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Thesis
Trajectories of therapeutic skills use and their dynamic relations to symptom change during cognitive-behavioral therapy for bulimia nervosa
Master of Science (M.S.), Drexel University
Sep 2023
DOI:
https://doi.org/10.17918/00001840
Abstract
Cognitive-behavioral therapy, including the enhanced version (CBT-E), is the leading treatment for bulimia nervosa (BN). Yet, a significant proportion of patients have suboptimal outcomes, prompting a need to investigate factors that drive symptom change during treatment. CBT-E teaches skills to address key mechanisms of change (i.e., reducing dietary restraint and increasing adaptive responses to cues for binge eating) and promotes skills use between sessions. It has been hypothesized that poor acquisition and use of CBT-E skills contribute to suboptimal treatment outcome, and limited research supports that therapeutic skills use is associated with improved treatment outcomes. However, the trajectories of patients' use of each CBT-E skill and the temporal relations between skills use and symptom change during treatment have not been explored. Examining patterns of skills use and their prospective associations with symptoms could inform interventions focused on targeting the most potent skills for symptom improvement and elucidate the optimal timing and frequency of skills practice. In this study, fifty-five adults (M age: 39.0 ± 14.1; 83.9% female; 64.3% White, 93.6% non-Hispanic/Latino) receiving CBT-E for BN-spectrum EDs self-monitored their eating and use of five therapeutic skills (i.e., regular eating, eating enough to prevent excessive hunger and eating a range of macronutrients, breaking dietary rules, urge management strategies, and mood management strategies) several times per day during treatment. Patients also self-reported their symptoms (i.e., frequency of binge eating, compensatory behaviors, and dietary restraint) weekly prior to each therapy session. This study examined trajectories in use of each CBT-E skill and weekly relations between use of each skill and behavioral BN symptoms throughout treatment. Participants showed significant increases in eating enough to prevent excessive hunger and eating a range of macronutrients from week to week during treatment, as well as significant increases in regular eating and urge management strategy use in the first half of treatment and a significant increase in breaking food rules in the second half of treatment. Regular eating, eating enough to prevent excessive hunger, and eating a range of macronutrients one week predicted lower ED symptoms the same week and the following week. Results provide preliminary evidence for temporal relationships between therapeutic skills use and symptom change on a weekly level and support that specific CBT-E skills are associated with differential patterns of BN symptom change during treatment. Findings highlight the promise of future work in this area to elucidate the most potent CBT-E skills for symptom improvement and inform more targeted interventions for BN-spectrum EDs.
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Details
- Title
- Trajectories of therapeutic skills use and their dynamic relations to symptom change during cognitive-behavioral therapy for bulimia nervosa
- Creators
- Laura D'Adamo
- Contributors
- Stephanie M. Manasse (Advisor)
- Awarding Institution
- Drexel University
- Degree Awarded
- Master of Science (M.S.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Number of pages
- 43 pages
- Resource Type
- Thesis
- Language
- English
- Academic Unit
- Psychological and Brain Sciences (Psychology); College of Arts and Sciences; Drexel University
- Other Identifier
- 991021230312004721