GUIDED SELF-CHANGE FOR BULIMIA-NERVOSA INCORPORATING USE OF A SELF-CARE MANUAL

Objective: The aim of this study was to evaluate the effectiveness of guided self-change for bulimia nervosa. Method: Sixty-two patients wit h DSM-III-R-defined bulimia nervosa were randomly assigned to 21 use o f a self-care manual plus eight fortnightly sessions of cognitive beha vior therapy (guided self-change) or 2) 16 sessions of weekly cognitiv e behavior therapy. Results: At the end of treatment and at follow-up an average of 43 weeks after the end of therapy, substantial improveme nts had been achieved in both groups on the main outcome measures: eat ing disorder symptoms according to experts' ratings (Eating Disorder E xamination subscores on overeating, vomiting, dietary restraint, and s hape and weight concerns), self-reports (Bulimic Investigatory Test Ed inburgh), and a 5-point severity scale. Also, improvement was seen on the subsidiary outcome measures: the Beck Depression Inventory, the Se lf-Concept Questionnaire, and Knowledge of nutrition, weight, and shap e. At follow-up, 71% of the cognitive behavior therapy group had not b inged or vomited during the week preceding. In the guided self-change group, 70% had not binged and 61% had not vomited during the week befo re follow-up. Conclusions: Guided self-change incorporating use of a s elf-care manual offers an approach that can be as effective as standar d cognitive behavior therapy in the long term and can considerably red uce the amount of therapist contact required.