RUNNING HEADER: Integrative Review of CBT 1

Integrative Review of Cognitive Behavioral Therapy in

Adolescents with Eating Disorders

Haley Mosman

November 20, 2016

Nursing Research 4122

I Pledge
Integrative Review of CBT 2

Abstract

Eating disorders are significant psychiatric illnesses that affect many children and

adolescents and can have profound effects on physical and psychosocial health. Various therapies

are available for treatment, including different psychotherapies and medications. This integrative

review aimed to evaluate the literature available that pertains to adolescents with eating disorders

who undergo cognitive behavioral therapy. The EBSCO and PubMed databases were used to find

relevant literature. The initial search resulted in 2,135 articles. Five were selected because they

adequately addressed the authors specific criteria. Ultimate findings demonstrated that cognitive

behavioral therapy is an acceptable therapy for adolescents suffering from eating disorders.

Limitations to this research include the authors lack of experience and the lack of research about

CBT and adolescent eating disorders. Future research should aim to compare tradition therapies

for eating disorders and CBT.

Integrative Review of CBT 3

Introduction & Background

Eating disorders of any variety are significant disorders that can have long-term physical

and psychological effects. These disorders involve obsessions with food, body weight and/or

shape, and loss of control (Eating Disorders, 2016). One population that is most vulnerable to

succumbing to eating disorders is the adolescent population. The National Institute of Mental

Health (NIMH) reports that 2.7% of all adolescents in the US suffer from some form of an eating

disorder and that adolescent females are 2.5 times more likely to develop an eating disorder than

their male counterparts. Various therapies are available as treatment options, one of which is

cognitive behavioral therapy (CBT).

CBT is a short-term psychotherapy that addresses a patients cognitive processes of

dealing with emotional issues. The goal is to change a persons pattern of thinking or behavior to

change attitude and way of thinking. While CBT has been studied extensively in adults and in

adolescents with anxiety and depression issues, it has not been aggressively pursued in the

population of adolescents with eating disorders. The aim of this integrative review was to

compile and evaluate the literature pertaining to the authors PICO question: what are the effects

of CBT on adolescents with eating disorders? The author chose to research this topic after

observing a close acquaintances struggle with anorexia nervosa.

Design & Search Methods

This integrative review evaluated five journal articles. The author utilized the EBSCO

and PubMed databases to find journal articles relating to the PICO question. Specific terms were

limited to CBT, cognitive behavioral therapy, adolescents, eating disorder, and eating

disorders. The author did not limit the search to one specific eating disorder as there was not

enough literature for the effect of CBT on specific eating disorders in adolescents. The PubMed
Integrative Review of CBT 4

database resulted in 20 articles while the search in the EBSCO database resulted in 2,115 articles.

It was noted that the EBSCO database highlighted many results that did not pertain to the

authors topic and PICO question.

Limits were furthered implemented to obtain quality research. Articles had to be peer-

reviewed and published between 2011 and 2016. The author of this integrative review also

limited the search to those articles only published in English. The author was able to select five

articles that met the criteria and were pertinent to the PICO question. All five articles chosen

were quantitative studies.

Findings & Results

The findings and results of this integrative review indicate that CBT is an effective,

reliable treatment for adolescents suffering from a spectrum of eating disorders. The research

articles are summarized in Table 1. The findings and results of the effects of CBT on adolescents

were organized as follows: Binge Eating Disorder (BED), Anorexia Nervosa (AN), and Bulimia

Nervosa (BN).

Binge Eating Disorder (BED)

Two of the studies reviewed the effects of CBT on adolescent who suffered from BED

(Grave et al., 2015; DeBar et al., 2013).

Grave et al. (2015) set out to examine the effects of CBT on adolescents with BED who

were not underweight. This study was a quasi-experimental cohort study of 68 adolescents.

