Guided self-help for bulimia nervosa in primary care: a randomized controlled trial

Area of Science:

• Psychiatry
• Psychology
• Primary Care Medicine

Background:

• Increasing access to cognitive behavioral therapy for bulimia nervosa necessitates exploring new delivery models.
• Guided Self-Help (GSH) in primary care presents a potentially valuable approach for bulimia nervosa treatment.

Purpose of the Study:

• To compare outcomes of GSH delivered by general practitioners (GPs) versus a delayed treatment control (DTC).
• To assess the maintenance of treatment gains at 3 and 6 months post-GSH intervention.

Main Methods:

• 109 women with bulimia nervosa were randomized to GSH (n=54) or DTC (n=55).
• GSH involved a 17-week guided self-help program with GP support using a specific manual.
• Assessments occurred pre-treatment, post-intervention/waiting period, and at 3- and 6-month follow-ups for the GSH group.

Main Results:

• Significant improvements in bulimic and psychological symptoms were observed in the GSH group compared to DTC.
• The GSH group experienced a 60% reduction in binge-eating episodes versus 6% in the DTC group.
• Remission from binge-eating and compensatory behaviors was achieved by 28% of the GSH group versus 11% of the DTC group, with gains maintained.

Conclusions:

• Outcomes of GSH delivered in primary care compare favorably with specialist-delivered psychological treatments for bulimia nervosa.
• GSH is a viable and effective treatment modality within the primary care setting for bulimia nervosa.