guided self-help for binge eating disorder and bulimia · 2020. 4. 24. · overcoming binge eating...
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The University of Manchester Research
Guided Self-Help for Binge Eating Disorder and Bulimia
Link to publication record in Manchester Research Explorer
Citation for published version (APA):Vermes, C. (2011). Guided Self-Help for Binge Eating Disorder and Bulimia: A Practice-Based Study. In BritishPsychological Society Annual Conference
Published in:British Psychological Society Annual Conference
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Download date:10. Sep. 2021
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Guided Self-Help for
Binge Eating Disorder and Bulimia:
A Practice-Based Study
Caroline VermesM.Ed, MA, MBACP (Accred.), UKRCP, MBPsS
BPS Conference, Glasgow, 5th May 2011
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Why we experimented with guided self-help for
overcoming binge eating
How we conducted the study: a controlled,
non-randomised treatment trial
What we found out about patient characteristics that may
be predictive of outcome
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Bulimia Nervosa (BN): Recurrent episodes (at
least twice a week) of binge eating followed by
inappropriate compensatory behaviour
Binge Eating Disorder (BED): As above in the
absence of inappropriate compensatory behaviour
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Anorexia 34%
Bulimia 25%
Binge Eating Disorder 35%
EDNOS & Subclinical 6%
Non-underweight clients who binge eat = approx 66% of client base
Referral and treatment by diagnosis:
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NHS mental health services:
Demand Exceeds Resource (DER)
Why?
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Cost of providing NICE-recommended treatment for
BN-BED (20 sessions of CBT) =
£1,300.00
Stockport NHS annual spend per patient for
outpatient eating disorders treatment =
£625.00
Both prices include clinical staff pay, training, case management, programme
development, management of outcome measures, administration, supplies, premises,
utilities, taxes, publicity, outreach, DNAs etc
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Waiting Lists: Bad
Stepped Care: Good
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NICE: CBT-BN/BED top recommendation
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NICE: Self-help possible first step
Cheaper, easier access and some studies found PSH/GSH to
deliver outcomes similar to therapist-delivered
psychological therapy, but with better prospects of longer
term remission
Perkins, S., Murphy, R., Schmidt, U., Williams, C. (2006). Self-help and guided self-help for eating
disorders. Cochrane Database of Systematic Reviews.
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Who provides CBT-BN PSH/GSH in UK?
“Not I” said the doctor
“Not I” said IAPT
“Not I” said the primary mental
health team
“Not I” said all the eating disorder
services in the land
So we said, “We’ll do it ourselves”
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How?
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Help Yourself!
Intensive Guided
Self-Help Course
for Overcoming
Binge Eating
© North West Centre for Eating Disorders, Ltd.
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The guided self-help programme:
12-week structured course of readings and homework
12 weekly professionally facilitated support groups
Up to 3 one-to-one counselling sessions
Access to specialist dietitian
*Rapid access*
*Within budget*
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The guided self-help programme
Inclusion Criteria
•Binge eating at least 2 x week
and/or compulsive eating through
the week
• Psychotropic and/or obesity
medication okay
Exclusion Criteria
•CORE score over 3.0
• PHQ-9 score over 18
• Recent history of serious self harm
• Recent history of anorexia
• Learning disability such that
bibliotherapy is contraindicated
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Which book?BOOK PROS CONS
Christopher Fairburn (1995)
Overcoming Binge Eating
Guilford
Available in most libraries.
Step-by-step programme
comprises “gold standard”
CBT-BN
Professorial and dry. Does
not deal directly with
common emotional issues
Randi McCabe, Traci
McFarlane and Marion
Olmsted (2004) The
Overcoming Bulimia
Workbook New Harbinger
Pleasant to read and use,
covers emotional issues, lots
of practical exercises.
