Exploring Treatment Experiences of Clients with Bulimia Nervosa
: Helpful and Unhelpful Aspects in CBT-E

  • Marina Pouliadi

Student thesis: PsychD

Abstract

CBT-E is currently the first-line model for the treatment of Bulimia Nervosa in the
U.K. Although findings from quantitative studies suggest that CBT is effective in treating the whole spectrum of eating disorders, dropout and relapse rates are worryingly high among service users receiving CBT-based treatments. Existing qualitative reports show that overly symptom-focused manualised approaches are perceived as unhelpful towards recovery, by service users. Furthermore, experiences of service users with bulimia nervosa have been consistently ignored within existing literature. This study explored treatment experiences of service users with bulimia nervosa that received CBT-E within an outpatient NHS eating disorders service. In addition, the study investigated which aspects of CBT-E and which therapist characteristics were perceived as helpful, and which as unhelpful, towards recovery, by service users. Data were collected through semi-structured interviews and were analysed using Thematic Analysis.
Four themes emerged: 1. Waiting for Therapy, 2. Understanding Bulimia Through Therapy, 3. Not Having Enough Space in Therapy, and 4. Negotiating Recovery. Analysis revealed that overall satisfaction with therapy was closely related to perceived therapy and therapist flexibility. Service users who perceived their therapist as flexible, tended to view CBT-E interventions as more helpful compared to participants that perceived their therapist as symptom-focused and protocol-driven. Perceived flexibility appeared to be related to therapists’ training background. Service users treated by clinicians only trained in CBT expressed an overall more negative view of the therapy, compared to service users treated by clinicians with a richer psychology and/or psychotherapy background. Findings are discussed in the light of existing literature. The contributions of this study are
discussed along with implications to clinical practice and policy-making within the NHS. Finally, limitations of the study and directions for future research are considered in detail.
Date of Award29 Sept 2023
Original languageEnglish
Awarding Institution
  • University of Roehampton
SupervisorLeigh Gibson (Director of Studies) & Savin Bapir-Tardy (Co-Supervisor)

Keywords

  • Bulimia nervosa
  • qualitative study
  • treatment experiences
  • cognitive-behavioural therapy
  • CBT-E

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