Cognitive-behavioral therapy for binge-eating disorder for non-responders to initial acute treatments: Randomized controlled trial.
Cognitive-behavioral therapy for binge-eating disorder for non-responders to initial acute treatments: Randomized controlled trial.
复制标题
对初始急性治疗无反应者的暴食症认知行为治疗：随机对照试验。
DOI：
10.1002/eat.23975
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Gueorguieva,Ralitza
中科院分区：
文献类型：
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作者：
Grilo,CarlosM;Lydecker,JanetA;Gueorguieva,Ralitza
目的某些治疗方法对暴饮暴食障碍(Bed)有明显疗效，但许多接受“循证”干预的患者并未获得足够的益处。鉴于缺乏对初始干预无效的患者进行治疗的对照研究，本研究测试了认知行为疗法(CBT)对初始急性治疗无效的卧床患者的疗效。方法2017年8月至2021年12月进行前瞻性随机双盲安慰剂对照单部位试验，测试由治疗师领导的CBT对肥胖卧床患者初始治疗(纳曲酮/安非他酮和/或行为疗法)无应答者为期16周的CBT。31例(平均年龄46.3 岁，女性占77.4%，白人占80.6%，平均体重指数38.99 kg/m2)患者在继续双盲药物治疗的基础上，随机分为CBT组(N= 18例)和非CBT组(N= 13例)。在基线、整个治疗过程和治疗后进行独立评估；83.9%完成治疗后评估。结果治疗后介入治疗缓解率(61.1%；N= 11/18)显著高于未接受治疗的患者(7.7%；N= 1/13)。暴饮暴食频率的混合模型(使用互补方法评估)收敛，揭示了CBT与时间之间显着的交互作用和CBT的显着主效应。暴饮暴食频率随CBT的增加而显著降低，但与非CBT相比变化不明显。由于只有4名患者在急性治疗期间接受了行为治疗，我们对27名在急性治疗期间接受药物治疗的患者进行了“敏感型”分析，发现CBT和非CBT的结果相同。结论初始药物治疗无效的卧床成人患者应该接受CBT。公共意义即使在暴饮暴食障碍的领先循证治疗中，许多患者也没有获得足够的好处。几乎没有一项对照研究检查了对最初干预无效的患者的治疗方法。这项研究发现，认知行为疗法对最初干预无效的暴饮暴食障碍患者有效，61%的患者实现了戒烟。
ObjectiveCertain treatments have demonstrated acute efficacy for binge‐eating disorder (BED) but many patients who receive “evidence‐based” interventions do not derive sufficient benefit. Given the dearth of controlled research examining treatments for patients who fail to respond to initial interventions, this study tested the efficacy of cognitive‐behavioral therapy (CBT) for patients with BED who do not respond to initial acute treatments.MethodsProspective randomized double‐blind placebo‐controlled single‐site trial, conducted August 2017–December 2021, tested 16‐weeks of therapist‐led CBT for non‐responders to initial treatment (naltrexone/bupropion and/or behavioral therapy) for BED with obesity. Thirty‐one patients (mean age 46.3 years, 77.4% women, 80.6% White, mean BMI 38.99 kg/m2) who were non‐responders to initial acute treatments were randomized to CBT (N= 18) or no‐CBT (N= 13), in addition to continuing double‐blinded pharmacotherapy. Independent assessments were performed at baseline, throughout treatment, and posttreatment; 83.9% completed posttreatment assessments.ResultsIntention‐to‐treat remission rates were significantly higher for CBT (61.1%;N= 11/18) than no‐CBT (7.7%;N= 1/13). Mixed models of binge‐eating frequency (assessed using complementary methods) converged revealing a significant interaction between CBT and time and a significant main effect of CBT. Binge‐eating frequency decreased significantly with CBT but did not change significantly with no‐CBT. Since only four patients received behavioral treatment during the acute treatments, we performed “sensitivity‐type” analyses restricted to the 27 patients who received pharmacotherapy during the acute treatment and found the same pattern of findings for CBT versus no‐CBT.ConclusionsAdult patients with BED who fail to respond to initial pharmacological treatments should be offered CBT.Public SignificanceEven with leading evidence‐based treatments for binge‐eating disorder, many patients do not derive sufficient benefit. Almost no controlled research has examined treatments for patients who fail to respond to initial interventions. This study found that that cognitive‐behavioral therapy was effective for patients with binge‐eating disorder who did not respond to initial interventions, with 61% achieving abstinence.