scholarly journals Case Report: Unexpected Remission From Extreme and Enduring Bulimia Nervosa With Repeated Ketamine Assisted Psychotherapy

2021 ◽  
Vol 12 ◽  
Author(s):  
Anya Ragnhildstveit ◽  
Laura Kate Jackson ◽  
Sarah Cunningham ◽  
Linda Good ◽  
Quinn Tanner ◽  
...  
Keyword(s):  
Bulimia Nervosa ◽  
Binge Eating ◽  
Psychosocial Functioning ◽  
Behavioral Treatment ◽  
Behavioral Therapy ◽  
Premature Mortality ◽  
Chronically Ill ◽  
Future Research ◽  
Sustained Remission ◽  
Individual Level

Background: Bulimia nervosa is a disabling psychiatric disorder that considerably impairs physical health, disrupts psychosocial functioning, and reduces overall quality of life. Despite available treatment, less than half of sufferers achieve recovery and approximately a third become chronically ill. Extreme and enduring cases are particularly resistant to first-line treatment, namely antidepressants and cognitive behavioral therapy, and have the highest rate of premature mortality. Here, we demonstrate that in such cases, repeated sessions of ketamine assisted psychotherapy (KAP) is an effective treatment alternative for improving symptoms.Case Presentation: A 21-year-old woman presented with extreme and enduring bulimia nervosa. She reported recurrent binge-eating and purging by self-induced vomiting 40 episodes per day, which proved refractory to both pharmacological and behavioral treatment at the outpatient, residential, and inpatient level. Provided this, her physician recommended repeated KAP as an exploratory and off-label intervention for her eating disorder. The patient underwent three courses of KAP over 3 months, with each course consisting of six sessions scheduled twice weekly. She showed dramatic reductions in binge-eating and purging following the first course of treatment that continued with the second and third. Complete cessation of behavioral symptoms was achieved 3 months post-treatment. Her remission has sustained for over 1 year to date.Conclusions: To our knowledge, this is the first report of repeated KAP used to treat bulimia nervosa that led to complete and sustained remission, a rare outcome for severe and enduring cases, let alone extreme ones. Additionally, it highlights the degree to which KAP can be tailored at the individual level based on symptom severity and treatment response. While its mechanism of action is unclear, repeated KAP is a promising intervention for bulimia nervosa that warrants future research and clinical practice consideration.

Cognitive–Behavioral Treatment of Depression in Men

2014 ◽  
Vol 9 (2) ◽  
pp. 94-102 ◽  
Author(s):  
Jason S. Spendelow
Keyword(s):  
Help Seeking ◽  
Behavioral Treatment ◽  
Behavioral Therapy ◽  
Empirical Support ◽  
Cognitive Behavioral ◽  
Public Health Issue ◽  
Future Research ◽  
Cognitive Behavioral Treatment ◽  
Negative Effects ◽  
Recommended Treatment

Depression is a significant public health issue and many researchers have suggested that modifications to conventional cognitive–behavioral therapy (CBT) are required to address infrequent help-seeking in men and counter negative effects of traditional masculinity on therapeutic engagement. This narrative review summarizes recommended alterations to CBT in the areas of therapeutic setting, process, and content. Key themes from this literature include a focus on behavioural interventions, and harmful cognitions that orginate from the traditional male gender stereotype. This literature is marked by limited empirical support for many of the recommended treatment modifications, and several options for future research are outlined.

scholarly journals Micro-level de-coupling of negative affect and binge eating in relationship to macro-level outcomes in binge eating disorder treatment

2020 ◽  
pp. 1-9
Author(s):  
Kathryn E. Smith ◽  
Tyler B. Mason ◽  
Lauren M. Schaefer ◽  
Lisa M. Anderson ◽  
Vivienne M. Hazzard ◽  
...  
Keyword(s):  
Emotion Regulation ◽  
Eating Disorder ◽  
Negative Affect ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Behavioral Treatment ◽  
Future Research ◽  
End Of Treatment ◽  
Pre Treatment

Abstract Background While negative affect reliably predicts binge eating, it is unknown how this association may decrease or ‘de-couple’ during treatment for binge eating disorder (BED), whether such change is greater in treatments targeting emotion regulation, or how such change predicts outcome. This study utilized multi-wave ecological momentary assessment (EMA) to assess changes in the momentary association between negative affect and subsequent binge-eating symptoms during Integrative Cognitive Affective Therapy (ICAT-BED) and Cognitive Behavior Therapy Guided Self-Help (CBTgsh). It was predicted that there would be stronger de-coupling effects in ICAT-BED compared to CBTgsh given the focus on emotion regulation skills in ICAT-BED and that greater de-coupling would predict outcomes. Methods Adults with BED were randomized to ICAT-BED or CBTgsh and completed 1-week EMA protocols and the Eating Disorder Examination (EDE) at pre-treatment, end-of-treatment, and 6-month follow-up (final N = 78). De-coupling was operationalized as a change in momentary associations between negative affect and binge-eating symptoms from pre-treatment to end-of-treatment. Results There was a significant de-coupling effect at follow-up but not end-of-treatment, and de-coupling did not differ between ICAT-BED and CBTgsh. Less de-coupling was associated with higher end-of-treatment EDE global scores at end-of-treatment and higher binge frequency at follow-up. Conclusions Both ICAT-BED and CBTgsh were associated with de-coupling of momentary negative affect and binge-eating symptoms, which in turn relate to cognitive and behavioral treatment outcomes. Future research is warranted to identify differential mechanisms of change across ICAT-BED and CBTgsh. Results also highlight the importance of developing momentary interventions to more effectively de-couple negative affect and binge eating.

