John A. Schneider

Group cognitive-behavioral therapy and group interpersonal psychotherapy for the nonpurging bulimic individual : a controlled comparison

Abstract This study evaluated the effectiveness of group cognitive-behavioral treatment (CBT) and group interpersonal psychotherapy (IPT) for binge eating. Fifty-six women with nonpurging bulimia were randomly assigned to 1 of 3 groups: CBT, IPT, or a wait-list control (WL). Treatment was administered in small groups that met for 16 weekly sessions. At posttreatment, both group CBT and group IPT treatment conditions showed significant improvement in reducing binge eating, whereas the WL condition did not. Binge eating remained significantly below baseline levels for both treatment conditions at 6-month and 1-year follow-ups. These data support the central role of both eating behavior and interpersonal factors in the understanding and treatment of bulimia.

Cognitive-Behavioral and Response-Prevention Treatments for Bulimia Nervosa.

This study was designed to assess the additive effects of major components of cognitive-behavioral treatment for bulimia nervosa. Seventy-seven female patients with bulimia nervosa were allocated at random to one of four conditions: wait-list control, self-monitoring of caloric intake and purging behaviors, cognitive-behavioral treatment, and cognitive-behavioral treatment combined with response prevention of vomiting. In the treatment conditions, participants were seen individually for fourteen 1-hr sessions over a 4-month period. All the treatment groups showed significant improvement, whereas the wait-list control group did not. Cognitive-behavioral treatment was, however, the most successful in reducing purging and in promoting positive psychological changes. Fifty-six percent of participants in this condition ceased binge eating and purging by the end of treatment, and the frequency of purging declined by 77.2% during the same period. Of the three treatment conditions, only cognitive-behavioral treatment was superior to the wait-list control. At the 6-month follow-up, 59% of the cognitive-behavioral group were abstinent, and purging had declined by 80%. Cognitive-behavioral treatment was significantly superior to the other treatment groups at this time. Thus, the addition of response prevention of vomiting did not enhance the efficacy of cognitive-behavioral treatment, and the evidence suggests that it may have had a deleterious effect.

Cluster B personality disorder characteristics predict outcome in the treatment of bulimia nervosa

The Personality Disorders Examination (PDE) was administered to 71 bulimia nervosa patients at baseline assessment in a study comparing the effectiveness of cognitive-behavioral treatment with desipramine or the combination of both treatments. Personality disorder subscales were combined into single DSM-III-R cluster scores. A high cluster B score (consisting of antisocial, borderline, histrionic, and narcissistic features) significantly predicted poor outcome at 16 weeks and was a better predictor of outcome than borderline personality characteristics alone or any other DSM-III-R cluster score or combination of cluster scores. In contrast pretreatment depression level, self-esteem, degree of dietary restraint, frequency of purging, and history of anorexia nervosa were not significantly related to outcome. At 1-year follow-up there was still a trend toward high cluster B scores predicting poor treatment outcome. Cluster B score was not significantly correlated with percentage of sessions attended nor did subjects with higher cluster B scores have a better outcome with either specific treatment. These results suggest that further investigation of alternative treatments is warranted with high cluster B individuals to determine if treatment effectiveness can be improved.

Bulimia in males: a matched comparison with females

The clinical characteristics of 15 male and 15 female bulimics matched as to age, duration of bulimia, and frequency of self-induced vomiting are compared. All subjects were given an extensive interview and psychometric evaluations to measure depression, anxiety, assertiveness, and attitudes about food and eating. Male subjects had relatively higher current and past weights, greater weight fluctuations, and more realistic perceptions about desired ideal weight than the women. Males also used fewer weight controls, such as laxatives, diet pills, and restrictive eating, but reported more present and past problems with drugs and alcohol. A statistically significant difference was found between men and women on marriage and sexual preference, with more women being married and more men reporting a homosexual or bisexual preference. Men and women scored similarly on psychometric measures. The findings are discussed in terms of differing sociocultural demands for men and women.

Gender, sexual orientation, and disordered eating

Abstract While most patients with bulimia nervosa are heterosexual women, a significant number of men with bulimia nervosa are gay males, suggesting that gay men, more than heterosexual men, may be at risk for developing eating disorders. This study compared the food-related attitudes and behaviors of heterosexual men and women in contrast with those of lesbians and gay men, attempting to find whether ones sexual orientation may contribute to differential risk. Two thousand employees were randomly selected from a large health care corporation, of whom 805 returned a completed questionnaire including Stunkard and Messicks (1985) Dietary Restraint and Disinhibition Scales. A stratified random sample was drawn to include demographically comparable groups of 25 lesbians, 50 gay men, 75 heterosexual women, and 75 heterosexual men. Women were less satisfied with their appearance at their present weight and expressed more restraint and more negative feelings after bingeing than did men. Heterosexual women were...

