Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial

Hunna J. Watson, Michele D. Levine, Stephanie C. Zerwas, Robert M. Hamer, Ross D. Crosby, Caroline S. Sprecher, Amy O'Brien, Benjamin Zimmer, Sara M. Hofmeier, Hans Kordy, Markus Moessner, Christine M. Peat, Cristin D. Runfola, Marsha D. Marcus, Cynthia M. Bulik

Research output: Research - peer-reviewArticle

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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.

LanguageEnglish (US)
Pages569-577
Number of pages9
JournalInternational Journal of Eating Disorders
Volume50
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Bulimia Nervosa
Cognitive Therapy
Internet
Randomized Controlled Trials
Body Mass Index
Odds Ratio
Temperament
Random Allocation
Treatment Failure
Psychopathology
Health Status
Personality
Quality of Life
Education
Feeding and Eating Disorders

Keywords

  • bulimia nervosa
  • cognitive-behavioral therapy
  • dropout
  • failure to engage
  • randomized controlled trial

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial. / Watson, Hunna J.; Levine, Michele D.; Zerwas, Stephanie C.; Hamer, Robert M.; Crosby, Ross D.; Sprecher, Caroline S.; O'Brien, Amy; Zimmer, Benjamin; Hofmeier, Sara M.; Kordy, Hans; Moessner, Markus; Peat, Christine M.; Runfola, Cristin D.; Marcus, Marsha D.; Bulik, Cynthia M.

In: International Journal of Eating Disorders, Vol. 50, No. 5, 01.05.2017, p. 569-577.

Research output: Research - peer-reviewArticle

Watson, HJ, Levine, MD, Zerwas, SC, Hamer, RM, Crosby, RD, Sprecher, CS, O'Brien, A, Zimmer, B, Hofmeier, SM, Kordy, H, Moessner, M, Peat, CM, Runfola, CD, Marcus, MD & Bulik, CM 2017, 'Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial' International Journal of Eating Disorders, vol 50, no. 5, pp. 569-577. DOI: 10.1002/eat.22644
Watson, Hunna J. ; Levine, Michele D. ; Zerwas, Stephanie C. ; Hamer, Robert M. ; Crosby, Ross D. ; Sprecher, Caroline S. ; O'Brien, Amy ; Zimmer, Benjamin ; Hofmeier, Sara M. ; Kordy, Hans ; Moessner, Markus ; Peat, Christine M. ; Runfola, Cristin D. ; Marcus, Marsha D. ; Bulik, Cynthia M./ Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial. In: International Journal of Eating Disorders. 2017 ; Vol. 50, No. 5. pp. 569-577
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AU - Zerwas,Stephanie C.

AU - Hamer,Robert M.

AU - Crosby,Ross D.

AU - Sprecher,Caroline S.

AU - O'Brien,Amy

AU - Zimmer,Benjamin

AU - Hofmeier,Sara M.

AU - Kordy,Hans

AU - Moessner,Markus

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N2 - 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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