Participants had to be between the ages of 13-19 years, have a BMI greater than or equal to 18.5,

and fulfill DSM-IV criteria for a binge eating disorder. Patients underwent 20 sessions of CBT

administered by three specially trained psychologists over 20 weeks. Participants were divided

into two separate groups: completers and non-completers. Completers finished the full 20
Integrative Review of CBT 5

sessions while non-completers did not. Data was assessed at two points in both groups: before

CBT was initiated and after the 20 sessions of CBT. Body weight and BMI were measured using

appropriate tools. A self-report questionnaire, EDE-Q, was used to examine the severity of eating

disorders.

Overall, participants experienced a decrease in the frequency of binge eating habits. 75%

of participants completed the full 20 sessions of CBT. 67.6% of participants had minimal eating

disorder psychopathology once the 20 session of CBT were completed. This study showed that

CBT is a valid treatment option for adolescents dealing with binge eating disorders.

DeBar et al. (2013) performed a randomized trial with the aim of developing and testing

CBT that was specific to adolescents with BED. Participants had to be between the ages of 12-18

years and have experience binge eating episodes once a week for the last 3 months. 26 patients

were recruited and randomized into two separate groups. The first group received cognitive

behavioral therapy while the second group was treatment as usual/delayed treatment (TAU-DT).

The CBT treatment consisted of 8 core sessions that focused on different topics related to healthy

eating habits and binging, followed by 4 optional sessions. TAU-DT participants received CBT

treatment at a later time.

Participants were assessed at baseline, 3 months after randomization, and 6 months after

randomization. All were assessed using EDE, Beck Depression Inventory, Screen for Child

Anxiety Related Emotional Disorders, and a self-report satisfaction questionnaire. DeBar et al.

(2013) found that the CBT participants had an abstinence from binging rate of 92.3% at the 3-

month check while the TAU-DT participants only had a 30% abstinence from binging rate. At the

12-month check, both groups had improved abstinence rates, with the CBT group at 100% and

the TAU-DT group at 50%. However, once CBT was initiated in the TAU-DT group, there was a
Integrative Review of CBT 6

75% abstinence rate at the 3 month check mark. This study demonstrates that CBT is an effective

treatment for adolescents with binge eating disorders.

Anorexia Nervosa (AN)

Two studies looked into the effectiveness of CBT in adolescent with anorexia nervosa:

Grave et al. (2014) and Cowdrey et al. (2016).

Grave et al. (2014) hoped to use a modified CBT method to improve outcomes and

reduce relapse in adolescents with AN. The study was quasi-experimental cohort study of

adolescents with AN. 27 patients were recruited who met the study criteria of being between the

ages of 13-17 years, meeting DSM-IV criteria for AN, and having previously failed outpatient

treatment for AN. Participants underwent 20 weeks of CBT, which was delivered by a trained

psychologist.

Various data points were assessed before and after treatment, at 6-month and 12-month

follow-ups. These points included weight, height, BMI, and EDE. General psychiatric features

were also assessed using the Brief Symptom Inventory method. Overall, there was an increase in

mean BMI and weight. Participants also demonstrated a decrease in eating disorder

psychopathology and generally psychopathology. This study demonstrated that CBT had positive

outcomes in the adolescent population with AN.

Cowdrey et al. (2016) aimed to investigate if CBT would be an effective treatment for an

adolescent suffering form AN. The study was an A-B experimental design of a single adolescent

female with AN. Eleven sessions of CBT were completed over the course of 75 days. EDE-Q,

RCADS, and SDQ were assessed before and eight months after treatment. Weekly weights were

taking during the course of treatment.

Integrative Review of CBT 7

While CBT was occurring, the patient experienced increases in weight and reported mood

improvements, improved concentration, and a regular menstrual cycle. At the 8-month follow up,

however, the researchers determined that progress was only partially maintained although they

did not discuss exact parameters of partial maintenance. They recognized that this patient only

received 11 sessions of CBT whereas most patients receive a minimum of about 20 sessions.

This study demonstrated that some patients may experience the positive effects of CBT while in

therapy, but CBT may not have lasting effects for some individuals.

