Adapting integrative cognitive-affective therapy for adolescents with full and subthreshold bulimia nervosa: A feasibility study

Jocelyn Lebow, Leslie Sim, Stephen Wonderlich, Carol B. Peterson

Research output: Contribution to journalArticlepeer-review


Background: Integrative Cognitive Affective Therapy (ICAT) is an empirically supported treatment for bulimia nervosa (BN) in adults. However, it is unclear whether a modified version, Integrative Cognitive Affective Therapy–Adolescent (ICAT-A) is feasible and beneficial for adolescents. This study evaluated the feasibility of ICAT-A for adolescents with BN or subthreshold BN. Methods: Eight adolescents with BN or subthreshold BN (mean age = 16.1) were enroled in the study. At baseline and end of treatment, adolescents who participated in ICAT-A completed the Eating Disorder Examination (EDE) and self-report measures of eating disorder symptoms, depression, anxiety, self-esteem and functional impairment. Results: Retention for the intervention (75%) suggests that the majority of participants found the intervention acceptable. Although all treatment completers participated in the clinician-administered assessment (EDE), compliance with end of treatment self-report questionnaires was compromised by the COVID-19 pandemic, which occurred during the treatment course of the majority of the sample. At the end of treatment, all 6 adolescents who completed the ICAT-A intervention were in full eating disorder remission based on EDE scores, with large effect sizes identified for reductions in EDE global scores (d = 2.71), objective binge episodes (d = 0.91), subjective binge episodes (d = 1.06) and compensatory behaviours (d = 1.72). Conclusion: Results suggest that ICAT-A is a feasible treatment that has promise for the treatment of adolescents with BN. Future studies are necessary to establish the efficacy of ICAT-A for adolescent BN.

Original languageEnglish (US)
Pages (from-to)178-187
Number of pages10
JournalEuropean Eating Disorders Review
Issue number1
StatePublished - Jan 2023

Bibliographical note

Funding Information:
This study was financed by a Feeding Hope Fund Grant from the National Eating Disorder Association and the Eating Recovery Foundation.

Publisher Copyright:
© 2022 Eating Disorders Association and John Wiley & Sons Ltd.


  • adolescent
  • bulimia nervosa
  • feeding and eating disorders

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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