Guided self-help effective in bulimia nervosa

The efficacy of cognitive-behavioural guided self-help (GSH) for bulimia nervosa delivered by non-specialist general practitioners (GPs) in primary care is demonstrated in a recent Australian study.The researchers aimed to compare outcomes between a GSH group and a delayed treatment control (DTC) group after 17 weeks, and to assess whether treatment gains in the GSH group were maintained during follow-up.The study included 109 women aged 18 years or older who met full or modified DSM-IV diagnostic criteria for bulimia nervosa. Women were recruited from the community in an attempt to attract a sample likely to visit a GP. Women were randomised to the GSH (n=54) or DTC (n=55) groups. Women in the latter group received no treatment during the study period.Women in the GSH group were given a self-help manual designed to aid recovery from bulimia nervosa and binge-eating and asked to work through it over the next 16 weeks. GPs provided support and encouragement during this time in the form of nine treatment sessions.An intention-to-treat (ITT) analysis showed that, compared with DTC, GSH produced significantly greater improvements in all eating pathology and body image variables at the end of treatment. In particular, the mean frequency of objective binge-eating (OBE) was reduced by 60% in the GSH group compared with 6% in the DTC group. In addition, among women who reported purging behaviour at baseline, purging episodes were reduced by 61% in the GSH group compared with 10% in the DTC group.Absolute remission from binge-eating and all compensatory behaviours was significantly greater in the GSH group than in the DTC group (28% versus 11%, pSignificant improvements in general psychopathology, including depression, anxiety, life satisfaction and occupational functioning were also observed in the GSH group.Treatment gains were maintained at three- and six-month follow-up. The researchers conclude that the study conditions were sufficiently close to natural primary care environments in Australia to strongly support the use of GSH by well informed GPs. They add that these findings indicate that GSH is a valuable treatment option and that efforts should be made to facilitate its implementation.Reference...