Treatment manuals: Use in the treatment of bulimia nervosa

doi:10.1016/j.brat.2011.09.002

Behaviour Research and Therapy

Volume 49, Issue 11, November 2011, Pages 815-820

https://doi.org/10.1016/j.brat.2011.09.002 Get rights and content

Abstract

As psychology has moved toward emphasizing evidence-based practice, use of treatment manuals has extended from research trials into clinical practice. Minimal research has directly evaluated use of manuals in clinical practice. This survey of international eating disorder professionals examined use of manuals with 259 clinicians’ most recent client with bulimia nervosa. Although evidence-based manuals for bulimia nervosa exist, only 35.9% of clinicians reported using a manual. Clinicians were more likely to use a manual if they were younger; were treating an adult client; were clinical psychologists; were involved in research related to eating disorders; and endorsed a cognitive-behavioral orientation. Clinicians were less likely to use a manual if they provided eclectic psychotherapy that incorporated multiple psychotherapeutic approaches. We conclude that psychotherapy provided in clinical practice often does not align with the specific form validated in research trials, and “eclecticism” is at odds with efforts to disseminate manuals into clinical practice.

Highlights

► Treatment in clinical practice often differs from that validated in research trials. ► 64% of therapists did not use a manual when providing psychotherapy for bulimia. ► Only 47% of CBT providers reported using a manual. ► Education field, research involvement and treatment approach related to manual use. ► Eclecticism may be at odds with efforts to disseminate manuals in clinical practice.

Section snippets

Participants

Potential participants were identified through the member directories of two international organizations for ED research, treatment, and prevention: the Academy for Eating Disorders (AED) and the Eating Disorders Research Society (EDRS). Both the AED and EDRS are primarily English-language organizations. To be eligible to participate in the present study, members must have provided multiple sessions of psychotherapy to at least one individual with BN in the past 12 months.

Measures

An online survey was

Results

An email message describing the study was sent to 1297 individuals who had their name and email address listed in the member directory of AED and/or EDRS. Sixty-seven of these messages were undeliverable. Of the 1230 potential participants whose emails did not bounce back, 36.3% (n = 446) responded. Of the respondents, 2.7% (n = 12) declined participation, 36.3% (n = 162) were ineligible to participate (i.e., had not provided psychotherapy to a client with BN in the past 12 months), and 61.0% (n = 272)

Discussion

This study surveying use of manuals in psychotherapy provision for BN provides information relevant to the current movement toward evidence-based practice in mental health. Overall, the data suggested a low rate of manual use for psychotherapy provision: only approximately one-third of participants indicated that they had used a manual when treating their most recent client with BN. Analysis of variables describing the clinician, client, and treatment approach provided insight into factors

Acknowledgments

This manuscript is based on a portion of the master’s thesis research of Laurel M. Wallace, which was completed under the supervision of Kristin M. von Ranson and supported in part by a Social Sciences and Humanities Research Council of Canada Master’s Scholarship. We thank Dr. Susann Laverty, Dr. Keith Dobson, and Dr. Jean Wallace for their assistance with study design, and Phil Masson for his assistance with data coding. Finally, we express sincere gratitude to those who volunteered their

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Research has shown that clinicians underuse or omit techniques that constitute an essential part of evidence-based therapies. However, it is not known whether this is the case in DBT for eating disorders. The aims of this study were; 1) exploring the extent to which DBT techniques were used by self-identified DBT clinicians treating eating disorders; 2) determining whether therapists fell into distinct groups, based on their usage of DBT techniques; and 3) examining whether clinician characteristics were related to the use of such techniques.
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Shorter communicationTreatment manuals: Use in the treatment of bulimia nervosa

Abstract

Highlights

Section snippets

Participants

Measures

Results

Discussion

Acknowledgments

Behaviour Research and Therapy

Behaviour Research and Therapy

Journal of Substance Abuse Treatment

Behaviour Research and Therapy

A national survey of practicing psychologists’ attitudes toward psychotherapy treatment manuals

Journal of Consulting and Clinical Psychology

Barriers to dissemination of evidence-based practices: addressing practitioners’ concerns about manual-based psychotherapies

Clinical Psychology: Science and Practice

Research- and community-based clinicians’ attitudes on treatment manuals

The American Journal on Addictions

Defining empirically supported therapies

Journal of Consulting and Clinical Psychology

Improved treatment outcome associated with the shift to empirically supported treatments in an outpatient clinic is maintained over a ten-year period

Professional Psychology: Research and Practice

Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments

British Journal of Psychiatry

The use of treatment manuals in cognitive therapy: experience and issues

Journal of Consulting and Clinical Psychology

Motivational enhancement therapy and self-help treatment for binge eaters

Psychology of Addictive Behaviors

Cognitive behavior therapy and eating disorders

Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up

American Journal of Psychiatry

Psychotherapy and bulimia nervosa: the longer-term effects of interpersonal psychotherapy, behavior therapy and cognitive behavior therapy

Archives of General Psychiatry

Cognitive behavioural treatment for binge-eating and bulimia nervosa

Usual care psychotherapy for depression in a large managed behavioural health organization

Administration and Policy in Mental Health

Shorter communication
Treatment manuals: Use in the treatment of bulimia nervosa