after programme completion, and then 3 and 6 months post-completion. Baseline data confirmed that intolerance of uncertainty and emotional acceptance accounted for up to 61% of self-reported anxiety across all participants. The 23 participants who were retained in the active conditions (14 mindfulness-based therapies, 9 cognitive behaviour therapies) showed significant decreases in anxiety that were maintained over 3, and to some extent also 6 months. Overall, results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools may provide a cost-effective method for delivering mental health support to those autistic adults who can engage effectively with online support tools. Lay abstract Anxiety in autism is an important target for psychological therapies because it is very common and because it significantly impacts upon quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can help autistic individuals learn to manage feelings of anxiety but access to such therapies remains problematic. In the current pilot study, we examined whether existing online cognitive behaviour therapy and mindfulness-based therapy self-help tools can help reduce anxiety in autistic adults. Specifically, 35 autistic adults were asked to try either an existing online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme while a further 19 autistic adults served as a waitlist comparison group. A first important finding was that 23 of the 35 (66%) participants who tried the online tools completed them, suggesting that such tools are, in principle, acceptable to many autistic adults. In addition, adults in the cognitive behaviour therapy and mindfulness-based therapy conditions reported significant decreases in anxiety over 3 and to some extent also 6 months that were less apparent in the waitlist group of participants. On broader measures of mental health and well-being, the benefits of the online tools were less apparent. Overall, the results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools should be explored further as a means of providing cost-effective mental health support to at least those autistic individuals who can engage effectively with such online tools.


2013 ◽  
Vol 30 (1) ◽  
pp. 12-23 ◽  
Author(s):  
Barry Tolchard ◽  
Malcolm W. Battersby

Cognitive-Behaviour Therapy (CBT) is considered the number one non-pharmacological treatment for a number of mental and psychological disorders (Tolin, 2010; Stuhlmiller & Tolchard, 2009). While CBT with problem gamblers has shown promise, the quality of the research in this area is lacking. One area of concern is that across the many trials and reports using CBT with gamblers no single unified approach has been used and so comparison across studies is limited. Similarly, translation of the CBT research into clinical practice is almost entirely absent (Walker, 2005). This article will explore the concepts of CBT with problem gamblers and identify common elements across all reported approaches. A unified model of CBT with problem gamblers will be suggested and the direct clinical application of this model described from a state-wide gambling service in Australia (Flinders Approach) with 205 problem gamblers. The results indicate that the Flinders Approach is successful in treating gamblers considered to be at the severest end of the experience, with a 69% completion rate. Implications for future research in which this model may be tested against other therapies and pharmacological treatments will be discussed.


2011 ◽  
Vol 4 (3) ◽  
pp. 89-100 ◽  
Author(s):  
Derek L. Milne ◽  
Robert P. Reiser

AbstractGovernment policy, like evaluations of clinical practice, indicates the growing importance of supervision in fostering practitioner development and in improving the fidelity of therapies. However, instruments with which to measure competent supervision are often problematic, thereby hampering these key activities (e.g. they are rare, rely on self-ratings by participants, and psychometric data can be limited). To contribute to progress, this paper reviews the current options for measuring competent clinical supervision by means of direct observation, a favoured approach within cognitive behaviour therapy (CBT). We systematically reviewed 10 existing instruments that were designed to observe and quantify competent supervision, focusing on three broad criteria for sound measurement (i.e. an instrument's Design, Implementation, and Yield: DIY). Suggestions for future research on instruments that can fulfil the functions that are provided distinctively through direct observation are outlined.


2015 ◽  
Vol 20 (2) ◽  
pp. 54-64 ◽  
Author(s):  
Caroline Jennings ◽  
Olivia Hewitt

Purpose – Cognitive behaviour therapy (CBT) is currently one of the recommended treatments for depression for the general population and guidance recommends that people with a learning disability should have access to the same treatments as people without a learning disability. The purpose of this paper is to identify, outline and evaluate current research on the effectiveness of CBT for depression for people with a learning disability. The clinical, service and research implications are considered. Design/methodology/approach – A systematic search was conducted and five relevant articles were identified for critical review. Findings – There is a limited but promising evidence base for the use of CBT for depression with people with learning disabilities. Research limitations/implications – The current review identified a number of methodological issues and future research should attempt to overcome these (e.g. small sample sizes and lack of controls). In particular, research should focus on determining the relative contribution of cognitive and behavioural techniques in producing a change in depressive symptoms. Practical implications – Services (including those provided as part of Improving Access to Psychological Therapies) should be offering CBT-based interventions for people with learning disabilities who are experiencing depression. Originality/value – This paper provides a comprehensive and up to date review of the current literature regarding the use of CBT for depression for people with a learning disability. This will be of value to clinicians working with people with a learning disability as well as those commissioning services.


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