SEQUENTIAL TREATMENT FOR BULIMIA-NERVOSA INCORPORATING A SELF-CARE MANUAL

Background. The aim of this study was to evaluate the effectiveness of a stepped care approach to the treatment of bulimia nervosa: a self-c are manual followed, if necessary, by a course of attenuated cognitive behavioural treatment (CBT) in comparison with standard CBT. Method. One hundred and ten patients, presenting at a tertiary referral centre with ICD-10 bulimia nervosa or atypical bulimia nervosa, were randoml y assigned to one of two treatment conditions; a) a sequential treatme nt group: 8 weeks with a self-care manual followed by up to eight sess ions of CBT (if still symptomatic) or b) 16 sessions of CBT. Results. Bulimic symptoms improved significantly in both groups with no signifi cant differences between the two groups on any of the measures at the end of treatment or at 18 months follow-up. At end of treatment 30% (9 5% CI: 18-46%) of the sequential group and 30% (95% CI: 17-47%) of the standard treatment group were free from all bulimic symptoms. Sixteen of those in the sequential group improved significantly with self-car e and did not require additional treatment. The median number of sessi ons taken by the sequential group was three (95% CI: 0-6). At 18 month s follow-up 40% (95% CI: 23-59%) of the sequential group and 41% (95% CI: 25-59%) of the CBT group were symptom free. Conclusions. A sequent ial approach to the treatment of bulimia may be as effective as standa rd CBT and can considerably reduce the amount of therapist contact req uired.