A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa

Wonderlich, S. A.; Peterson, C. B.; Crosby, R. D.; Smith, T. L.; Klein, M. H.; Mitchell, J. E.; Crow, S. J.

doi:10.1017/s0033291713001098

Cited by 270Eating Disorders and BehaviorsNutrition, Health and Food BehaviorAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa

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Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E., Crow, S. J.·2014·Psychological Medicine

DOI 10.1017/s0033291713001098PMC PMC5551978

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Abstract

BACKGROUND: The purpose of this investigation was to compare a new psychotherapy for bulimia nervosa (BN), integrative cognitive-affective therapy (ICAT), with an established treatment, 'enhanced' cognitive-behavioral therapy (CBT-E). METHOD: Eighty adults with symptoms of BN were randomized to ICAT or CBT-E for 21 sessions over 19 weeks. Bulimic symptoms, measured by the Eating Disorder Examination (EDE), were assessed at baseline, at the end of treatment (EOT) and at the 4-month follow-up. Treatment outcome, measured by binge eating frequency, purging frequency, global eating disorder severity, emotion regulation, self-oriented cognition, depression, anxiety and self-esteem, was determined using generalized estimating equations (GEEs), logistic regression and a general linear model (intent-to-treat). RESULTS: Both treatments were associated with significant improvement in bulimic symptoms and in all measures of outcome, and no statistically significant differences were observed between the two conditions at EOT or follow-up. Intent-to-treat abstinence rates for ICAT (37.5% at EOT, 32.5% at follow-up) and CBT-E (22.5% at both EOT and follow-up) were not significantly different. CONCLUSIONS: ICAT was associated with significant improvements in bulimic and associated symptoms that did not differ from those obtained with CBT-E. This initial randomized controlled trial of a new individual psychotherapy for BN suggests that targeting emotion and self-oriented cognition in the context of nutritional rehabilitation may be efficacious and worthy of further study.

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Evidence-based practices for eating disorders that address both eating disorder symptoms and emotion regulation have demonstrated benefits for individuals with eating disorders.
“While EPBs for EDs that address both ED symptoms and emotion regulation have demonstrated benefits for individuals with EDs (14, 16, 17)”
From The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment (2021) · cites this paper as [14]

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Authors: Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E., & Crow, S. J.
Affiliations: University of North Dakota (US)
University of Minnesota (US)
University of Wisconsin–Madison (US)
Corresponding author: Wonderlich, S. A.
ORCID: Wonderlich, S. A.
Peterson, C. B.
Crosby, R. D.
Klein, M. H.
Mitchell, J. E.
Crow, S. J.
Venue: Psychological Medicine
Publisher: Cambridge University Press (CUP)
Published: 2013-05-23
Volume: 44
Issue: 3
Pages: 543-553
ISSN: 0033-2917 (ISSN-L)
1469-8978
DOI: 10.1017/s0033291713001098
PMC: PMC5551978
OpenAlex: W2144634405
Cited by: 270
References: 44
Citations by year: 2026: 11 · 2025: 17 · 2024: 19 · 2023: 20 · 2022: 23 · 2021: 32 · 2020: 19 · 2019: 19 · 2018: 16 · 2017: 33 · 2016: 17 · 2015: 28 · 2014: 11 · 2013: 5
FWCI: 22.42
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.cambridge.org/core/terms (unspecified)
Locations: Psychological Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (K02MH065919, R01MH059674, R34MH077571, T32MH082761)
National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK60456, R01DK061973, R01DK061912)
Topics: Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: bulimia nervosa, psychotherapy comparison, binge eating, purging, emotion regulation, nutritional rehabilitation, eating disorder severity, treatment outcomes
MeSH terms: Adaptation, Psychological, Adult, Anxiety, Bulimia, Depression, Emotions, Female, Humans, Interpersonal Relations, Interview, Psychological, Male, Models, Psychological, Patient Education as Topic, Surveys and Questionnaires, Self Concept, Severity of Illness Index, Models, Statistical, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Bulimia Nervosa, Evidence-Based Practice, Intention to Treat Analysis, Motivational Interviewing

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A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa

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