The role of perceived self-efficacy in recovery from bulimia: a preliminary examination

Abstract The relationship between change in purging behavior accompanying cognitive-behavioral treatment for bulimia and enhancement of perceived self-regulatory efficacy was assessed for several efficacy domains. Treatment effected enhancement of perceived self-efficacy in several domains, including refraining from binge eating in various situations and mood states, using stimulus-control techniques and alternative activities, and developing satisfactory social relationships. Increases in self-efficacy were associated with decreases in vomiting frequency in the following domains: self-efficacy to control binge eating while in various mood states, to control eating patterns using stimulus-control techniques, and the acceptance of current body shape and the need for larger clothing. While perceived self-efficacy in the first two domains increased as a result of treatment, it did not in the third. A prospective analysis revealed a near-significant correspondence between efficacy predictions for controlling bulimic behavior in various moods and later binge eating in those moods.

Comparing the cost effectiveness of psychiatric treatments: bulimia nervosa

We conducted an exploratory post hoc study that compared the cost effectiveness of five treatments for bulimia nervosa: 15 weeks of cognitive behavioral therapy (CB) followed by three monthly sessions, 16 weeks (Med16) and 24 weeks (Med24) of desipramine (< or = 300 mg/day), and CB combined with desipramine for those durations (Combo16 and Combo24). We illustrate how a treatments cost effectiveness varies according to when evaluation is done and how effectiveness and cost are defined. At 32 weeks, Med16 appears the most cost-effective treatment, and Combo16 appears the least. At 1 year, Med24 appears the most cost-effective treatment, and Combo16 appears the least. Using this post hoc analysis as an example, we discuss the pitfalls and limitations of cost-effectiveness analysis of psychiatric treatments.

Cognitive-behavioral treatment with and without exposure plus response prevention in the treatment of bulimia nervosa: a reply to Leitenberg and Rosen.

In this reply to Leitenberg and Rosen (1989), we conclude that the evidence that response prevention of vomiting adds significantly to the efficacy of cognitive-behavioral treatment of bulimia nervosa is not strong. In this context and given the finding in our previous study (Agras, Schneider, Arnow, Raeburn, & Telch, 1989) that the addition of response prevention did not increase the efficacy of cognitive-behavioral treatment and may have reduced it, we believe that our cautionary note concerning the addition of response prevention to cognitive-behavioral treatment should stand.

Relaxation training in essential hypertension: A failure of retraining in relaxation procedures

Twenty-two participants in a large-scale controlled outcome study of the effects of relaxation training in essential hypertension, who showed substantial initial blood pressure lowering followed by a return toward baseline values, were randomly allocated either to retraining in the relaxation procedures or to routine follow-up care. While retraining was associated with reductions in blood pressure, these changes were not significantly different from those receiving only routine follow-up. Unobtrusive measures suggested that participants complied with home practice instructions. Thus, we conclude that retraining in relaxation procedures is no more effective in producing blood pressure lowering than routine booster sessions, and that attention should be given to relapse prevention rather than retraining after relapse.

Interpersonal behavior and cardiovascular reactivity in pharmacologically-treated hypertensives

This study examined the interpersonal behavior and concomitant cardiovascular reactivity (CVR) of hypertensive patients whose resting blood pressure was controlled by antihypertensive medication. Thirty hypertensive and 30 normotensive subjects matched for age, sex and occupational status were recruited from an industrial setting. The groups were compared on measures of interpersonal behavior, blood pressure and heart rate while they engaged in both role-played (RP) and naturalistic interactions (NI) requiring positive and negative assertion. Interpersonal behavior of the groups was generally similar, with two exceptions: hypertensives made fewer requests for new behavior in the negative RP and verbalized more praise statements in the positive NI. There were no differences between the groups on measures of CVR during interpersonal interactions. Overall effectiveness during scenes requiring negative assertion was associated with increased cardiovascular reactivity, especially for hypertensives. The interpersonal behavior and cardiovascular responses of patients taking beta-blocker medication did not differ from those taking diuretics. These findings are discussed with regard to methodological considerations pertinent to the assessment of interpersonal behavior and the issue of heterogeneity among hypertensives.