Bara-Carril, N., Williams, C. J., Pombo-Carril, M. G., Reid, Y., Murray, K., Aubin, S., Harkin, P. J. R., Treasure, J., & Schmidt, U. (2004). A preliminary investigation into the feasibility and efficacy of a CD-ROM-based cognitive-behavioral self-help intervention for bulimia nervosa. International Journal of Eating Disorders, 35, 538-548.

Correspondence Address:
Nuria Bara-Carril, South London and Maudsley NHS Trust, Eating Disorders Unit, P.O. Box 59, De Crespigny Park, London, England SE5 8AF.

Abstract
Many patients with bulimia nervosa find it hard to access evidence-based treatment such as cognitive-behavioral therapy (CBT). The aim of the current study was to evaluate the feasibility and efficacy of a novel CD-ROM-based cognitive-behavioral multimedia self-help intervention for the treatment of bulimia nervosa. Patients with bulimia nervosa referred to a catchment area-based eating disorder service were offered eight sessions of a novel CD-ROM cognitive-behavioral self-help treatment without any added therapist input. We report here the take-up and drop-out rates and efficacy of this intervention. Of 60 participants who were offered the intervention, 47 took it up. At follow-up, there were significant reductions in hinging and compensatory behaviors, most clearly in self-induced vomiting. This intervention has potential as a first step in the treatment of bulimia nervosa and for dissemination to nonspecialist settings. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

Butryn, M. L., Lowe, M. R., Safer, D. L., & Agras, W. S. (2006). Weight suppression is a robust predictor of outcome in the cognitive-behavioral treatment of bulimia nervosa. Journal of Abnormal Psychology, 115, 62-67.

Correspondence Address:
Michael R. Lowe, Department of Psychology, Drexel University, MS 626, 245 North 15th Street, Philadelphia, PA, US, 19102, lowe@drexel.edu.

Abstract
This study examined weight suppression (difference between highest premorbid weight and pretreatment weight) as a predictor of outcome in 188 outpatients with bulimia nervosa enrolled in a cognitive- behavioral therapy intervention. Participants who dropped out of treatment had significantly higher levels of weight suppression than treatment completers. Of participants who completed treatment, those who continued to engage in binge eating or purging had significantly higher levels of weight suppression than those who were abstinent from bingeing and purging. Results did not change when body mass index, dietary restraint, weight and shape concerns, or other relevant variables were controlled. Relinquishing bulimic behaviors and adopting normal eating patterns may be most feasible for patients who are closest to their highest premorbid weights.(PsycINFO Database Record (c) 2006 APA, all rights reserved)

Carter, J. C., McFarlane, T. L., Bewell, C., Olmsted, M. P., Woodside, D. B., Kaplan, A. S., Crosby, R. D. Maintenance treatment for anorexia nervosa: A comparison of cognitive behavior therapy and treatment as usual. International Journal of Eating Disorders, 42 (3), 202-207.

Correspondence Address:
Jacqueline C. Carter, Toronto General Hospital, 200 Elizabeth Street EN8-241, Toronto, ON, Canada, M5G 2C4, Jacqueline.carter@uhn.on.ca.

Abstract
Objective: The aim of this study was to compare two maintenance treatment conditions for weight-restored anorexia nervosa (AN): individual cognitive behavior therapy (CBT) and maintenance treatment as usual (MTAU). Method: This study was a nonrandomized clinical trial. The participants were 88 patients with AN who had achieved a minimum body mass index (BMI) of 19.5 and control of binge eating and purging symptoms after completing a specialized hospital-based program. Forty-six patients received 1 year of manualized individual CBT and 42 were in an assessment-only control condition (i.e., MTAU) for 1 year. This condition was intended to mirror follow-up care as usual. Participants in both the conditions were assessed at 3-month intervals during the 1-year study. The main outcome variable was time to relapse. Results: When relapse was defined as a BMI =17.5 for 3 months or the resumption of regular binge eating and/or purging behavior for 3 months, time to relapse was significantly longer in the CBT condition when compared with MTAU. At 1 year, 65% of the CBT group and 34% of the MTAU group had not relapsed. Discussion: The current findings provide preliminary evidence that CBT may be helpful in improving outcome and preventing relapse in weight-restored AN. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Cooper, M., Todd, G., Turner, H., & Wells, A. (2007). Cognitive therapy for bulimia nervosa: An A-B replication series. Clinical Psychology & Psychotherapy, 14, 402-411.