Bulimia Nervosa (BN)

One quantitative study compared the use of CBT to that of family-based therapy (FBT)

for the treatment of bulimia nervosa (Grange et al., 2015). Grange et al. (2015) considered FBT

to be the more effective method for treating BN than CBT. The authors hypothesized that FBT

would be superior to CBT for this [adolescent] age group (Grange et al., 2015).

The authors of the study conducted a three-armed, 2-site randomized clinical trial. The

three interventions studied were CBT, FBT, and supportive psychotherapy (SPT). Participants

were recruited with the criteria that they be between the ages of 13-18 years and met the criteria

for DSM-IV diagnosed bulimia nervosa. 130 patients were recruited and randomized into the

CBT group, the FBT group, or the SPT group at a ratio of 2:2:1. Individuals underwent 18

sessions of whichever therapy they were assigned over the course of six months. Participants

were assessed at baseline, end of treatment, 6 months after completed therapy, and 12 months

after completed therapy using the EDE method. Results were then analyzed by utilizing

longitudinal mixed-effects modeling.

Grange et al. (2015) found that FBT was a more effective treatment for adolescents with

BN initially compared to CBT. At end of treatment, the group who receive FBT had an
Integrative Review of CBT 8

abstinence rate of 39.4% while the CBT group had a rate of only 19.7%. At 6-months post-

treatment, the FBT group still had higher abstinence ratings than that of the CBT group (44.0%

compared to 25.4%, respectively). However, at the 12-month follow-up, the two treatments were

comparable in their effectiveness. This study demonstrated that FBT may be more beneficial to

adolescents with BN in the short-term; however, CBT may be just as effective for other

adolescents, depending on patient circumstances.

Discussions & Implications

The research addressed the PICO question of author of this integrative review.

Overall, the research in this review indicated that CBT has a positive effect in the treatment of

eating disorders. Most patients in these studies experienced improvements in weight gain and

decreases in eating disorder behaviors, such as binging, purging, or restricting. Much of the data

obtained in the articles was of statistical significance. This provided hard evidence for the

support of CBT in treating eating disorders in adolescents. It should be noted, however, that the

length of time CBT is provided is important. Cowdrey et al. (2016) found that CBT was

beneficial to their patient with AN while treatment was active; however, once treatment stopped,

progress was only partially maintained.

CBT has been a widely accepted therapy in the adult population for many issues ranging

from depression to eating disorders. However, it has not been studied as intensively in the

adolescent population, especially in those adolescents with eating disorders of any variety. It is

important to identify and implement treatment in a timely manner due to the potential

catastrophic effects of eating disorders. Future research should look into comparing CBT alone

and CBT with other therapies. Grange et al. (2015) found that FBT was more beneficial in the

short-term treatment of BN than CBT. Long-term, both therapies proved to have the desired
Integrative Review of CBT 9

effects of improving patient conditions; however, it may be beneficial to merge the two therapies.

Future research should also look into how CBT can be delivered remotely. Not everyone has

access to in-patient or outpatient care settings. It is imperative to reach those individuals who

may be isolated.

Limitations & Conclusion

There are several limitations in this study that should be noted. Primarily, the author has

little experience performing research and writing integrative reviews. This could skew the results

to what the author hopes to find, instead of the true evidence available in the literature. Another

limitation is the breadth of literature available on this issue. Although the initial literature search

appeared to result in thousands of articles, many of them did not pertain to the PICO question at

all. Instead, they addressed issues in the adult population or in children with anxiety and

depressive disorders. There was a noted delimitation. The author of this integrative review only

analyzed and reported on five articles.

In conclusion, this integrative review found solid evidence in support of using CBT in

adolescents with eating disorders. Many patients experienced positive results while undergoing

CBT and these results lasted during follow-up for some patients.. Although there this integrative

review provides support for the use of CBT, there is need for further research in the area to

continue determining CBTs effectiveness long term, how it may be used in conjunction with

other therapies, and if it is better suited for specific eating disorders.