Cognitive-Behavior Therapy With Eating Disorders: The Role of Medications in Treatment

2007 ◽  
Vol 21 (1) ◽  
pp. 16-27 ◽  
Author(s):  
Wayne A. Bowers ◽  
Arnold E. Andersen
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Cognitive Behavioral Therapy ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Behavioral Therapy ◽  
Combined Treatment ◽  
Comprehensive Treatment

Cognitive-behavioral therapy has demonstrated efficacy in the treatment of bulimia nervosa, but there is less empirical data on its usefulness with anorexia nervosa or binge-eating disorder. The use of cognitive-behavioral therapy (CBT) is recommended as the first line of treatment for bulimia nervosa and strongly recommended in combination when medications alone have not been effective. Combined treatment also improves symptoms such as anxiety, depression, and dietary restriction. Empirical studies support the usefulness of CBT with binge-eating disorder and suggest higher remission rates with combined treatment. No single psychotherapy or medicine alone is effective in treating anorexia nervosa. CBT is typically used as part of a comprehensive treatment program with nutritional rehabilitation and prudent use of medication. Both CBT and medication may have benefits in maintaining gains for anorexia nervosa patients after inpatient treatment. More research on CBT alone and in combination with medication is needed to adequately understand the respective roles of these therapies in a comprehensive treatment of eating disorders.

Treatments for Eating Disorders

2015 ◽  
Author(s):  
Kathleen M. Pike ◽  
Loren M. Gianini ◽  
Katharine L. Loeb ◽  
Daniel Le Grange
Keyword(s):  
Eating Disorders ◽  
Weight Loss ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Evidence Based Treatments ◽  
Substantial Progress

Substantial progress in advancing evidence-based treatments for eating disorders has been made. Many well-designed studies provide cumulative support for cognitive-behavioral therapy (CBT) as the treatment of choice for bulimia nervosa. Interpersonal psychotherapy (IPT) and pharmacotherapy are considered appropriate alternative treatments for bulimia nervosa. While CBT, IPT and pharmacotherapy often produce significant reductions in binge eating and compensatory behaviors, these treatment options need to be improved to help more individuals achieve full and lasting recovery. In the treatment of binge eating disorder, CBT and IPT have been shown to be the most efficacious in reducing symptoms and improving psychological outcomes. Weight loss is often an additional goal of those entering treatment for binge eating disorder; however, existing treatments have generally been unsuccessful in producing significant maintainable weight loss. Initial studies suggest that CBT may be associated with improved outcome both in the acute and maintenance phases of treatment for anorexia nervosa.

Psychopharmacology in the Treatment of Eating Disorders

2018 ◽  
pp. 384-403
Author(s):  
Lindsay J. Moskowitz ◽  
Benson Ku ◽  
Shervin Shadianloo ◽  
Victor M. Fornari
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Behavioral Therapy ◽  
Mood Stabilizers ◽  
United States Food ◽  
Family Based

Given the high morbidity and mortality rates associated with eating disorders (EDs), many studies have examined the use of medications to treat these disorders. However, with the exception of fluoxetine (for those 12 years and older with bulimia nervosa) and lisdexamfetamine (for adults with moderate-to-severe binge eating disorder), no other medications have been approved by the United States Food and Drug Administration to treat any eating disorder. This article will review many of the positive and negative studies for use of medication in the treatment of eating disorders, including anorexia nervosa, bulimia nervosa, atypical anorexia nervosa, avoidant/restrictive food intake disorder, and binge eating disorder. Various classes of medication will be reviewed, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics. Although the information in this article is important in the education of both patients and their parents, medications should be used cautiously in those with EDs. It should be emphasized that to date, therapy—family-based therapy and enhanced cognitive behavioral therapy—is the mainstay of treatment, with nutrition therapy and correction of malnutrition as the crucial first step in treatment.

