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Panel Title: Treatment outcome, client attachment, and therapy process in a randomized controlledtrialofpsychoanalyticpsychotherapyandcognitivebehaviortherapyforbulimianervosa
Presenters:StigPoulsen(Moderator),SusanneLunn,&SarahDaniel–UniversityofCopenhagen,
Denmark
Discussant:KennethLevy–PennStateUniversity,USA
Abstract
Severalrandomizedcontrolledstudiesofvariouspsychotherapeutictreatmentsforbulimianervosa(BN)documenttheefficacyofcognitivebehaviortherapy(CBT)forBN(Fairburn,2008)aswell
aslongertermeffectsofinterpersonaltherapy(c.f.Hay,Bacaltchuk,&Stefano,2004;Shapiroet
al.,2007).Still,only30to50%ofclientswithBNarefullyrecoveredfollowingCBT(Wilson,Grilo,&
Vitousek,2007).Thus,thedevelopmentandtestingofothertreatmentmodalitiesaswellasidentificationofmoderatorsofoutcomeinCBTseemindicated.
PsychoanalyticpsychotherapyislargelyuntestedasatreatmentmodalityforBN.Onlyonerandomizedcontrolledtrialofshort-termpsychodynamicpsychotherapyforBNhasbeenconducted
(Garneretal.,1993),andnotrialsoflonger-termpsychoanalyticpsychotherapyforBNhavebeen
performed.
TheCopenhagenBulimiaTrialisarandomizedcontrolledtrialcomparingmanualizedtwoyear
weeklyindividualpsychoanalyticpsychotherapytostandardCBTforBN.Thefirstpaperpresents
themainoutcomedataofthetrial.Besidestheoverallaimoftestingtheefficacyofthetwo
treatmentmodalities,aparticularresearchfocushasbeentoidentifyclientcharacteristicsthat
mightserveascriteriafordifferentialassignmentofclientstodifferenttypesoftreatment.Accordingly,thesecondpaperfocusesonclientattachmentasapotentialmoderatoroftreatment
outcomewithinthetwotreatmentmodalities.Finally,thethirdpaperpresentsaqualitativemultiplecaseanalysisofsuccessfulandunsuccessfulpsychoanalyticpsychotherapiesbasedonclient
interviewsconductedafterthetreatments.
Keywords:Evidence-basedpsychotherapies,Attachment&development,Quantitative&qualitativemethod.
PaperinaPanel
Title:Arandomizedcontrolledtrialofpsychoanalyticpsychotherapyandcognitivebehaviortherapyforbulimianervosa
Authors:StigPoulsen(presenter),SusanneLunn,SarahDaniel–UniversityofCopenhagen,Denmark
Abstract
Aim:Whereascognitivebehaviortherapy(CBT)isestablishedasanefficacioustreatmentforbulimianervosa(BN),theefficacyoflonger-termpsychoanalyticpsychotherapy(PPT)hasnotpreviouslybeeninvestigated.ThispaperpresentsthemainoutcomedataoftheCopenhagenBulimia
Trial,arandomizedcontrolledtrialcomparingCBTwithPPTastreatmentsforBN.
Methods:70adultclients,fulfillingtheDSM-IVcriteriaforbulimianervosawererandomlyassignedtoeitherindividualCBTfor20weeksorweeklyindividualPPTfortwoyears.TheEating
DisorderExamination(EDE)wasconductedwithallclientsbeforetreatment,5monthsafterthe
beginningoftreatment(endofCBT),and24monthsafterthebeginningoftreatment(endofPPT).
Primaryoutcomevariableswerea)fullrecoveryfrombulimianervosaandb)remissionofthebulimicsymptomsdefinedasbingingandpurginglessthantwiceperweekoverthelast28days.
Results:Anintention-to-treatanalysisshowedthatastatisticallysignificantproportionofclientsin
CBTwereremittedat5and24months,whileforPPTtheproportionofclientsremittedwassignificantat24months.CBTwassignificantlysuperiortoPPTinbothintention-to-treatandcompleter
analysesatboth5monthsand24monthsandinboththepercentagesofclientsrecoveredand
remitted.GlobalEDEscoresweresignificantlylowerinCBTclientsthaninPPTat5months,but
notat24months.
