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: Contribution to journalArticle

    14 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)569-577
    Number of pages9
    JournalInternational Journal of Eating Disorders
    Volume50
    Issue number5
    DOIs
    Publication statusPublished - 1 May 2017

    Fingerprint Dive into the research topics of 'Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial'. Together they form a unique fingerprint.

  • Cite this