Objective: This study examined predictors and moderators of outcome in 2 treatments for bulimia nervosa (BN). Method: Eighty adults with BN symptoms at 1 of 2 sites were randomized to 21 sessions of integrative cognitive-affective therapy for BN (ICAT-BN) or enhanced cognitive behavior therapy (CBT-E). Generalized linear models examined predictors and moderators of improvements in bulimic behavior and eating disorder psychopathology at end of treatment (EOT) and 4-month follow-up (FU). Results: At EOT, individuals with higher dietary restraint had greater reductions in bulimic behavior. At FU, individuals with higher weight and shape concern had greater reductions in bulimic behavior, whereas those with greater baseline depression had less improvement in eating disorder psychopathology. Individuals higher in stimulus seeking had greater reductions in bulimic behavior and eating disorder psychopathology at follow up in ICAT-BN than in CBT-E, whereas individuals lower in stimulus seeking had greater reductions in bulimic behavior in CBT-E than in ICAT-BN. Finally, individuals with higher affective lability had greater reductions in eating disorder psychopathology in ICAT-BN than in CBT-E, whereas improvements were comparable across treatments for individuals with lower affective lability. Conclusions: This study identified 3 nonspecific predictors of outcome (i.e., dietary restraint, weight and shape concern, and depression) and 2 moderators (i.e., affective lability and stimulus seeking). All moderator effects emerged at FU rather than at EOT, suggesting that the moderating effects of treatment were not immediately apparent. These results suggest that individuals with higher affective lability and stimulus seeking may benefit more from treatment with a greater focus on affective states and self-regulation.
Bibliographical noteFunding Information:
We thank Li Cao for her contribution to data analysis, as well as Andrea B. Goldschmidt for her assistance with manuscript conceptualization and preparation. This work was supported by Grants R34MH077571 and T32MH082761 from the National Institute of Mental Health, Grants R01DK61912 and P30DK50456 from the National Institute of Diabetes and Digestive and Kidney Diseases, and the Neuropsychiatric Research Institute. (Clinical Trials.gov Identifier: NCT00773617.).
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- bulimia nervosa
- treatment outcome