Bulimia
Therapy
The outpatient day-clinic therapy offering of the 8-week program includes:
- On average, 6 therapeutic hours per week (group and individual psychotherapy, occupational therapy)
- Physiotherapy and sports therapy, individually and in groups, 4 hours per week
- Relaxation training according to Jacobson
- Self-assertion training according to Ullrich (saying no, making social contacts) 1 hour per week
- Computer training methods 1 hour per week
We place particular emphasis on
- Attention to social behavior in the group
- Video confrontations (altering body image distortions)
- Exposure exercises (eating in restaurants) and attempts to rhythmize eating behavior through eating logs
- Initiating social medical measures (career counseling, assistance with career, education, financial, and residential matters, etc.).
If indicated, medication therapies, such as with Fluoxetine (SSRI), are also used. This is done in consultation with the pre- and post-treatment doctors.
Individual therapy offering
Weight program and individual therapy as needed.
Therapy goals
- Permanent cessation of the eating and purging behavior
- Weight stabilization
- Prevention of consequences.
To achieve this, we initially work with the patient in the first process phase:
- on therapy motivation
- on compliance
- on a deeper understanding of the problem and disease relationships
- on access to bodily experience through sports and physiotherapy.
This first process phase may extend over a longer period, often even over the entire 8-week duration. This means that symptom-free status may not be reached, but awareness of further therapeutic steps has been established.
Depending on the personality structure and cognitive abilities, work may also be done on introspection ability, confrontational ability, and conflict resolution skills.
Scientifically expected success rate
According to strict criteria (no vomiting, no laxatives, no weight loss) in outpatient therapies for Bulimia nervosa (Fairburn, 1993), the following results are observed:
- In an outpatient setting, 30-50% of patients discontinue therapy.
- Of the remaining patients, about 40% are symptom-free at the end of therapy, and about 30% remain symptom-free 1 year after therapy.
- Cognitive-behavioral therapy is superior to interpersonal therapy (Agras et al., 2000). 45% are no longer bulimic after treatment. One year later, IPT and CBT are equivalent (40% are no longer bulimic).
- Cognitive-behavioral group therapy is effective (Polnay, A. et al., 2013)
Literature on Bulimia nervosa
Agras, W.S., Walsh, T., Fairburn, C.G., Wilson, G.T., Kraemer, H.C. (2000). A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Arch. Gen. Psychiatry, 57(5), 459-66.
Fairnburn, C.G., Jones, R., Peveler, R.C., Hope, R.A., & O’Connor, M. (1993). Psychotherapy an bulimia nervosa: The longer-term effects of interpersonal psychotherapy, behaviour therapy an cognitive behaviour therapy. Archives of General Psychiatry, 50, 419-429.
Polnay A, James VA, Hodges L, Murray GD, Munro C, Lawrie SM.(2013). Group therapy for people with bulimia nervosa: systematic review and meta-analysis. Psychol Med.,15:1-14.
