Bulimia nervosa (BN) is a serious and often chronic psychiatric disorder with high rates of medical complications, social impairment and comorbid psychopathology. Cognitive behavioral therapy (CBT) has been shown to be an efficacious approach to the treatment of BN with substantial reductions in core binge eating and compensatory behaviors, as well as psychological impairments. However, in spite of its demonstrated efficacy, 50-70% of bulimic individuals remain symptomatic following treatment with CBT, a significant number drop out of treatment, and relapse rates are substantial. The need for new psychological treatments for BN that can improve the overall response to treatment is high. Integrative cognitive-affective therapy (ICAT) is a new, manual-based, psychological approach to the treatment of BN. ICAT incorporates both conceptual and clinical techniques from existing theories of motivation, emotion, interpersonal functioning, and behavioral change interventions. ICAT is based on a conceptual model of BN that includes several core constructs such as self-discrepancy, affective states, interpersonal patterns, and self-directed style. ICAT includes a clinician manual, patient workbook, and personal digital assistant based treatment modules, all of which are offered in a 20-session, 16-week format. Pilot data testing the model underlying ICAT are promising and suggest that several of the core constructs are significantly associated with BN. Furthermore, two waves of pilot testing indicate that ICAT is feasible to administer and is able to reduce bulimic symptomatology in a relatively short timeframe. ICAT appears to be a promising approach to the treatment of BN and we are requesting funding in this application to refine treatment manuals, develop assessment procedures, and conduct a small randomized controlled trial comparing ICAT to CBT. ? ? ?
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