Correspondence Address:
Myra Cooper, Isis Education Centre, University of Oxford, Warneford Hospital, Oxford, United Kingdom, OX3 7JX, Myra.cooper@hrnc.ox.ac.uk.

Abstract
Objective: To investigate whether a new treatment for bulimia nervosa (BN) works, and to examine its effects on key cognitions and behaviours hypothesized to be important in the underlying model. Method: An A-B single-case series with follow-up was conducted. Treatment was based on a specific model of BN. It consisted of individualized formulation, enhancing motivation for change, cognitive restructuring of specific cognitions, behavioural experiments and targeting particular underlying assumptions and negative self-beliefs. Relapse prevention was also addressed. Results: All treatment completers did extremely well and no longer met Diagnostic and Statistical Manual of Mental Disorders, 4th edition revised (DSM-IV) criteria for bulimia nervosa. Two were entirely symptom-free at the end of treatment and at follow-up. The third experienced only very occasional binge eating and vomiting. Individual scores on self-report symptom measures and on all measures of cognition indicated a return to normative levels. Discussion: Treatment focusing on specific cognitive change is a promising intervention for BN. Further work might usefully evaluate this treatment in a larger study. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Devlin, M. J., Goldfein, J. A., Petkova, E., Jiang, H., Raizman, P. ., Wolk, S., Mayer, L., Carino, J., Bellace, D., Kamenetz, C., Dobrow, I., & Walsh, B. T. (2005). Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder. Obesity Research, 13, 1077-1088.

Correspondence Address:
Michael J. Devlin, New York State Psychiatric Institute, Unit 116, 1051 Riverside Drive, New York, NY, US, 10032, mjd5@columbia.edu.

Abstract
Objective: Although binge eating disorder is a common and distressing concomitant of obesity, it has not yet been established whether affected individuals presenting to behavioral weight control programs should receive specialized treatments to supplement standard treatment. This study was designed to examine the added benefit of two adjunctive interventions, individual cognitive behavioral therapy (CBT) and fluoxetine, offered in the context of group behavioral weight control treatment. Research Methods and Procedures: One hundred sixteen overweight/ obese women and men with binge eating disorder were all assigned to receive a 16-session group behavioral weight control treatment over 20 weeks. Simultaneously, subjects were randomly assigned to receive CBT+fluoxetine, CBT+placebo, fluoxetine, or placebo in a two-by-two factorial design. Outcome measures, assessed at the end of the 16-session acute treatment phase, included binge frequency, weight, and measures of eating-related and general psychopathology. Results: Overall, subjects showed substantial improvement in binge eating and both general and eating-related psychopathology, but little weight loss. Subjects who received individual CBT improved more in binge frequency than did those not receiving CBT (p<0.001), and binge abstinence was significantly more common in subjects receiving CBT vs. those who did not (62% vs. 33%, p<0.001). Fluoxetine treatment was associated with greater reduction in depressive symptoms (p<0.05). The 54 subjects who achieved binge abstinence improved more on all measures than the 62 subjects who did not. In particular, these subjects lost, on average, 6.2 kg compared with a gain of 0.7 kg among non-abstainers. Discussion: Adjunctive individual CBT results in significant additional binge reduction in obese binge eaters receiving standard behavioral weight control treatment. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Herrera, E. A., Johnston, C. A., & Steele, R. G (2004). A comparison of cognitive and behavioral treatments for pediatric obesity. Children's Health Care, 33, 151-167.

Correspondence Address:
Eve Herrera, Clinical Child Psychology Department, University of Kansas, 2011 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, Kansas, rsteele@ku.edu.

