The University of Manchester Research

Guided Self-Help for Binge Eating Disorder and Bulimia

Link to publication record in Manchester Research Explorer

Citation for published version (APA):Vermes, C. (2011). Guided Self-Help for Binge Eating Disorder and Bulimia: A Practice-Based Study. In BritishPsychological Society Annual Conference

Published in:British Psychological Society Annual Conference

Citing this paperPlease note that where the full-text provided on Manchester Research Explorer is the Author Accepted Manuscriptor Proof version this may differ from the final Published version. If citing, it is advised that you check and use thepublisher's definitive version.

General rightsCopyright and moral rights for the publications made accessible in the Research Explorer are retained by theauthors and/or other copyright owners and it is a condition of accessing publications that users recognise andabide by the legal requirements associated with these rights.

Takedown policyIf you believe that this document breaches copyright please refer to the University of Manchester’s TakedownProcedures [http://man.ac.uk/04Y6Bo] or contact uml.scholarlycommunications@manchester.ac.uk providingrelevant details, so we can investigate your claim.

Download date:10. Sep. 2021

Guided Self-Help for

Binge Eating Disorder and Bulimia:

A Practice-Based Study

Caroline VermesM.Ed, MA, MBACP (Accred.), UKRCP, MBPsS

BPS Conference, Glasgow, 5th May 2011

Why we experimented with guided self-help for

overcoming binge eating

How we conducted the study: a controlled,

non-randomised treatment trial

What we found out about patient characteristics that may

be predictive of outcome

Bulimia Nervosa (BN): Recurrent episodes (at

least twice a week) of binge eating followed by

inappropriate compensatory behaviour

Binge Eating Disorder (BED): As above in the

absence of inappropriate compensatory behaviour

Anorexia 34%

Bulimia 25%

Binge Eating Disorder 35%

EDNOS & Subclinical 6%

Non-underweight clients who binge eat = approx 66% of client base

Referral and treatment by diagnosis:

NHS mental health services:

Demand Exceeds Resource (DER)

Why?

Cost of providing NICE-recommended treatment for

BN-BED (20 sessions of CBT) =

£1,300.00

Stockport NHS annual spend per patient for

outpatient eating disorders treatment =

£625.00

Both prices include clinical staff pay, training, case management, programme

development, management of outcome measures, administration, supplies, premises,

utilities, taxes, publicity, outreach, DNAs etc

Waiting Lists: Bad

Stepped Care: Good

NICE: CBT-BN/BED top recommendation

NICE: Self-help possible first step

Cheaper, easier access and some studies found PSH/GSH to

deliver outcomes similar to therapist-delivered

psychological therapy, but with better prospects of longer

term remission

Perkins, S., Murphy, R., Schmidt, U., Williams, C. (2006). Self-help and guided self-help for eating

disorders. Cochrane Database of Systematic Reviews.

Who provides CBT-BN PSH/GSH in UK?

“Not I” said the doctor

“Not I” said IAPT

“Not I” said the primary mental

health team

“Not I” said all the eating disorder

services in the land

So we said, “We’ll do it ourselves”

How?

Help Yourself!

Intensive Guided

Self-Help Course

for Overcoming

Binge Eating

© North West Centre for Eating Disorders, Ltd.

The guided self-help programme:

12-week structured course of readings and homework

12 weekly professionally facilitated support groups

Up to 3 one-to-one counselling sessions

Access to specialist dietitian

*Rapid access*

*Within budget*

The guided self-help programme

Inclusion Criteria

•Binge eating at least 2 x week

and/or compulsive eating through

the week

• Psychotropic and/or obesity

medication okay

Exclusion Criteria

•CORE score over 3.0

• PHQ-9 score over 18

• Recent history of serious self harm

• Recent history of anorexia

• Learning disability such that

bibliotherapy is contraindicated

Which book?BOOK PROS CONS

Christopher Fairburn (1995)

Overcoming Binge Eating

Guilford

Available in most libraries.

Step-by-step programme

comprises “gold standard”

CBT-BN

Professorial and dry. Does

not deal directly with

common emotional issues

Randi McCabe, Traci

McFarlane and Marion

Olmsted (2004) The

Overcoming Bulimia

Workbook New Harbinger

Pleasant to read and use,

covers emotional issues, lots

of practical exercises.

