Rapid Response to Day Hospital Treatment in Bulimia Nervosa and Purging Disorder: a Randomized Controlled Trial of an Intervention to Facilitate Early Behaviour Change
Notice bibliographique
Résumé
Even the most effective treatments for bulimia nervosa and purging disorder have high rates of nonremission and relapse. As such, improving treatment efficacy is an important research priority in this area. Research has consistently demonstrated that rapid response – defined as substantial improvements in key eating disorder behaviours (e.g., binge eating, vomiting, dietary restriction) during the initial weeks of cognitive behavioural therapy (CBT) – is the strongest and most robust predictor of good outcomes at end-of-treatment and in follow-up (Vall & Wade, 2015). Further, research has failed to identify pre-treatment demographic or clinical variables that account for this relationship, suggesting that rapid response is due to elements of CBT itself. This study aimed to demonstrate that rapid response can be clinically facilitated. A four-session CBT intervention focused on encouraging rapid response was compared to a matched-intensity motivational interviewing intervention, both adjunctive to intensive treatment in a randomized controlled trial. The CBT intervention included psychoeducation about rapid response, a focus on goal-setting, and use of behavioural skills for making concrete changes. Forty-four women with bulimia nervosa or purging disorder participated in the study. There were no baseline differences between groups on any demographic or clinical variables. Intent-to-treat results showed that compared to those who received motivational interviewing, participants who received CBT were significantly more likely to make a rapid response to day hospital treatment, and had fewer total eating disorder behaviours and more normalized eating during the first 4 weeks of day hospital treatment. Additionally, between baseline and day hospital end-of-treatment, participants who received CBT made significantly greater improvements on overvaluation of weight and shape and difficulties with emotion regulation. These findings indicate that rapid response to intensive treatment can be clinically facilitated using an adjunctive intervention focused on encouraging rapid and substantial change. These findings also suggest that rapid response may be related to improved outcome via improvements in overvaluation of weight and shape or emotion regulation. This study provides support for theoretical contentions that rapid response is due to CBT-related factors, and provides the framework for future research investigating rapid response as a causal mechanism of good outcome for eating disorders.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».