BOOK REVIEWS: Integrative Group Treatment for Bulimia Nervosa
Reprinted from Eating Disorders Review
January/February 2003 Volume 14, Number 1
©2003 Gürze Books
(Helen Riess and Mary Dockray-Miller, New York, Columbia University Press, 2002. 260 pp; $39.50)
A number of studies have shown that Cognitive-Behavior Therapy (CBT) and Interpersonal Therapy (IPT) are each effective, in both individual and group therapy formats, for reducing symptoms of bulimia nervosa and symptoms of depression. These authors describe a form of therapy that integrates key elements of both of these approaches into a single modality that has been offered in a 12-week-long, once-a-week, 90-minute format, conducted by one or two group leaders, at the Massachusetts General Hospital. Based on data from half a dozen completed groups involving women 21-40 years of age, this method appears, at least at the end of the 12 group sessions, to result in about 60% reduction in binge and purge episodes (and, in some cases, has led to abstinence). It has also been followed by a substantial reduction in symptoms of depression as assessed on the Beck Depression Inventory. The treatment employs strategies that directly affect eating behaviors as well as strategies that focus on the interpersonal and relational context in which the disordered eating evolved and persists. The authors are clear at the outset about criteria for patients selected into the group, excluding those with anorexia nervosa, severe personality disorder or psychosis, suicidality and/or chemical dependency problems. The essence of the book provides a detailed session-by-session treatment manual, complete with log sheets and some handouts, for therapists who may want to use this approach. The first three sessions are devoted to psycho-education and the second three to the cognitive behavioral phase. Session 7 concerns cognitive-experiential issues and sessions 8-12 involve the interpersonal/relational phase with some experiential components woven through. In the 11th session, discussions regarding possible referrals for additional ongoing therapy are addressed. Techniques incorporated range from essay writing homework through assigned readings, psychodrama exercises and group meals.
No mention is made of whether any of these patients simultaneously participated in individual therapies or used psychiatric medications, so from my reading it's difficult to know whether the gains are entirely attributable to the patients' work in these groups. As the authors indicate, additional research will be needed to show the longer-term impact (e.g., 1-5 years), the need for additional treatment to sustain and facilitate further improvements, and the effectiveness of this approach in relation to other modalities. In the meantime, this manner of integrating CBT and IPT approaches makes intuitive sense clinically. Therapists contemplating running treatment groups for the types of bulimia nervosa patients addressed here will do well to consult this book.