New bulimia nervosa therapy for patients with eating disorders

An eating disorders research team led by Stephen Wonderlich, a Director of Clinical Research at the Neuropsychiatric Research Institute (NRI), has developed a successful bulimia nervosa therapy that can provide patients an alternative for treating this debilitating disorder.

Wonderlich, also a University of North Dakota Chester Fritz Distinguished Professor of Neuroscience, says the new treatment is psychological in nature and focuses on eating- and emotion- related behavior through the arduous process of dealing with, and hopefully eliminating, their bulimic symptoms.

The therapy was developed over a period of more than 10 years with 80 patients treated in a randomized, controlled trial based at NRI in Fargo and at the University of Minnesota, Department of Psychiatry, with co-PI Carol B. Peterson.

James Mitchell, Wonderlich's colleague at NRI and also Chester Fritz Distinguished Professor and chair of Neuroscience, participated in developing this therapeutic treatment.
In a manuscript explaining the research, the objective is described as comparing a new psychotherapy for bulimia nervosa--titled "Integrative Cognitive-Affective Therapy-- with an established treatment from England.

"In a scientifically controlled comparison with the treatment developed by Chris Fairburn at Oxford University, which is the most scientifically supported treatment available for adult individuals with bulimia nervosa, this new treatment performed comparatively well," said Wonderlich, who also is a partner with Mitchell and surgeon Luis Garcia at the Sanford Eating Disorders and Weight Management Center, Fargo.

"We had one of the lowest dropout rates in a scientific trial ever with this population," Wonderlich said. "In other words, just about everyone who started the trial completed the treatment, which with these patients is important, just getting people to complete the treatment."

Wonderlich said the trial was well-run with research teams at each site, Fargo and Minneapolis, and an evaluation team at the University of Wisconsin-Madison.

"When we did the scientific comparison, there was no difference between our treatment and the established treatment in terms of outcomes--they were comparable, or equal, in their efficacy," he said. "This is good news for the field because now there is another promising alternative treatment available which is a little different in nature than the Oxford treatment."

"Basically, what we're trying to do is get people (with bulimia nervosa) to eat differently," Wonderlich said, "but you also have to look at the way they view the world and function in it. The Oxford treatment focuses on the bulimic individual's overvaluing of body shape and weight as well as dietary restriction, while our treatment focuses on eating behavior as well as what we would call emotional variables and relationship variables."

"Our treatment is basically saying that we think that emotional processes--feeling badly--are very important in triggering bulimic behaviors," he said. "People actually engage in the bulimic behaviors because they feel better momentarily. "

The treatment is based on research conducted with NRI colleagues Ross Crosby and Scott Engel in which patients used personal digital assistants such as the Palm Pilot to document their feelings and behaviors, a key part of the therapy.

"Now we will use cell phones or smart phones," Wonderlich said. "Basically, we're asking patients to report how they feel and observe the increase in negative emotions leading up to the behavior; what we want to know is what are things that make people feel badly, and then help them recognize that, and change their responses to those negative emotions."