Bulimia nervosa is a health-threatening, emotional disorder involving the loss of control over food intake (binge eating) followed by self-induced vomiting in normal weight individuals (typically women). Cognitive-behavioral treatments have shown considerable promise in the treatment of this disorder, although controlled studies with adequate long-term follow-up and systematic analysis of relapse rates are lacking. The present proposal seeks to remedy this lack of evaluation. The PI has developed a cognitive-behavioral treatment (CBT) program that has produced encouraging findings with predominantly young, college age women. The existing literature about the treatment of older, more chronic cases is conflicting, and this proposal provides the first experimental comparison of the treatment of younger versus older (more chronic) patients. In treating these two sub-groups of bulimics, the PI's CBT approach will be compared with A. Lazarus' technical eclecticism (TE), a broader form of psychotherapy, and a minimal treatment condition. It may be that TE, with its broader focus, will prove more effective than CBT with the more chronic and more disturbed patients. Within the CBT treatment, a novel vicarious learning method for overcoming patient resistance to the use of the technique of exposure and vomit prevention will be evaluated. Within the context of this outcome study, detailed analyses will be made of competing theories of the mechanisms responsible for therapeutic success and failure. The CBT and TE treatments make specific predictions about long-term maintenance of improvement. Particular emphasis is placed on facilitating and assessing long-term improvement with a view to testing the respective theories of relapse prevention.
