An uncontrolled evaluation of inpatient and outpatient cognitive-behavior therapy for bulimia nervosa.
Inpatient CBT beats bulimia faster than outpatient, yet slower outpatient gains may last longer.
01Research in Context
What this study did
Wanchisen et al. (1989) ran an uncontrolled study of CBT for bulimia.
They treated 41 women in two settings: 20 lived on an inpatient unit, 21 came to day sessions.
Therapy added exposure plus response prevention and cognitive restructuring to standard CBT.
Staff tracked binge and vomit counts over the study period, then again six months later.
What they found
Both groups got better.
Inpatients cut binges and vomiting faster, but some slipped back after discharge.
Outpatients improved more slowly, yet their gains looked steadier at follow-up.
How this fits with other research
Douma et al. (2006) conceptually replicated the urge-reduction goal.
They showed one adult woman that eating bite-by-bite with ten-second pauses wiped out her post-meal vomiting urge.
The tiny single-case result supports the 1989 package: slow, rule-governed eating can curb purging.
Manabe (1990) surveyed bulimic women and listed top binge triggers: skipping meals, eating alone, fights with mothers or partners.
You can fold those cues into the same exposure-plus-response-prevention drills A et al. tested.
Why it matters
If you treat adults with disordered eating, expect faster gains in a controlled setting, but plan extra relapse-prevention for the return home.
Teach clients to spot the triggers Manabe (1990) found and to eat slowly as Douma et al. (2006) did.
Combine both tactics with the 1989 CBT package to make improvement stick.
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02At a glance
03Original abstract
Inpatient (n = 27) and outpatient (n = 22) cognitive-behavior therapy programs for bulimia nervosa were evaluated in an uncontrolled experiment. Both treatment conditions included exposure with response prevention and cognitive restructuring. Inpatient treatment had a mean length of stay of 5 weeks. Outpatient treatment lasted 15 weeks. Both groups were followed after the end of treatment. The results showed that both programs were effective in reducing problems associated with bulimia nervosa. The inpatient program led to very rapid progress, whereas the outpatient program led to more gradual improvement. There was, however, a trend toward relapse for inpatients. Other psychological disturbances, (e.g., depression) were improved after inpatient, but not outpatient, treatment. These data were discussed in terms of their implications for treatment planning for cases of bulimia nervosa.
Behavior modification, 1989 · doi:10.1177/01454455890133004