{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:43:15Z","timestamp":1791895395528,"version":"4.3.4"},"reference-count":31,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2018,1,2]],"date-time":"2018-01-02T00:00:00Z","timestamp":1514851200000},"content-version":"unspecified","delay-in-days":2438,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J\n                        Psychiatry"],"published-print":{"date-parts":[[2011,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study compared the best available treatment for bulimia nervosa,\n                           cognitive\u2013behavioural therapy (CBT) augmented by fluoxetine if indicated,\n                           with a stepped-care treatment approach in order to enhance treatment\n                           effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To establish the relative effectiveness of these two approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a randomised trial conducted at four clinical centres\n                           (Clinicaltrials.gov registration number: NCT00733525). A total of 293\n                           participants with bulimia nervosa were randomised to one of two treatment\n                           conditions: manual-based CBT delivered in an individual therapy format\n                           involving 20 sessions over 18 weeks and participants who were predicted\n                           to be non-responders after 6 sessions of CBT had fluoxetine added to\n                           treatment; or a stepped-care approach that began with supervised\n                           self-help, with the addition of fluoxetine in participants who were\n                           predicted to be non-responders after six sessions, followed by CBT for\n                           those who failed to achieve abstinence with self-help and medication\n                           management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both in the intent-to-treat and completer samples, there were no\n                           differences between the two treatment conditions in inducing recovery (no\n                           binge eating or purging behaviours for 28 days) or remission (no longer\n                           meeting DSM\u2013IV criteria). At the end of 1-year follow-up, the\n                           stepped-care condition was significantly superior to CBT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Therapist-assisted self-help was an effective first-level treatment in\n                           the stepped-care sequence, and the full sequence was more effective than\n                           CBT suggesting that treatment is enhanced with a more individualised\n                           approach.<\/jats:p><\/jats:sec>","DOI":"10.1192\/bjp.bp.110.082172","type":"journal-article","created":{"date-parts":[[2011,3,18]],"date-time":"2011-03-18T01:58:54Z","timestamp":1300413534000},"page":"391-397","source":"Crossref","is-referenced-by-count":98,"title":["Stepped care and cognitive\u2013behavioural therapy for bulimia\n                        nervosa: randomised trial"],"prefix":"10.1192","volume":"198","author":[{"given":"James E.","family":"Mitchell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stewart","family":"Agras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Crow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Halmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Fairburn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Bryson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Kraemer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2018,1,2]]},"reference":[{"key":"S0007125000255165_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(94)90002-7"},{"key":"S0007125000255165_ref31","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.166.5.660"},{"key":"S0007125000255165_ref26","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1961.01710120031004"},{"key":"S0007125000255165_ref16","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1976.01770090101010"},{"key":"S0007125000255165_ref14","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.157.8.1302"},{"key":"S0007125000255165_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17669-1"},{"key":"S0007125000255165_ref8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2005.00735.x"},{"key":"S0007125000255165_ref7","doi-asserted-by":"publisher","DOI":"10.1002\/eat.20475"},{"key":"S0007125000255165_ref17","volume-title":"Binge Eating: Nature, Assessment, and Treatment","author":"Fairburn","year":"1993"},{"key":"S0007125000255165_ref23","volume-title":"Structured Clinical Interview for DSM\u2013IV Personality Disorders. 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