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Cognitive-Behavioral Therapy and Other Short-Term Approaches 123 have no guided assistance. In the initial study, Cooper, Coker, and Fleming (1994) showed that more than half the bulimic patients reported marked clinical improvement using a therapist-led, selfhelp manual. With the advent of managed health care, impetus has developed in our field to identify the most cost-effective and easily disseminated forms of treatment. Fairburn and Peveler (1990) have suggested the adoption of a stepped-care approach in the treatment of binge-eating disorders. This health care delivery model involves first offering a simple treatment, since some patients will respond positively. The first treatment tier might be an unsupervised selfhelp format. Those who do not respond move on to the next step, which involves more intensive therapy. For example, it might consist of a guided self-help treatment. Should self-help prove unsuccessful, then the third level of care, such as a CBT approach, would be required. If the patient proves to be a nonresponder, then another level of treatment would be instituted, such as the addition of an antidepressant, partial hospitalization, or an inpatient stay. Recent research has shown that this model may be promising for both bulimia nervosa (Davis et al. 1999) and binge-eating disorders (Peterson et al. 1998). Of particular importance at this juncture, however, is for researchers to identify patient characteristics that may predict the level of stepped-up care to which the individual will respond. CONCLUDING REMARKS The efficacy of cognitive-behavioral therapy and interpersonal psychotherapy has been clearly demonstrated in the treatment of bingeeating disorders. Furthermore, initial clinical studies have been encouraging for the use of CBT in treating anorexia nervosa as well, and controlled clinical trials are currently under way. Since cognitive-behavioral therapy and interpersonal psychotherapy are both manualized treatments, they have the added advantage of being widely available to clinicians and easier for experienced therapists to acquire the skills needed to use these approaches. Moreover, since these approaches are highly structured
124 Cognitive-Behavioral Therapy and Other Short-Term Approaches and have time limits, both clinician and patient are forced to remain focused on a circumscribed set of symptoms and behaviors, and to work hard on making well-defined changes. All these features are especially attractive given the reality of managed care and the corresponding need for adequate and effective treatment within that circumscribed framework. References Agras, W. S. and R. F. Apple. 1997. Overcoming Eating Disorders: A Cognitive-Behavioral Treatment for Bulimia Nervosa and Binge-Eating Disorder. Therapist Guide. San Antonio: The Psychological Corporation. Agras, W. S., E. M. Rossiter, B. Arnow, J. A. Schneider, C. F. Telch, S. D. Raeburn, B. Bruce, M. Perl, and L. M. Koran. 1992. “Pharmacologic and Cognitive-Behavioral Treatment for Bulimia Nervosa: A Controlled Comparison.” American Journal of Psychiatry 149:82–87. Agras, W. S., J. A. Schneider, B. Arnow, S. D. Raeburn, and C. F. Telch. 1989. “Cognitive-Behavioral and Response Prevention Treatments for Bulimia Nervosa.” Journal of Consulting and Clinical Psychology 57:215–21. Agras, W. S., C. F. Telch, B. Arnow, D. Eldredge, and M. Marnell. 1997. “One-Year Follow-up of Cognitive-Behavioral Therapy for Obese Individuals with Binge Eating Disorder.” Journal of Consulting and Clinical Psychology 65:343–47. Beck, A. T., A. J. Rush, B. F. Shaw, and G. Emery. 1979. Cognitive Therapy of Depression. New York: Guilford. Cooper, P. J., S. Coker, and C. Fleming. 1994. “Self-Help for Bulimia Nervosa: A Preliminary Report.” International Journal of Eating Disorders 16:401–4. Cooper, P. J., and C. G. Fairburn. 1984. “Cognitive-Behavioral Treatment of Anorexia Nervosa: Some Preliminary Findings.” Journal of Psychosomatic Research 28:493–99. Davis, R., G. McVey, M. Heinmaa, W. Rockert, and S. Kennedy. 1999. “Sequencing of Cognitive-Behavioral Treatments for Bulimia Nervosa.” International Journal of Eating Disorders 25:361–74. Diagnostic and Statistical Manual of Mental Disorders (IV). 1994. Washington, D.C.: American Psychiatric Association. Fairburn, C. G. 1981. “A Cognitive Behavioural Approach to the Management of Bulimia.” Psychological Medicine 11:707–11.
