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Testing a stepped care model for binge-eating disorder: a two-step randomized controlled trial

Published online by Cambridge University Press:  24 May 2018

Giorgio A. Tasca*
Affiliation:
University of Ottawa, School of Psychology and The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
Diana Koszycki
Affiliation:
University of Ottawa, Faculty of Education and Institut du savoir Montfort, Department of Psychiatry, Ottawa, Canada
Agostino Brugnera
Affiliation:
Universita degli studi di Bergamo, Department of Human and Social Sciences, Bergamo, Italy
Livia Chyurlia
Affiliation:
University of Ottawa, School of Psychology, Ottawa, Canada
Nicole Hammond
Affiliation:
University of Ottawa, School of Epidemiology, Public Health, and Preventive Medicine, Ottawa, Canada
Kylie Francis
Affiliation:
The Royal Ottawa Health Care Group, Department of Psychology, Ottawa, Canada
Kerri Ritchie
Affiliation:
University of Ottawa, School of Psychology and The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
Iryna Ivanova
Affiliation:
The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
Genevieve Proulx
Affiliation:
The Ottawa Hospital, Department of Social Work, Ottawa, Canada
Brian Wilson
Affiliation:
The Ottawa Hospital, Department of Social Work, Ottawa, Canada
Julie Beaulac
Affiliation:
University of Ottawa, School of Psychology and The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
Hany Bissada
Affiliation:
University of Ottawa, Department of Psychiatry and The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
Erin Beasley
Affiliation:
The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
Nancy Mcquaid
Affiliation:
University of Ottawa, School of Psychology, Ottawa, Canada
Renee Grenon
Affiliation:
University of Ottawa, School of Psychology, Ottawa, Canada
Benjamin Fortin-Langelier
Affiliation:
The Royal Ottawa Health Care Group, Department of Psychiatry, Ottawa, Canada
Angelo Compare
Affiliation:
Universita degli studi di Bergamo, Department of Human and Social Sciences, Bergamo, Italy
Louise Balfour
Affiliation:
University of Ottawa, School of Psychology and The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
*
Author for correspondence: Giorgio A. Tasca, E-mail: gtasca@uottawa.ca

Abstract

Background

A stepped care approach involves patients first receiving low-intensity treatment followed by higher intensity treatment. This two-step randomized controlled trial investigated the efficacy of a sequential stepped care approach for the psychological treatment of binge-eating disorder (BED).

Methods

In the first step, all participants with BED (n = 135) received unguided self-help (USH) based on a cognitive-behavioral therapy model. In the second step, participants who remained in the trial were randomized either to 16 weeks of group psychodynamic-interpersonal psychotherapy (GPIP) (n = 39) or to a no-treatment control condition (n = 46). Outcomes were assessed for USH in step 1, and then for step 2 up to 6-months post-treatment using multilevel regression slope discontinuity models.

Results

In the first step, USH resulted in large and statistically significant reductions in the frequency of binge eating. Statistically significant moderate to large reductions in eating disorder cognitions were also noted. In the second step, there was no difference in change in frequency of binge eating between GPIP and the control condition. Compared with controls, GPIP resulted in significant and large improvement in attachment avoidance and interpersonal problems.

Conclusions

The findings indicated that a second step of a stepped care approach did not significantly reduce binge-eating symptoms beyond the effects of USH alone. The study provided some evidence for the second step potentially to reduce factors known to maintain binge eating in the long run, such as attachment avoidance and interpersonal problems.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2018 

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