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The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self‐directed behavior, and self‐discrepancy within the mediation model
Author(s) -
Peterson Carol B.,
Berg Kelly C.,
Crosby Ross D.,
Lavender Jason M.,
Accurso Erin C.,
Ciao Anna C.,
Smith Tracey L.,
Klein Marjorie,
Mitchell James E.,
Crow Scott J.,
Wonderlich Stephen A.
Publication year - 2017
Publication title -
international journal of eating disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.785
H-Index - 138
eISSN - 1098-108X
pISSN - 0276-3478
DOI - 10.1002/eat.22669
Subject(s) - psychology , bulimia nervosa , binge eating , binge eating disorder , mediation , clinical psychology , cognitive behavioral therapy , eating disorders , cognition , outcome (game theory) , psychotherapist , experience sampling method , psychiatry , mathematics , mathematical economics , political science , law , social psychology
Objective The purpose of this investigation was to examine the indirect effects of Integrative Cognitive‐Affective Therapy (ICAT‐BN) and Cognitive‐Behavioral Therapy‐Enhanced (CBT‐E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self‐directed behavior, and self‐discrepancy. Method Eighty adults with BN were randomized to 21 sessions of ICAT‐BN or CBT‐E. A regression‐based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self‐directed behavior measured at mid‐treatment, as well as the indirect effects of treatment at follow‐up through emotion regulation, self‐directed behavior, and self‐discrepancy measured at end of treatment. Results No significant differences in outcome between treatment conditions were observed, and no significant direct or indirect effects were found. Examination of the individual paths within the indirect effects models revealed comparable treatment effects. Across treatments, improvements in emotion regulation and self‐directed behavior between baseline and mid‐treatment predicted improvements in global eating disorder scores but not binge eating and purging frequency at end of treatment. Baseline to end of treatment improvements in emotion regulation and self‐directed behavior also predicted improvements in global eating disorder scores at follow‐up. Baseline to end of treatment improvements in emotion regulation predicted improvements in binge eating and baseline to end of treatment increases in positive self‐directed behavior predicted improvements in purging at follow‐up. Discussion These findings suggest that emotion regulation and self‐directed behavior are important treatment targets and that ICAT‐BN and CBT‐E are comparable in modifying these psychological processes among individuals with BN.