Discussion:Theresultswillbediscussedwithaparticularfocusonpossibleexplanationsforthe
relativelackofsuccessofPPT.
Keywords:Evidence-basedpsychotherapies.
PaperinaPanel
Title: Client attachment and treatment outcome in psychoanalytic psychotherapy and cognitive
behaviortherapyforbulimianervosa
Authors:SarahDaniel(presenter),StigPoulsen,SusanneLunn–UniversityofCopenhagen,Denmark
Abstract
Aim: Theoretically as well as empirically, eating disorders have been related to insecure attachment.Furthermore,agrowingpsychotherapyresearchliteraturehasaddressedthelinkbetween
clientattachmentandkeyaspectsoftreatmentprocessandoutcome.Clientattachmenthasbeen
posited as a potential moderator of treatment outcome that might be relevant to the choice of
intervention type and strategy. This paper explores the relation between client attachment and
treatment outcome in psychoanalytic psychotherapy (PPT) and cognitive behavior therapy (CBT)
forbulimianervosa.
Method:IntheCopenhagenBulimiaTrial,clientswereassessedwiththeAdultAttachmentInterview(AAI)atintake,after5monthsoftreatment,andafter24months.Treatmentoutcomewas
evaluatedusingtheEatingDisorderExamination(EDE)atthesameintervals.
Results:Althoughthemajorityofclientshadinsecureattachmentstatesofmind,32%weresecure
ontheirintakeAAIs.Contrarytoexpectations,secureattachmentwasnotrelatedtobettertreat-
mentoutcomes.Whileoverall,CBTwassuperiortoPPTinalleviatingeatingdisordersymptoms,
CBTtreatmentresultswithpreoccupiedclientswerepoorcomparedtosecureanddismissingclients. There was a significant interaction between type of attachment insecurity and treatment
typeinpredictingthefrequencyofpurgingatoutcome.CBTwaslessefficientinreducingpurging
withmorepreoccupiedclients,whereasoutcomeinPPTwasnotrelatedtoattachment.
Discussion:Thediscussionwillfocusonthesurprisinglackofeffectofclientattachmentsecurity
andonhowtomakesenseoftheapparentmismatchbetweenpreoccupiedclientsandCBT.
Keywords:Evidence-basedpsychotherapies,Attachment&development.
PaperinaPanel
Title: A multiple case study of psychoanalytic therapies with good and poor outcome in clients
withbulimianervosa
Authors:SusanneLunn(presenter),StigPoulsen,SarahDaniel–UniversityofCopenhagen,Denmark
Abstract
Aim:Inpsychotherapyresearch,arecurrentquestioniswhatworksforwhom.IntheCopenhagen
BulimiaTrial,CBTwassuperiortoPPTinrelievingsymptomsinbulimicclients.However,withclients with preoccupied attachment states of mind the two therapy types had results that were
more comparable. This paper provides a qualitative exploration of PPT cases with good or poor
outcomeinpreoccupiedclientswithbulimianervosa(BN).
Method:Fourpreoccupiedclients,tworecoveredandtwounchanged,wereselectedfromatotal
of34PPTcases.Afterendingtheirtherapies,allclientswereinterviewedabouttheirexperience
of the therapy using an adapted version of the Client Change Interview Schedule (Elliott, 1996).
Salientcharacteristicsoftheclientexperiencesingoodandpooroutcometherapieswereidentifiedthroughqualitativecaseanalysisandcomparedtothetherapists’journalnotes.
ResultsandDiscussion:Inthepresentation,wewillreportthestrengthsandchallengesofPPTin
relationtopreoccupiedclientswithparticularregardtothetherapeuticallianceandthepsychotherapyprocess.FindingswillbediscussedwithregardtochoiceoftreatmentforclientswithBN.
Keywords:Evidence-basedpsychotherapies,Quantitativeandqualitativemethod.