{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T12:19:23Z","timestamp":1763036363750},"reference-count":11,"publisher":"Royal College of Psychiatrists","issue":"1","license":[{"start":{"date-parts":[[2018,1,2]],"date-time":"2018-01-02T00:00:00Z","timestamp":1514851200000},"content-version":"unspecified","delay-in-days":8037,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[1996,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The aim of this study was to evaluate the effectiveness of a stepped care approach to the treatment of bulimia nervosa: a self-care manual followed, if necessary, by a course of attenuated cognitive behavioural treatment (CBT) in comparison with standard CBT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>One hundred and ten patients, presenting at a tertiary referral centre with ICD\u201310 bulimia nervosa or atypical bulimia nervosa, were randomly assigned to one of two treatment conditions; a) a sequential treatment group: 8 weeks with a self-care manual followed by up to eight sessions of CBT (if still symptomatic) or b) 16 sessions of CBT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Bulimic symptoms improved significantly in both groups with no significant differences between the two groups on any of the measures at the end of treatment or at 18 months follow-up. At end of treatment 30% (95% CI: 18\u201346%) of the sequential group and 30% (95% CI: 17\u201347%) of the standard treatment group were free from all bulimic symptoms. Sixteen of those in the sequential group improved significantly with self-care and did not require additional treatment. The median number of sessions taken by the sequential group was three (95% CI: 0\u20136). At 18 months follow-up 40% (95% CI: 23\u201359%) of the sequential group and 41% (95% CI: 25\u201359%) of the CBT group were symptom free.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A sequential approach to the treatment of bulimia may be as effective as standard CBT and can considerably reduce the amount of therapist contact required.<\/jats:p><\/jats:sec>","DOI":"10.1192\/bjp.168.1.94","type":"journal-article","created":{"date-parts":[[2008,10,15]],"date-time":"2008-10-15T05:35:17Z","timestamp":1224048917000},"page":"94-98","source":"Crossref","is-referenced-by-count":114,"title":["Sequential Treatment for Bulimia Nervosa Incorporating A Self-Care Manual"],"prefix":"10.1192","volume":"168","author":[{"given":"Janet","family":"Treasure","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Troop","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Tiller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gill","family":"Todd","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Turnbull","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"170","published-online":{"date-parts":[[2018,1,2]]},"reference":[{"key":"S0007125000066691_ref3","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1991.01810290075014"},{"key":"S0007125000066691_ref10","doi-asserted-by":"publisher","DOI":"10.3109\/09540269309028296"},{"key":"S0007125000066691_ref8","doi-asserted-by":"publisher","DOI":"10.1002\/1098-108X(199304)13:3<273::AID-EAT2260130305>3.0.CO;2-B"},{"key":"S0007125000066691_ref4","first-page":"516","volume-title":"ECDEU Assessment Manual for Psychopharmacology","author":"Guy","year":"1976"},{"key":"S0007125000066691_ref7","volume-title":"Getting Better Bit(e) by Bit(e).","author":"Schmidt","year":"1993"},{"key":"S0007125000066691_ref6","volume-title":"Eating Disorders. 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