Integrative Review of CBT 10

Resources

National Alliance on Mental Illness (2016). Eating Disorders. Retrieved from

https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml?

utm_source=rss&utm_medium=rss

National Alliance on Mental Illness (2016). Eating Disorders Among Children. Retrieved

from

https://www.nimh.nih.gov/health/statistics/prevalence/eating-disorders-

among-children.shtml

Grave, R., et al. (2015). Transdiagnostic Cognitive Behaviour Therapy for Adolescents

With an Eating Disorder Who are not Underweight. Behaviour Research Therapy

73, 79-82.

DeBar, L. et al. (2013). Cognitive Behavioral Treatment for Recurrent Binge Eating in

Adolescent Girls: A Pilot Study. Cognitive and Behavioral Practice 20, 147-161.

Grave, R. et al (2014). Inpatient Cognitive Behavior Therapy for Adolescents with

Anorexia Nervosa: Immediate and Longer-Term Effects. Frontiers in Psychiatry

5 (14), 1-7.

Cowdrey, F. & Davis, J. (2016). Response to Enhance Cognitive Behavioural Therapy in

An Adolescent with Anorexia Nervosa. Behavioural and Cognitive

Psychotherapy 44, 717-722.

Grange, D. et al. (2015). Randomized Clinical Trial of Family Based Treatment and

Cognitive Behavioral Therapy for Adolescent Bulimia Nervosa. Journal of the

American Academy of Child and Adolescent Psychiatry 54 (11), 886-894.

Integrative Review of CBT 11

First Author Grave, R. (2015) Department Head of Department of Eating

(Year)/Qualificatio and Weight Disorders at Villa Garda Hospital in Garda, Italy
ns
Background/Probl - Data supports the used of CBT in adults with eating disorders
em Statement that are not underweight, but research has not addressed this
therapy in adolescents with the same condition.
- Aim: Evaluate effect of CBT in a cohort of adolescents who
were not underweight
Conceptual/theore - Not discussed
tical Framework

Design/Method/ - Quantitative Quasi experimental

Philosophical - Cohort of adolescents not underweight
Underpinnings - Patients underwent 20 sessions of CBT over 20 weeks to
evaluate if effects of CBT
- CBT administered by 3 specifically trained clinical
psychologists
Sample/ - Ethically approved by IRB of Villa Garda Hospital; no
Setting/Ethical discussion of consent, confidentiality, or ability to withdraw from
Considerations study
- Sample eligibility: between ages of 13-19 years; BMI greater
or equal to 18.5; fulfill DSM-IV diagnostic criteria for BN or
EDNOS
- Sample: 68 individuals; mean age of 16.5 years; all single; 2
male, 66 female; mean duration of eating disorder 1.7 years
- Setting: Eating Disorder Clinic in Verona, Italy
Major Variables - Cognitive Behavioral Therapy (CBT): short-term
Studied (and their psychotherapy that addresses a patients cognitive processes
definition), if of dealing with emotional issues; goal is to change a persons
appropriate pattern of thinking or behavior to change attitude and way of
thinking
- Completers: individuals who completed full 20 sessions of
CBT
- Non-completers: individuals that did not complete 20 sessions
of CBT
Measurement - 2 assessment points: before and after 20 sessions of CBT
Tool/Data - Body weight
Collection Method - BMI: calculated with CDC charts
- Self-report Eating Disorder Examination Questionnaire (EDE-
Q)
- Symptoms Checklist-90 for general psychiatric features
Data Analysis - T-test and Chi-square test to compare completer group and
non-completer group
- McNemar test compared categorical data between completers
and non-completers
Integrative Review of CBT 12

