Guided self-help is a useful and cost-effective treatment for people with bulimia nervosa and binge eating disorder who are referred to hospital. This type of therapy can be offered in primary care and is a promising alternative to a long wait for full therapy.

 

Published in the September issue of the British Journal of Psychiatry this randomised controlled trial compared three forms of self-help over four months with a waiting-list comparison group. Use of services was measured over the next eight months.

 

Participants in the trial were referred from primary care to the Leicester Eating Disorders Service. They were diagnosed with bulimia nervosa, partial syndromes of the condition, or with binge eating disorder. The self-help treatment offered was based on the book Overcoming Binge Eating, by Christopher Fairburn.

 

121 patients entered the trial, of whom only four were male. 61 patients were on antidepressant medication. 31 patients were randomised to the waiting list, 32 to self-help with minimal guidance, 30 to self-help with face-to-face guidance and 28 to self-help with telephone guidance.

 

At the four-month reassessment appointment, patients were offered further treatment depending on their condition and how much they had improved. This ‘stepped care’ approach included full therapy (cognitive or interpersonal), more guided self-help or no further treatment apart from being given the self-help book. Participants were then reassessed at eight and 12 months.

 

Drop-out rates at four months varied from 22% in the minimal guidance group to 29% for the waiting list group. Those who had the most treatment had a significantly greater chance of improvement. At four months it was found that 19% in the waiting list group showed improvement, 25% in the minimal guidance group, and 36% and 50% in the telephone and face-to-face guidance groups respectively.

 

This rate of improvement among those receiving guided self-help is similar to that reported in other studies for more elaborate treatments. However, in the stepped care stage of treatment in the specialist eating disorders unit, guided self-help did not save overall clinical input in the long run.

 

The authors conclude that self-help based upon a book is an effective treatment for bulimia nervosa and binge eating disorder when accompanied by a few sessions of professional guidance, even when this is given over the telephone. Telephone guidance could be useful in, for example, rural areas where patients or therapists might have to travel long distances. Primary care may well be the best place for guided self-help.

 

For further information, please contact Liz Fox or Deborah Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 6298 or 6127

E-mail: efox@rcpsych.ac.uk or dhart@rcpsych.ac.uk