Eating disorders are debilitating psychiatric conditions that produce numerous medical complications. Progress has been made in identifying empirically supported treatments for eating disorders, especially for bulimia nervosa. The most promising approach, cognitive-behavior therapy (CBT), has been found to be more effective than alternate treatments in a number of studies. However, all of these studies have been conducted using efficacy designs. The applicability of these findings to applied clinical settings generally, and to intensive outpatient (IOP) programs in particular, is unknown. The purpose of the proposed research is to adapt a key component of CBT, called Normalization of Eating (NOE), to IOP programs and to evaluate its impact using an effectiveness design. During a 4-month Adaptation Phase, the research team will work collaboratively with the IOP directors and therapists to adapt key components of CBT manuals for anorexia and bulimia nervosa for use in the lOPs and to train IOP therapists in their application.
The specific aims of the project are to: 1) adapt NOE procedures from CBT treatment manuals for use among AN- and BN-spectrum patients treated at an IOP program; 2) collect descriptive data on the therapists' evaluation of the NOE adaptation process as well as their perceptions of the effectiveness of the lOP's approach to treating eating and weight problems during the treatment-as-usual (TAU) and TAD + NOE phases of the study; and 3) conduct a pilot test of the TAU + NOE program by comparing it with TAU at two IOP sites. The study will be conducted in three phases: Eight months of TAU, four months of the Adaptation Phase, and eight months of TAU + NOE. Outcome during the TAU and TAU + NOE phases will be evaluated by assessing patients at baseline, post-treatment, and a 6-month follow-up on body weight, the Eating Disorders Examination, the Structured Clinical Interview for DSM-IV Axis I Disorders and several widely-used selfreport measures of disordered eating.
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