Nominated “best book” by

our clients

U.S. book, not available in

most libraries

Lindsey Hall and Leigh

Cohn (2001) Bulimia: A

Guide to Recovery

Gurze

Written by a recovered

person, offers insight into the

recovery process that other

self- help books lack

U.S. book, not available in

most libraries

The Study

Comparative: cost and outcomes of GSH versus

treatment as usual: 1:1 integrative psychotherapy (IP)

Method: Quantitative treatment trial

Control group: Naturally occurring waiting list of

patients with similar symptom profiles

Oct 2009 – March 2010 uptake and completion GSH versus 1:1 IP

252 referrals received, of which 166 for binge/compulsive eating

86 (52% of total referred for BN/BED) meet GSH inclusion

criteria & are offered assessment

70 clients (81% of those offered) attend assessment. 66 are included

in this study

28 clients (42% of assessed group) opt to wait for 1:1 therapy

(10-20 weeks to start)

2 still in therapy 6 on waiting list at end of study

(28.6% of cohort)

1:1 ATTRITION 8 DNR after assessment

5 DO < 4 sessions (46.4 % of cohort)

1:1 COMPLETERS

7 participants

(25% of cohort)

COMPLETE DATA

6 participants

INCOMPLETE DATA 1 participant

38 (58% of assessed group) opt to do GSH

(10 weeks or less to start)

GSH ATTRITION 1 DNR after assessment

2 DO < 4 weeks(7.9% of cohort)

GSH COMPLETERS

32 (84% of cohort)

COMPLETE DATA 31 participants

INCOMPLETE DATA 1 participant

Outcome measures

1. SEDS - Sterling Eating Disorder Scales

2. CORE (measure of psychosocial distress)

3. PHQ-9 (depression)

4. GAD-7 (anxiety)

5. Client self-report

What we found

GSH completers: 56% (18/32) in remission (avg. 13 sessions)

IP completers: 86% (6/7) in remission (avg. 18 sessions)

Finding One: Clinical Outcomes

1

1.2

1.4

1.6

1.8

2

2.2

2.4

X times more likely to be non-clinical after GSH

For whom was GSH less helpful?

A. People who gained insufficient benefit from

completing the course

B. People who opted out of GSH and then DO/DNR

when offered alternative treatment

What we learned about GSH completers who were

not in remission by the end of the course

• Significantly higher anxiety scores at baseline

(mean baseline GAD-7 score for non-remitted was 15.9

compared to 8.7 for the remitted subgroup)

• 76.9% of the non-remitted sub-group had a

mood disorder compared to 27.7% of the remitted group

Baseline characteristics of remitted and unremitted GSH completers were analysed using unrelated t-tests

GSH = 8% versus IP = 46%

Finding Two: Attrition

What we learned about the IP DO/DNR group

1. Significantly longer mean wait to start treatment

(m = 16.6 weeks vs. m = 3.6 weeks for GSH)

2. 77% had BN vs. 54% had BN in the overall study group

Significantly lower bulimic dietary behaviour scores than the GSH completer group

2. Significantly lower mean BMI

(m= 26.7 vs. m=33.8 for IP completers and 29.2 for GSH completers)

4. 38.5% were taking antidepressant medication compared to 33.3% of IP completers

and 23.3% of GSH completers

Scores on PHQ-9 were similar across the groups (potentially due in part to medication

effects), so larger sample sizes would be required to test whether depression plus

medication increases likelihood of DO/DNR

Baseline characteristics of study groups were analysed with one-way ANOVA with Tukey’s post hoc multiple comparisons

Average NHS cost per IP completer = £1170.00

vs. NHS cost per GSH completer = £527.19

IP cost per participant in remission = £1950.00

GSH cost per participant in remission = £1151.90

Finding Three: Cost

Conclusions

GSH BN-BED is a cost-effective alternative to high intensity

psychological therapy for approximately 25% of all patients

referred to secondary care

It offers significantly shorter waiting times

It is particularly helpful for patients who do not have a

concurrent mood or anxiety condition

Steps must be taken to engage patients with bulimia and mood

disorders in an acceptable form of treatment within ten weeks of

referral to reduce risk they will be lost to treatment

www.oakwoodhouse.co.uk