Cognitions in Anorexia Nervosa: Changes at Discharge From a Cognitive Therapy Milieu Inpatient Treatment Program

2000 ◽  
Vol 14 (4) ◽  
pp. 393-401 ◽  
Author(s):  
Wayne A. Bowers ◽  
Lynn S. Ansher
Keyword(s):  
Anorexia Nervosa ◽  
Bulimia Nervosa ◽  
Cognitive Therapy ◽  
Inpatient Treatment ◽  
Cognitive Distortions ◽  
Behavioral Therapy ◽  
Cognitive Change ◽  
Future Research ◽  
Negative Cognitions ◽  
Before And After

Cognitive-behavioral therapy (CBT) has been effective in the treatment of various disorders including bulimia nervosa. However, little is known about the effectiveness of CBT on treatment of anorexia nervosa. Thirty-two patients were treated for anorexia nervosa on an inpatient unit. They were evaluated before and after treatment by three measures assessing negative cognitions. The unit milieu was designed to use cognitive therapy principles with CBT being administered primarily in groups, supplemented with individual sessions. At discharge all patients had displayed significant cognitive change in their disorder. Also, at time of discharge, this group of patients had significant changes in their schemas and cognitive distortions consistent with a cognitive therapy perspective. Future research is needed to identify the effect of CBT on anorexia nervosa within a wide variety of treatment settings.

Cognitive Behavioral Therapy for Anxiety and Fear in Pediatric Pain Contexts

2017 ◽  
Vol 31 (1) ◽  
pp. 41-56 ◽  
Author(s):  
C. Meghan McMurtry ◽  
Rachel M. Tomlinson ◽  
Lara M. Genik
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Treatment ◽  
Behavioral Therapy ◽  
Evidence Base ◽  
Cognitive Behavioral ◽  
Future Research ◽  
Cognitive Behavioral Treatment ◽  
Case Examples ◽  
Acute Form ◽  
Inflammatory Bowel

Pain is a highly prevalent experience in pediatric medical populations, both in an acute form (e.g., iatrogenic pain from needle procedures) as well as in more chronic forms (e.g., as a result of arthritis, inflammatory bowel disease, or as a disease/disorder in and of itself). Guided by the biopsychosocial model, the overarching objective of this work is to examine cognitive behavioral treatment of anxiety in pain contexts. Specific aims are to (a) provide a brief overview of anxiety in youth with a high fear of needles and those experiencing chronic pain, (b) review the evidence base for cognitive behavioral therapy (CBT) for these populations, (c) outline considerations for implementing CBT-based approaches, and (d) provide two case examples which illustrate the application of CBT in these contexts. Brief concluding remarks include suggestions for future research such as improved screening and treatment of comorbid anxiety in the context of pain.

scholarly journals Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Bulimia nervosa and Binge-eating disorder: Pilot Single-Arm Trial (Preprint)

2019 ◽  
Author(s):  
Sayo Hamatani ◽  
Noriko Numata ◽  
Kazuki Matsumoto ◽  
Chihiro Sutoh ◽  
Hanae Ibuki ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Cognitive Behavioral Therapy ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Real Time ◽  
Binge Eating Disorder ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Secondary Outcomes ◽  
Therapist Support

BACKGROUND A major problem in providing mental health services is the lack of access to treatment, especially in remote areas. Thus far, no clinical studies have demonstrated the feasibility of Internet-based cognitive behavioral therapy (ICBT) with real-time therapist support via videoconference for bulimia nervosa (BN) and binge-eating disorder (BED) at the same time in Japan. OBJECTIVE To evaluate the feasibility of ICBT via videoconference for patients with BN or BED. METHODS Five Japanese subjects (mean age 35.4 ± 9.2 years) with BN and BED received 16 weekly sessions of individualized ICBT via videoconference with real-time therapist support. Treatment included CBT tailored specifically to the presenting diagnosis. The primary outcome was a reduction in the Eating Disorder Examination interview-16 (EDE 16) for BN and BED: the combined objective binge and purging episodes; objective binge episodes; purging episodes. The secondary outcomes were the EDE-Q, the Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, the Motivational Ruler for motivation to change, the EuroQol-5 Dimension for quality of life, the Patient Health Questionnaire-9 for depression, the Generalized Anxiety Disorder questionnaire-7 for anxiety, and the Working Alliance Inventory-Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and at weeks 8 (mid intervention), and 16 (post intervention) during therapy. Patients were asked about adverse events at each session. For the primary analysis, treatment-related changes were assessed by comparing participant scores and the 95% confidence intervals using the paired t-test. RESULTS Although the mean combined objective binge episodes and purging episodes improved from 47.60 to 13.60 (71% reduction) and showed a medium effect size (Cohen’s d, -0.76), there was no significant reduction in the combined these episodes (EDE 16D, -41; 95% confidence interval -2.089, 0.576; P = 0.17). There were no significant treatment-related changes in the secondary outcomes. The WAI-SF scores remained consistently high (64.8–66.0) during treatment. CONCLUSIONS ICBT via videoconference is feasible in Japanese patients with BN and BED. CLINICALTRIAL UMIN000029426

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