THE ROLE OF EXPOSURE WITH RESPONSE PREVENTION IN THE COGNITIVE-BEHAVIORAL THERAPY FOR BULIMIA-NERVOSA

Background. One hundred and thirty-five women with bulimia nervosa par ticipated in a randomized clinical trial designed to determine whether the addition of exposure with response prevention to a core of cognit ive-behavioural therapy (CBT) leads to greater clinical improvement an d lower risk of relapse. We present results from the end of treatment and 6- and 12-month follow-up. Methods. Participants received eight se ssions of CBT and were then randomized to either exposure to pre-binge cues (B-ERP), exposure to pre-purge cues (P-ERP), or a relaxation tra ining control condition (RELAX). Results. CBT produced significant cli nical change. At the end of the behavioural treatments, there were no significant differences across the three groups on abstinence (66% in B-ERP, 45% in P-ERP and 47% in RELAX), or frequency of bingeing and pu rging. B-ERP, but not P-ERP, significantly reduced anxiety on the cue reactivity assessment, food restriction, body dissatisfaction and depr ession. These differences were not maintained at 6-month follow-up. At 12-months, B-ERP was independently associated with lower food restric tion and better global functioning. Conclusions. CBT is a highly effec tive treatment for bulimia nervosa. B-ERP was modestly superior to P-E RP at post-treatment; however, the advantage did not remain throughout the follow-up interval. ERP for bulimia nervosa is an expensive and l ogistically complicated treatment that does not appear to offer any si gnificant additive benefits that are proportional to the amount of eff ort required to implement the treatment.