- Wilcoxon test compared continuous data between completers

and non-completers
- Effect size assessed magnitude of difference between
completers and non-completers
Findings/Discussi - Overall decrease in frequency of binge eating, vomiting,
on and/or laxative use
- 75% (51/68) of participants completed full 20 sessions of CBT
(main finding)
- 67.6% (46/68) had minimal residual eating disorder
psychopathology (main finding)
- 50% of binge eaters and/or purgers (25/50) ceased all forms
of behavior
- Acknowledges CBT as promising treatment for adolescents
with eating disorders who are not underweight
- Recommendations for future research: compare CBT to other
leading treatments for this population; study CBT in all eating
disorders; study how this therapy can be administered in real
world scenarios that lack specifically trained psychologists
Appraisal/Worth - CBT appears to have excellent results in this population
to practice - May be alternative to other classical treatments for this eating
disorders
- Should consider follow-up of patients who undergo CBT and
long-term outcomes and effects

First Author DeBar, L. (2013) Assistant Program Director at Kaiser

(Year)/Qualificatio Permanente Center for Health Research in Portland, OR
ns
Background/Probl - Binge eating is a significant issue in adolescents with longer
em Statement term health effects including risk for obesity and other
psychiatric disorder such as anxiety and depression
- Aim: Develop and test adolescent-specific CBT to treat
adolescents with BED
Conceptual/theore - Not discussed
tical Framework
Integrative Review of CBT 13

Design/Method/ - Quantitative
Philosophical - Randomized trial
Underpinnings - Half of participants randomized into CBT while other half was
randomized into the control group of TAU-DT
- CBT consisted of 8 core sessions focusing on different topics
that revolved around eating behavior and emotion, as well as 4
optional sessions
Sample/ - Ethical considerations: None mentioned; assumed due to the
Setting/Ethical fact that the study was conducted by non-profit HMO
Considerations - Sample eligibility: female between ages of 12-18 years;
currently living with parent; binge eating episode (as defined by
DSM-IV) of at least once a week for last 3 months
- Sample: 26 participants; mean age 15.2 years;
- Setting: primary care clinic
Major Variables - Cognitive Behavioral Therapy (CBT): short-term
Studied (and their psychotherapy that addresses a patients cognitive processes
definition), if of dealing with emotional issues; goal is to change a persons
appropriate pattern of thinking or behavior to change attitude and way of
thinking
- Treatment as usual/delay treatment (TAU-DT): treatment
protocol that is currently in place and practiced for this
population (TAU); receiving treatment at a later date in a study
than those in the experimental group (DT)
- Binge Eating Disorder (BED): eating episodes that involve
consuming more than the average person over a 2 hour period
while experiencing a loss of control
Measurement - 3 assessment points: baseline, 3 months after randomization,
Tool/Data 6 months after randomization
Collection Method - Modified version of Eating Disorder Examination (EDE)
- Screen for Child Anxiety Related Emotional Disorders
- Beck Depression Inventory
- Self-report Client Satisfaction Questionnaire

Data Analysis - Chi-square and t-test to compare baseline of CBT group and
TAU-DT group
Findings/Discussi - All CBT participants attended 6 of 8 core sessions; 77% of
on CBT participants attended all 8 core sessions
- Only 70% of TAU-DT participants attended 6 of 8 core
sessions
- CBT participants had 92.3% abstinence from binge eating at 3
month check and 100% abstinence at 6 month check
- TAU-DT participants had only 30% abstinence form binge
eating at 3 month check and 50% abstinence at 6 month check;
however, once CBT was initiated in this group, there was 75%
abstinence from binge eating at 3 month check. Suggests
treatment works in both groups
Integrative Review of CBT 14

- BMI in both groups did not significantly differ over time

- Findings support effectiveness of CBT adapted specifically for
adolescents

Appraisal/Worth - Demonstrated effectiveness of CBT in CBT group

to practice - Patients are more satisfied when CBT is appropriately adapted
to population age and developmental level

First Author Grave, R. (2014) Department Head of Department of Eating

(Year)/Qualificatio and Weight Disorders at Villa Garda Hospital in Garda, Italy
ns
Background/Probl - Inpatient treatment of AN is successful for most patients, but
em Statement there is high rate of relapse and recurrence. AN can have
significant long term physical and psychological effects
- Aim: use CBT approach modified for adolescents to improve
outcomes and reduce relapse in adolescent population with AN
- 3 clinical questions: What proportion of patients complete
inpatient program? What was the outcome for patients who
finish program? Were changes sustained?
Conceptual/theore - Not discussed
tical Framework