Nominated “best book” by
our clients
U.S. book, not available in
most libraries
Lindsey Hall and Leigh
Cohn (2001) Bulimia: A
Guide to Recovery
Gurze
Written by a recovered
person, offers insight into the
recovery process that other
self- help books lack
U.S. book, not available in
most libraries
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The Study
Comparative: cost and outcomes of GSH versus
treatment as usual: 1:1 integrative psychotherapy (IP)
Method: Quantitative treatment trial
Control group: Naturally occurring waiting list of
patients with similar symptom profiles
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Oct 2009 – March 2010 uptake and completion GSH versus 1:1 IP
252 referrals received, of which 166 for binge/compulsive eating
86 (52% of total referred for BN/BED) meet GSH inclusion
criteria & are offered assessment
70 clients (81% of those offered) attend assessment. 66 are included
in this study
28 clients (42% of assessed group) opt to wait for 1:1 therapy
(10-20 weeks to start)
2 still in therapy 6 on waiting list at end of study
(28.6% of cohort)
1:1 ATTRITION 8 DNR after assessment
5 DO < 4 sessions (46.4 % of cohort)
1:1 COMPLETERS
7 participants
(25% of cohort)
COMPLETE DATA
6 participants
INCOMPLETE DATA 1 participant
38 (58% of assessed group) opt to do GSH
(10 weeks or less to start)
GSH ATTRITION 1 DNR after assessment
2 DO < 4 weeks(7.9% of cohort)
GSH COMPLETERS
32 (84% of cohort)
COMPLETE DATA 31 participants
INCOMPLETE DATA 1 participant
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Outcome measures
1. SEDS - Sterling Eating Disorder Scales
2. CORE (measure of psychosocial distress)
3. PHQ-9 (depression)
4. GAD-7 (anxiety)
5. Client self-report
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What we found
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GSH completers: 56% (18/32) in remission (avg. 13 sessions)
IP completers: 86% (6/7) in remission (avg. 18 sessions)
Finding One: Clinical Outcomes
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1
1.2
1.4
1.6
1.8
2
2.2
2.4
X times more likely to be non-clinical after GSH
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For whom was GSH less helpful?
A. People who gained insufficient benefit from
completing the course
B. People who opted out of GSH and then DO/DNR
when offered alternative treatment
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What we learned about GSH completers who were
not in remission by the end of the course
• Significantly higher anxiety scores at baseline
(mean baseline GAD-7 score for non-remitted was 15.9
compared to 8.7 for the remitted subgroup)
• 76.9% of the non-remitted sub-group had a
mood disorder compared to 27.7% of the remitted group
Baseline characteristics of remitted and unremitted GSH completers were analysed using unrelated t-tests
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GSH = 8% versus IP = 46%
Finding Two: Attrition
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What we learned about the IP DO/DNR group
1. Significantly longer mean wait to start treatment
(m = 16.6 weeks vs. m = 3.6 weeks for GSH)
2. 77% had BN vs. 54% had BN in the overall study group
Significantly lower bulimic dietary behaviour scores than the GSH completer group
2. Significantly lower mean BMI
(m= 26.7 vs. m=33.8 for IP completers and 29.2 for GSH completers)
4. 38.5% were taking antidepressant medication compared to 33.3% of IP completers
and 23.3% of GSH completers
Scores on PHQ-9 were similar across the groups (potentially due in part to medication
effects), so larger sample sizes would be required to test whether depression plus
medication increases likelihood of DO/DNR
Baseline characteristics of study groups were analysed with one-way ANOVA with Tukey’s post hoc multiple comparisons
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Average NHS cost per IP completer = £1170.00
vs. NHS cost per GSH completer = £527.19
IP cost per participant in remission = £1950.00
GSH cost per participant in remission = £1151.90
Finding Three: Cost
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Conclusions
GSH BN-BED is a cost-effective alternative to high intensity
psychological therapy for approximately 25% of all patients
referred to secondary care
It offers significantly shorter waiting times
It is particularly helpful for patients who do not have a
concurrent mood or anxiety condition
Steps must be taken to engage patients with bulimia and mood
disorders in an acceptable form of treatment within ten weeks of
referral to reduce risk they will be lost to treatment
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