Hunna J Watson1,2,3,4, Michele D Levine5, Stephanie C Zerwas1, Robert M Hamer1,6, Ross D Crosby7,8, Caroline S Sprecher1, Amy O'Brien2, Benjamin Zimmer9, Sara M Hofmeier1, Hans Kordy9, Markus Moessner9, Christine M Peat1, Cristin D Runfola1,10, Marsha D Marcus5, Cynthia M Bulik1,11,12. 1. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2. Eating Disorders Program, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Western, Australia. 3. School of Paediatrics and Child Health, The University of Western Australia, Crawley, Western Australia, Australia. 4. School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia. 5. Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 6. Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 7. Neuropsychiatric Research Institute, Fargo, North Dakota. 8. Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. 9. Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany. 10. Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 11. Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 12. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Abstract
OBJECTIVE: We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout. METHOD: Participants (N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors. RESULTS: Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96). DISCUSSION: Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout.
RCT Entities:
OBJECTIVE: We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout. METHOD:Participants (N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors. RESULTS: Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96). DISCUSSION: Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout.
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