Abstract
We compared outcomes for cognitive, behavioral, and comparison group treatments for pediatric obesity. Fifty children (M = 11.5 years) and their parents were randomly assigned to weight management groups with either cognitive or behavioral components. Data from an additional 25 children and their parents who had previously received treatment for pediatric obesity were used as a comparison condition. Participants in all of the conditions had a significant decrease in their percentages over their ideal body mass indexes (BMIs). The results indicate that the behavioral condition was superior to the comparison condition after age, sex, and change in height were controlled. No statistical difference was found between the cognitive and comparison conditions or between the cognitive or behavioral conditions. However, more children in the behavioral condition evidenced positive change in BMI status (e.g., from very obese to obese) than children in the cognitive or comparison conditions. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

Lundgren, J. D., Danoff-Burg, S., & Anderson, D. A. (2004). Cognitive-behavioral therapy for Bulimia Nervosa: An empirical analysis of clinical significance. International Journal of Eating Disorders, 35, 262-274.

Correspondence Address:
Jennifer D. Lundgren, Department of Psychology, University at Albany-SUNY, Social Sciences 369, Albany, NY, US, 12222, jl3799@albany.edu Abstract
Objective: The purpose of this review was to assess the clinical significance of cognitive-behavioral therapy for bulimia nervosa using the reliable change index and normative comparison analyses. Method: Fifteen treatment outcome studies using either individual or group cognitive-behavioral therapy for bulimia nervosa were selected for inclusion. Results: Results suggest that cognitive-behavioral therapy for bulimia nervosa produces clinically significant change for many treatment outcome measures when using the reliable change index. However, posttreatment symptomatology is rarely within a normative range when examined with normative comparison analyses. Discussion: This review provides a first step in examining the clinical significance of treatment for bulimia nervosa. Future studies should further this work by comparing the clinical significance of different types of treatment for bulimia nervosa using additional assessment measures. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

Munsch, S., Biedert, E., Meyer, A., Michael, T., Schlup, B., Tuch, A., & Margraf, J. (2007). A randomized comparison of cognitive behavioral therapy and behavioral weight loss treatment for overweight individuals with binge eating disorder. International Journal of Eating Disorders, 40, 102-113.

Correspondence Address:
Simone Munsch: Institute for Psychology, University of Basel, Missionsstrasse 62a, Basel, Switzerland, 4055, jsimone.munsch@unibas.ch.

Abstract
Objectives: The aim of this study was to determine the efficacy of cognitive-behavioral therapy (CBT) and behavioral weight loss treatment (BWLT) for overweight patients with binge eating disorder (BED). Method: Eighty obese patients meeting criteria of BED according to DSM-IV-TR were randomly assigned to either CBT or BWLT consisting of 16 weekly treatments and 6 monthly follow-up sessions. Binge eating, general psychopathology, and body mass index (BMI) were assessed before, during, and after treatment, and at 12-month follow-up. Results: At posttreatment results favored CBT as the more effective treatment. Analysis of the course of treatments pointed to a faster improvement of binge eating in CBT based on the number of self-reported weekly binges, but faster reduction of BMI in BWLT. At 12-month follow-up, no substantial differences between the two treatment conditions existed. Conclusion: CBT was somewhat more efficacious than BWLT in treating binge eating but this superior effect was barely maintained in the long term. Further research into cost effectiveness is needed to assess which treatment should be considered the treatment of choice. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Richards, P. S., Berrett, M. E., Hardman, R. K., & Eggett, Dennis L. (2006). Comparative efficacy of spirituality, cognitive, and emotional support groups for treating eating disorder inpatients. Eating Disorders: The Journal of Treatment and Prevention, 14, 401-415.

Correspondence Address:
Scott P. Richards, Department of Counseling Psychology, Brigham Young University, Provo, Utah, USA, 84602 scott_richards@byu.edu.

