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Bulimia nervosa in adolescents: a new therapeutic frontier

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Journal of Family Therapy

Published online on

Abstract

Enhanced cognitive behaviour therapy (CBT‐E) is the first‐line treatment for bulimia nervosa (BN) in adulthood. There is limited evidence for therapies for children and adolescents with BN; however family‐based treatment (FBT) is being increasingly used. This case study contrasts the delivery of FBT with an augmented version (CBT‐E) in two adolescents presenting with BN. In both cases, the adolescents achieved remission from BN symptoms, (cessation of bingeing and compensatory behaviour) at the end of treatment. The families reported that FBT provided a platform for them to work together and view BN as a family issue, rather than leaving the onus on the young person to recover independently. The addition of CBT‐E strategies assisted with managing cognitions associated with bodyweight and shape concerns and appeared to be useful in a more complex presentation with comorbidities. Future research should examine the effectiveness of augmenting CBT‐E strategies to FBT using larger samples and more rigorous research designs. Practitioner points Involving families in the treatment of adolescent BN is both effective and acceptable to young people and their families. Two promising treatment approaches, FBT‐BN and CBT‐E, can effectively be combined to provide a therapy which has the strengths of both modalities alone. Adolescents with comorbidities or complex presentations may benefit most from combining the two modalities to develop additional skills and strategies. 青少年中的神经性贪食症:治疗新前线 强化认知行为治疗是针对成年人神经性贪食症的一线疗法。关于青少年神经性贪食症的治疗手段的实证不多;然而, 家庭为本的治疗越来越多地得到使用。该个案研究对比了两个患有神经性贪食症的青少年接受家庭为本治疗附加强化认知治疗的情况。在两个案例中, 青少年的神经性贪食症症状都在治疗结束时有所缓解(停止暴食和补偿行为)。根据家庭的报告, 家庭为本治疗为他们提供了一个一起努力的平台, 且神经性贪食症被视为一个家庭问题, 而不是把独立康复的责任全部推到青少年身上。增加的强化认知疗法的策略有助于管理与体重和体型担忧相关的认知, 似乎在更为复杂的共病情况下十分有用。今后的研究应当在更大的样本和更严谨的实验设计之下, 考察增加了强化认知疗法策略的家庭为本治疗的有效性。 对实务工作者的启示 将家庭纳入青少年神经性贪食症的治疗过程既有效, 又能被青少年和家庭所接受。 两种有潜力的治疗手段, 家庭为本治疗和强化认知行为治疗, 可以有效结合, 以提供吸取两者长处的治疗方法。 有共病情况或者复杂病情的青少年或许会从两种疗法的结合中获益更多, 因为他们可以发展额外的技能和策略。 关键词:青少年神经性贪食症;强化认知行为治疗;家庭为本治疗;个案研究;家庭治疗;饮食紊乱