Design/Method/ - Quantitative quasi experimental

Philosophical - Cohort study of adolescents with severe AN
Underpinnings - Patients underwent 20 weeks of CBT for severe AN; first 4
weeks required 2 weekly sessions, then once a week; effects of
CBT were evaluated
- CBT was delivered by trained psychologist during individual
and optional group settings
Integrative Review of CBT 15

Sample/ - Ethically approved by ethics committee of the Local Health

Setting/Ethical Unit 22-Bussolengo; patients and parents signed informed
Considerations consent; patients were ensured anonymity
- Sample eligibility: between ages of 13-17 years; meet DSM-IV
criteria for anorexia nervosa; patients must have previously
failed outpatient treatment
- Sample: 27 individuals; mean age of 16 years; all single; 1
male, 26 female; mean duration of eating disorder 2 years; all
patient substantially underweight
- Setting: open unit specialized to treat adolescents with eating
disorders; located at Villa Garda Hospital in Verona, Italy
Major Variables - Anorexia Nervosa: psychiatric eating disorder characterized by
Studied (and their abnormally low BMI, extreme fear of weight gain, and distorted
definition), if body image
appropriate - Cognitive Behavioral Therapy (CBT): short-term
psychotherapy that addresses a patients cognitive processes
of dealing with emotional issues; goal is to change a persons
pattern of thinking or behavior to change attitude and way of
thinking
Measurement - Weight: beam balance scale
Tool/Data - Height: wall-mounted stadiometer
Collection Method - BMI calculated using CDC growth chart
- Eating Disorder Examination 12th edition adapted for
adolescents
- Brief Symptom Inventory assessed general psychiatric
features
Data Analysis - Bonferroni post-hoc test verified significant changes
- Statistical analyses performed by SPSS version 20.0
Findings/Discussi - Increase in weight at 6 month follow-up mean BMI was
on 27.3; at 12 month follow-up mean BMI was 29.9
- Decrease in eating disorder and general psychopathology;
maintained at 6 month and 12 month follow up
- Clinical questions findings 1. Only 1 patient didnt complete
program; 2. Increase in weight (mean weight gain from
admission to discharge was 11.7kg), eating disorder
psychopathology and general psychiatric features improved; 3.
Changes well maintained 81.5% (22/27) compliance at 6
months & 85.2% (23/27) compliance at 12 months
- Findings demonstrate CBT in inpatient setting is appropriate
treatment for adolescents with AN. Patients had improved
results that were maintained at 6 and 12 month follow-up
Appraisal/Worth - CBT has good outcomes in this population
to practice - Changes maintained in long term follow-up
- Future research of CBT in adolescents with AN is needed
Integrative Review of CBT 16

First Author Cowdrey, C. (2016) Clinical Psychology Unit and Research

(Year)/Qualificatio Centre at the University of Bath in Bath, England
ns
Background/Probl - Scant research has been performed on effectiveness of CBT
em Statement in adolescents with eating disorders
- Aim: investigate whether CBT would be effective treatment for
patient and help achieve patient-determined goals
Conceptual/theore - Not discussed
tical Framework
Design/Method/ - A-B experimental design A was baseline; B was
Philosophical intervention phase
Underpinnings - Single case
- 11 CBT sessions completed over course of 75 days; patient
evaluated at baseline, during treatment, and 8 months after
treatment was completed
- CBT performed by licensed therapist
Sample/ - IRB not mentioned; parent and patient provided informed
Setting/Ethical consent; authors noted that study complied with national and
Considerations institutional standards and follow Helsinki Declaration of 1975
- Single patient referred for treatment of AN
- Patient was single, 15 year old female
- Setting: not discussed
Major Variables - Anorexia Nervosa: psychiatric eating disorder characterized by
Studied (and their abnormally low BMI, extreme fear of weight gain, and distorted
definition), if body image
appropriate - Cognitive Behavioral Therapy (CBT): short-term
psychotherapy that addresses a patients cognitive processes
of dealing with emotional issues; goal is to change a persons
pattern of thinking or behavior to change attitude and way of
thinking
Measurement - Weekly weights
Tool/Data - Eating Disorder Examination Questionnaire (EDE-Q)
Collection Method - Revised Child Anxiety and Depression Scale (RCADS)
- Strengths and Difficulties Questionnaire (SDQ)

