Benjamin Zimmer

The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis

Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM–IV) diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, and wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive–behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms.

CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa

Objective: Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). Method: In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. Results: At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. Conclusions: CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.

Cost-effectiveness of an internet-based aftercare intervention after inpatient treatment in a psychosomatic hospital.

Abstract Objective: The implementation of new interventions into routine care requires the demonstration of both their effectiveness and cost-effectiveness. Method: We explored the cost-effectiveness of an Internet-based aftercare program in addition to treatment as usual (CHAT) which was compared to treatment as usual (TAU) following inpatient treatment. Incremental cost-effectiveness ratios were calculated based on cost of the intervention, cost of outpatient treatment, and remission rates within 1 year after discharge from hospital. Results: Assuming a willingness-to-pay of an additional 14.87 € per treatment for every additional percent of remission, CHAT was cost-effective against TAU at a 95% level of certainty. Cost per remission equaled 2664.84 € in TAU and 1752.75 € in CHAT (34.2% savings). Conclusions: This is the first evidence that Internet-based aftercare may enhance long-term treatment outcome in a cost-effective way.

Effectiveness of an Internet-based preparation for psychosomatic treatment: Results of a controlled observational study.

OBJECTIVE Patients often have to sustain long waiting periods between the time they first apply for psychotherapy and the actual uptake of the treatment. To support patients who are on a wait-list for inpatient psychosomatic treatment an Internet-based preparatory treatment (VORSTAT) was developed. In a randomized controlled trial, VORSTAT proved to increase treatment motivation prior to intake and to accelerate the accommodation phase at the beginning of inpatient treatment. No impact of VORSTAT on inpatient treatment outcome was found. The aim of the present study was to investigate the effectiveness of VORSTAT after implementing the service into routine care. METHODS A large naturalistic observational study comparing VORSTAT participants (N=911) against non-participants (N=1721) was conducted. Propensity scores were used to control for potential confounding variables due to the non-randomized group allocation. Reliable improvement of self-reported impairment achieved during inpatient treatment was used as outcome measure. RESULTS VORSTAT participants showed higher rates of reliable improvement in physical impairment (50.8% vs. 44.9%), psychological impairment (41.2% vs. 29.9%), and social problems (22.3% vs. 15.2%). CONCLUSION An Internet-based preparation for psychotherapy is an effective approach to improve outcome of inpatient psychosomatic treatment.

Chat-und E-Mail-Brücke: Nachsorge nach stationärer Psychotherapie

In diesem Kapitel werden zwei internetbasierte Programme-Chat-und E-Mail-Brucke-zur Optimierung der integrierten psychosozialen Versorgung vorgestellt. Die Angebote wurden von der Forschungsstelle fur Psychotherapie in Zusammenarbeit mit der Panorama-Fachklinik fur Psychosomatik, Psychotherapeutische Medizin und Naturheilverfahren Scheidegg/Allgau konzipiert und entwickelt. Sie richten sich an Patienten, die nach ihrer Entlassung aus der stationaren Therapie eine Weiterbetreuung wahrend der kritischen Phase des Ubergangs von der Klinik in den Alltag (mit oder ohne ambulante Behandlung) wunschen.

The communication of chronically III patients in an internet chat for aftercare of inpatient psychosomatic treatment

AIM E-Health applications open new avenues for seamless care of patients with a chronic disease. This study examines the demand and the usage pattern of an Internet-assisted aftercare group-treatment following inpatient treatment. METHODS The analysis uses data from telephone interviews which were conducted 12 months after discharge. 168 study participants of the prospective controlled effectiveness study (73.7%) participated. The frequency and the time of beginning an outpatient psychotherapy are compared between controls and chat participants. Computerized text-analyses of the chat-scripts are used to examine the usage pattern of the chat-aftercare. Statements of the patients with chronic symptoms at the beginning and at the end of their chat participation are quoted for illustration of the contents of the group therapy sessions. RESULTS Patients with chronic course of illness utilize the online-based aftercare more frequently and more actively than patients with short durations of illness. Words indicating cognitive processes are used more frequently by chat participant with chronic illness. Chat participants with chronic course of illness who are receiving no additional outpatient psychotherapy, relapse considerably less frequently than controls without any psychotherapeutic support. CONCLUSION Patients with chronic course of illness use online aftercare treatment to sustainably improve their health status.

Cost-effectiveness of internet-based cognitive-behavioral treatment for bulimia nervosa: Results of a randomized controlled trial

OBJECTIVE To evaluate the cost-effectiveness of Internet-based cognitive-behavioral therapy for bulimia nervosa (CBT-BN) compared to face-to-face delivery of CBT-BN. METHODS This study is a planned secondary analysis of data from a randomized clinical trial. Participants were 179 adults (98% female, mean age = 28 years) meeting DSM-IV criteria for bulimia nervosa who were randomized to group face-to-face or group Internet-based CBT-BN for 16 sessions during 20 weeks. The cost-effectiveness analysis was conducted from a third-party payor perspective, and a partial societal perspective analysis was conducted to investigate cost-utility (ie, cost per gain in quality-adjusted life-years) and patient out-of-pocket travel-related costs. Net health care costs were calculated from protocol and nonprotocol health care services using third-party payor cost estimates. The primary outcome measure in the clinical trial was abstinence from binge eating and purging, and the trial start and end dates were 2008 and 2016. RESULTS The mean cost per abstinent patient at posttreatment was

CBT4BN versus CBTF2F: Comparison of online versus face-to-face treatment for bulimia nervosa☆

7,757 (95% confidence limit [CL],

Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial

4,515,

Therapieevaluation in der stationären Psychotherapie mit Web-AKQUASI

13,361) for face-to-face and