Objective: The purpose of this investigation was to examine the indirect effects of Integrative Cognitive-Affective Therapy (ICAT-BN) and Cognitive-Behavioral Therapy-Enhanced (CBT-E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self-directed behavior, and self-discrepancy. Method: Eighty adults with BN were randomized to 21 sessions of ICAT-BN or CBT-E. A regression-based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self-directed behavior measured at mid-treatment, as well as the indirect effects of treatment at follow-up through emotion regulation, self-directed behavior, and self-discrepancy measured at end of treatment. Results: No significant differences in outcome between treatment conditions were observed, and no significant direct or indirect effects were found. Examination of the individual paths within the indirect effects models revealed comparable treatment effects. Across treatments, improvements in emotion regulation and self-directed behavior between baseline and mid-treatment predicted improvements in global eating disorder scores but not binge eating and purging frequency at end of treatment. Baseline to end of treatment improvements in emotion regulation and self-directed behavior also predicted improvements in global eating disorder scores at follow-up. Baseline to end of treatment improvements in emotion regulation predicted improvements in binge eating and baseline to end of treatment increases in positive self-directed behavior predicted improvements in purging at follow-up. Discussion: These findings suggest that emotion regulation and self-directed behavior are important treatment targets and that ICAT-BN and CBT-E are comparable in modifying these psychological processes among individuals with BN.
Bibliographical noteFunding Information:
The authors with to thank Drs. Tricia Cook Myers, Kathryn Miller, and Lorraine Swan-Kremeier for serving as therapists on the study, Li Cao, M.S. and Ann Erickson for their contributions to data analysis, Nora Durkin, M.A., Scott Engel, Ph.D., Leah Jappe, Ph.D., and Heather Simonich, M.A., for their assistance with data collection, assessment interviewing, and manuscript preparation. Ross Crosby, Ph.D., is a statistical consultant for Health Outcomes Solutions (Winter Park, Florida). Stephen Wonderlich, Ph.D., Carol Peterson, Ph.D., Tracey Smith, Ph.D., Marjorie Klein, Ph.D., James Mitchell, M.D., and Scott Crow, M.D., are coauthors of ?Integrative Cognitive-Affective Therapy for Bulimia Nervosa: A Treatment Manual? (Guilford Press, 2015). Clinical Trials.gov Identifier: NCT00773617
- bulimia nervosa
- cognitive-behavioral therapy
- emotion regulation
- emotion-focused therapy
- integrative cognitive-affective therapy