Data Analysis - Not discussed

Integrative Review of CBT 17

Findings/Discussi - Baseline results were variable

on - Steep decline in counts of AN behaviors and reduction to zero
counts occurred approximately at 5th session of CBT
- Weight increased from 47kg to 52.2kg by end of final session
of CBT
- Patient reported some qualitative data: better able to
concentrate, mood improvements, regular menstrual cycle
- At 8 month follow-up, progress only partially maintained,
although partially maintained was not fully explained
Appraisal/Worth - This study was different in that only 11 session of CBT were
to practice implemented. Typically patients receive 20+ sessions
- Patient improved with regards to eating disorder behaviors, so
likely beneficial treatment for adolescents with AN
- More research with AN and CBT needs to be performed
- CBT should last longer than 11 sessions

First Author Grave, R. (2015) Department Head of Department of Eating

(Year)/Qualificatio and Weight Disorders at Villa Garda Hospital in Garda, Italy
ns
Background/Probl - Bulimia nervosa (BN) is a type of eating disorder affecting
em Statement adolescents but little research has been done to compare
cognitive behavioral therapy (CBT) to the leading treatment for
BN, which is family based treatment (FBT) to determine which
is more effective
- Hypothesis: FBT would be more effective in treating
adolescents with BN than CBT

Conceptual/theore - Not discussed

tical Framework
Design/Method/ - Quantitative
Philosophical - 2-site randomized control trial FBT, CBT, SPT arms of study
Underpinnings (randomized 2:2:1)
Integrative Review of CBT 18

- All treatments deliver in 18 sessions over period of 6 months

Sample/ - IRB approval from University of Chicago and Stanford
Setting/Ethical University; written consent obtained from parents and
Considerations participants
- Sample eligibility: between ages of 13-18 years; meet DSM-IV
criteria for bulimia nervosa;
- Sample: 130 individuals; mean age of 15.8 years; 94% of
participants were female; mean duration of illness was
18.9months
- Setting: Department of Psychiatry and Behavioral
Neuroscience at the University of Chicago in Chicago, IL and
Department of Psychiatry and Behavioral Sciences at Stanford
University in Stanford, CA
Major Variables - Bulimia Nervosa (BN):
Studied (and their - Cognitive Behavioral Therapy (CBT): short-term
definition), if psychotherapy that addresses a patients cognitive processes
appropriate of dealing with emotional issues; goal is to change a persons
pattern of thinking or behavior to change attitude and way of
thinking
- Family Based Therapy (FBT):
- Supportive Psychotherapy (PST):
Measurement - Assessment occurred at baseline, end-of-treatment (EOT), 6
Tool/Data months, and 12 months
Collection Method - Abstinence from binge eating and purging measures using
Eating Disorder Examination (EDE)
Data Analysis - Longitudinal modeling framework
- Longitudinal mixed-effects
Findings/Discussi - FBT resulted in higher abstinence from binging behaviors
on (39.4%) than CBT (19.7%) at end of treatment
- FBT resulted in higher abstinence from binging behaviors
(44.0%) than CBT (25.0%) at 6 month follow up
- No significant statistical difference between 2 methods at 12
month follow up
- FBT better treatment than CBT for adolescents with BN;
however, no real difference at 12 month follow up so CBT may
be more acceptable option for some patients
Appraisal/Worth - The two methods need to be further compared to determine
to practice which may be better for adolescents with BN