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

    9 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

    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

    Cite this

    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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    title = "Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial",
    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.",
    keywords = "bulimia nervosa, cognitive-behavioral therapy, dropout, failure to engage, randomized controlled trial",
    author = "Watson, {Hunna J.} and Levine, {Michele D.} and Zerwas, {Stephanie C.} and Hamer, {Robert M.} and Crosby, {Ross D.} and Sprecher, {Caroline S.} and Amy O'Brien and Benjamin Zimmer and Hofmeier, {Sara M.} and Hans Kordy and Markus Moessner and Peat, {Christine M.} and Runfola, {Cristin D.} and Marcus, {Marsha D.} and Bulik, {Cynthia M.}",
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    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. https://doi.org/10.1002/eat.22644

    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: Contribution to journalArticle

    TY - JOUR

    T1 - Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial

    AU - Watson, Hunna J.

    AU - Levine, Michele D.

    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

    AU - Peat, Christine M.

    AU - Runfola, Cristin D.

    AU - Marcus, Marsha D.

    AU - Bulik, Cynthia M.

    PY - 2017/5/1

    Y1 - 2017/5/1

    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.

    AB - 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.

    KW - bulimia nervosa

    KW - cognitive-behavioral therapy

    KW - dropout

    KW - failure to engage

    KW - randomized controlled trial

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    DO - 10.1002/eat.22644

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