Engagement and outcome in the treatment of bulimia nervosa: first phase ofa sequential design comparing motivation enhancement therapy and cognitivebehavioural therapy

Despite the major advances in the development of treatments for bulimia ner vosa, drop-outs and a lack of engagement in treatment, continue to be probl ems. Recent studies suggest that the transtheoretical model of change may b e applicable to bulimia nervosa. The aim of this study was to examine the r oles of readiness to change and therapeutic alliance in determining engagem ent and outcome in the first phase of treatment. One hundred and twenty fiv e consecutive female patients meeting DSM-IV criteria for bulimia nervosa t ook part in a randomised controlled treatment trial. The first phase of the sequential treatment compared four sessions of either cognitive behavioura l therapy (CBT) or motivational enhancement therapy (MET) in engaging patie nts in treatment and reducing symptoms. Patients in the action stage showed greater improvement in symptoms of binge eating than did patients in the c ontemplation stage. Higher pretreatment scores on action were also related to the development of a better therapeutic alliance (as perceived by patien ts) after four weeks. However. pretreatment stage of change did not predict who dropped out of treatment. There were no differences between MET and CB T in terms of reducing bulimic symptoms or in terms of developing a therape utic alliance or increasing readiness to change. The results suggest that t he transtheoretical model of change may have some validity in the treatment of bulimia nervosa although current measures of readiness to change may re quire modification. Overall, readiness to change is more strongly related t o improvement and the development of a therapeutic alliance than the specif ic type of treatment. (C) 1999 Elsevier Science Ltd. All rights reserved.