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The British Journal of Psychiatry (2002) 181: 230-235
© 2002 The Royal College of Psychiatrists

Self-help for bulimic disorders: a randomised controlled trial comparing minimal guidance with face-to-face or telephone guidance

ROBERT L. PALMER, FRCPsych

Department of Psychiatry, Leicester Warwick Medical School

HELEN BIRCHALL, MRCPsych and LESLEY McGRAIN, RMN, SRN

Brandon Unit, Leicester General Hospital, Leicestershire and Rutland NHS Healthcare Trust

VICTORIA SULLIVAN, MA

Department of Psychiatry, Leicester Warwick Medical School, Leicester, UK

Correspondence: Dr R. L. Palmer, University Department of Psychiatry, Brandon Unit, Leicester General Hospital, Leicester LE5 4PW, UK. Fax: 0116 225 6235; e-mail: dkb5{at}le.ac.uk

Declaration of interest None.

Funding detailed in Acknowledgements.

Background There is great potential demand for treatment of bulimia nervosa and binge eating disorder. Skilled therapists are in short supply. Self-help and guided self-help based upon books have shown some promise as an economical alternative to full therapy in some cases.

Aims To investigate the efficacy and effectiveness of self-help with and without guidance in a specialist secondary service.

Method A randomised controlled trial comparing three forms of self-help over 4 months with a waiting-list comparison group and measurement of service consumption over the subsequent 8 months.

Results Self-help delivered with four sessions of face-to-face guidance led to improved outcome over 4 months. There is also some evidence to support the use of telephone guidance. A minority of participants achieved lasting remission of their disorder in relation to self-help, but there was no significant difference in final outcome between the groups after they had progressed through the stepped care programme. Patients initially offered guided self-help had a lower long-term drop-out rate.

Conclusions Guided self-help is a worthwhile initial response to bulimia nervosa and binge eating disorder. It is a treatment that could be delivered in primary care and in other non-specialist settings.


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