Abstract
Spiritual interventions are rarely used in contemporary treatment programs and little empirical evidence is available concerning their effectiveness. The purpose of the present study was to evaluate the effectiveness of a spiritual group intervention for eating disorder inpatients. We compared the effectiveness of a Spirituality group with Cognitive and Emotional Support groups using a randomized, control group design. Participants were 122 women receiving inpatient eating disorder treatment. Patients in the Spirituality group tended to score significantly lower on psychological disturbance and eating disorder symptoms at the conclusion of treatment compared to patients in the other groups, and higher on spiritual well-being. On weekly outcome measures, patients in the Spirituality group improved significantly more quickly during the first four weeks of treatment. This study provides preliminary evidence that attending to eating disorder patients' spiritual growth and well-being during inpatient treatment may help reduce depression and anxiety, relationship distress, social role conflict, and eating disorder symptoms. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Stahre, L. & Hallstrom, T. (2005). A short-term cognitive group treatment program gives substantial weight reduction up to 18 months from the end of treatment: A randomized controlled trial. Eating and Weight Disorders, 10, 51-58.

Correspondence Address:
Lisbeth Stahre, Enebrovagen 26, Eskilstuna, Sweden, SE-633 47, lisbeth.stahre@telia.com.

Abstract
Objective: To describe and evaluate long-term efficacy (18 months from the end of treatment) of a new cognitive short-term weight reducing treatment program for obese patients. Subjects: One hundred and five obese [Body Mass Index (BMI) >=30] patients participated in the study. Of these, 62 took part in the treatment program and 43 served as controls. Method: From an obesity unit's waiting list the patients were randomly assigned to either a treatment group or remained in the waiting list to serve as a control group. The treatment group participated in a 10-week (30 hours) cognitive group treatment program. All participants were weighed at the outset of the study, directly after treatment and at a 6-, 12- and 18-month post-treatment follow-up without any booster treatment after the 10-week program. Results: Fifty-seven (92%) patients completed treatment. For the 34 (60%) patients who participated in the study 18 months after treatment was terminated, the mean weight loss at treatment's end was 8.5 kg (SD=16.1). Eighteen months later their mean weight loss was 10.4 kg (SD=10.8). The control patients (n=31, 72%) that participated in the study during the same period increased in weight by 2.3 kg (SD=7.0). The weight difference between the treatment and control group at the 18-month follow-up was highly significant (p<0.001). Conclusion: The cognitive group treatment program was highly acceptable among the participants and was completed by nearly all the patients. The 10-week treatment program resulted in satisfactory weight loss. The weight difference between the treatment group and controls was nearly the same at 18 months after end of treatment as at six months. The study, therefore, does not provide support for the contention that a lengthy therapy for obesity is necessary if treatment results are lasting. (PsycINFO Database Record (c) 2005 APA, all rights reserved).

Werrij, M. Q., Jansen, A., Mulkens, S., Elgersma, H., Ament, A.J.H.A., Hospers, H. J. (2009). Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity. Journal of Psychosomatic Research 67(4), 315-324.

Correspondence Address:
Marieke Q. Werrij, Department of Work and Social Psychology (Uns 5), Faculty of Psychology, Maastricht University, P.O. Box 616, Maastricht, Netherlands, 6200 MD, m.werrij@psychology.unimaas.nl .

Abstract
Objective: The treatment of obesity is universally disappointing; although usually some weight loss is reported directly after treatment, eventual relapse to, or even above, former body weight is common. In this study it is tested whether the addition of cognitive therapy to a standard dietetic treatment for obesity might prevent relapse. It is argued that the addition of cognitive therapy might not only be effective in reducing weight and related concerns, depressed mood, and low self-esteem, but also has an enduring effect that lasts beyond the end of treatment. Methods: Non-eating-disordered overweight and obese participants in a community health center (N=204) were randomly assigned to a group dietetic treatment+cognitive therapy or a group dietetic treatment+physical exercise. Results: Both treatments were quite successful and led to significant decreases in BMI, specific eating psychopathology (binge eating, weight-, shape-, and eating concerns) and general psychopathology (depression, low self-esteem). In the long run, however, the cognitive dietetic treatment was significantly better than the exercise dietetic treatment; participants in the cognitive dietetic treatment maintained all their weight loss, whereas participants in the physical exercise dietetic treatment regained part (25%) of their lost weight. Conclusion: Cognitive therapy had enduring effects that lasted beyond the end of treatment. This potential prophylactic effect of cognitive therapy is promising; it might be a new strategy to combat the global epidemic of obesity. (PsycINFO Database Record (c) 2009 (PsycINFO Database Record (c) 2009 APA, all rights reserved).