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editor BARBARA P. KINOY EATING DISO
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Eating Disorders New Directions in
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To our patients’ children and gra
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viii Contents 3. Psychiatric Consul
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x Foreword Although serious deficie
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preface In 1994, in the first editi
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Preface xv psychological hazards to
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Preface xvii partial, complete, or
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acknowledgments We wish to acknowle
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contributors Debra Bader, CSW, BCD:
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Eating Disorders
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Introduction diane w. mickley I am
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Introduction 3 needs of patients wh
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Introduction 5 therapy or on medica
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1 Medical Aspects of Anorexia and B
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Medical Aspects of Anorexia and Bul
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2 Recovery Through Nutritional Coun
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Recovery Through Nutritional Counse
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Lesson 1: Daily Caloric Need and Me
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ical activity to a normal level. If
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patient who binges, it may be helpf
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and allowing herself to consume a l
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Figure 2.3 Typical Hunger and Food
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herself. She frequently feels hopel
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3 Psychiatric Consultation with Eat
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Psychiatric Consultation 51 standab
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Psychiatric Consultation 53 difficu
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Psychiatric Consultation 55 Obsessi
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4 A Family Systems Perspective on R
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A Family Systems Perspective on Rec
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she calls her mother and tells her
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Page 98 and 99: A Family Systems Perspective on Rec
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Page 102 and 103: 5 Relationship to Food as to the Wo
Page 104 and 105: iors—somehow to integrate the fra
Page 106 and 107: treatment, Theresa wanted to see an
Page 108 and 109: Relationship to Food as to the Worl
Page 114 and 115: 6 The Therapeutic Use of Humor in t
Page 116 and 117: The Therapeutic Use of Humor 91 Amy
Page 118 and 119: The Therapeutic Use of Humor 93 was
Page 120 and 121: The Therapeutic Use of Humor 95 ass
Page 122 and 123: The Therapeutic Use of Humor 97 Ron
Page 124 and 125: Jodie’s Story 99 capacity to make
Page 126 and 127: Jodie’s Story 101 house and a ter
Page 128 and 129: Jodie’s Story 103 She did not do
Page 130 and 131: adness. The dream also revealed tha
Page 132 and 133: 8 Eating Disorders and Managed Care
Page 134 and 135: Eating Disorders and Managed Care 1
Page 136 and 137: Eating Disorders and Managed Care 1
Page 138 and 139: Cognitive-Behavioral Therapy and Ot
Page 152 and 153: 10 The Nurse’s Role in a Pilot Pr
Page 154 and 155: The Nurse’s Role in a Pilot Progr
Page 156 and 157: The Nurse’s Role in a Pilot Progr
Page 158 and 159: 11 Individual Psychotherapy: A Long
Page 160 and 161: Individual Psychotherapy 135 Such p
Page 162 and 163: Individual Psychotherapy 137 empath
Page 164 and 165: weight and shape, as well as change
Page 166 and 167: Individual Psychotherapy 141 vomiti
Page 168 and 169: Individual Psychotherapy 143 During
Page 170 and 171: Individual Psychotherapy 145 and re
Page 172 and 173: Individual Psychotherapy 147 Mitche
Page 174 and 175: Young Adult Women 149 to surface an
Page 176 and 177: Young Adult Women 151 with their at
Page 178 and 179: Young Adult Women 153 ing; in fact,
Page 180 and 181: Young Adult Women 155 doomed, and a
Page 182 and 183: part of a treatment team where the
Page 184 and 185: 13 Recovery margaret goldkopf-woodt
Page 186 and 187: Recovery 161 I can appreciate both
Page 188 and 189: Recovery 163 meant. I certainly cou
Page 190 and 191: Recovery 165 ate other uncomfortabl
Page 192 and 193: Recovery 167 connection between my
Page 194 and 195: Recovery 169 safe place, and our ow
Page 196 and 197: Recovery 171 My pregnancies and mot
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Recovery 173 They seem to be living
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Recovery 175 Self-disclosure remain
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nel. All that I feared, the hurts I
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Afterword 179 surprisingly rapidly
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Afterword 181 With eating disorders
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Treatment helped me to face life, i
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AA/BA. See American Anorexia/Bulimi
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37; prevention of, 29-31; rigid die
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problems and, 19; events triggering
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Keel, P. K., 180 Keller, H., 133 Ke
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Psychoeducational group therapy, 12
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112-20; IPT, 121-22; psychoeducatio
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