***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A controlled trial comparing family therapy with individual supportive therapy in anorexia nervosa and bulimia nervosa was undertaken . Eighty patients ( 57 with anorexia nervosa ; 23 with bulimia nervosa ) were first admitted to a specialized unit to restore their weight to normal . Before discharge , they were r and omly allocated to family therapy or the control treatment ( individual supportive therapy ) . After one year of psychological treatment , they were reassessed , using body weight , menstrual function , and ratings on the Morgan and Russell scales . Family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun before the age of 19 years . A more tentative finding was the greater value of individual supportive therapy in older patients . To our knowledge , this is the first controlled trial of family therapy in anorexia nervosa and clarifies the specific indications for this treatment Since the primary role of psychoeducation in eating disorders is to act as a foundation for other interventions , nutritional rehabilitation should use the same therapeutic principles as psychotherapy . This paper looks at the possibility that traditional psychoeducational results can be enhanced in patients with bulimia nervosa by a new nutritional rehabilitation programme focused on psychobiological reorganization of eating behaviour as opposed to the prescription of regular eating patterns . Forty women with purging-type bulimia nervosa were enrolled for a 24-week experimental period of cognitive-behavioural psychotherapy ( CBT ) and were r and omly and evenly divided into two groups to follow a psychobiological nutritional rehabilitation ( PNR ) and a traditional nutritional rehabilitation ( TNR ) programme respectively . The follow-up period averaged 6 months ; four subjects dropped out . The baselines of both groups were comparable with regard to key features , including binge and vomiting frequency , and carbohydrate and lipid intake . Both groups improved significantly over time , though improvements in bingeing and vomiting and lipid intake were greater in the PNR group ( p<0.001 ) , both at the end of the study and at the follow-up . This psychobiological approach to appetite and weight control may constitute a theoretical framework facilitating the application of cognitive-behavioural guidelines to both nutritional rehabilitation and psychotherapy Previous research on the treatment of out patients with bulimia nervosa has focused on two treatment strategies : ( 1 ) drug therapy , primarily using tricyclic antidepressants , and ( 2 ) psychotherapy , often employing behavioral and cognitive behavioral techniques . We report here the short-term treatment outcome of a 12-week comparison trial of bulimic out patients who were r and omly assigned to one of four treatment cells : ( 1 ) imipramine hydrochloride treatment , ( 2 ) placebo treatment , ( 3 ) imipramine treatment combined with intensive group psychotherapy , and ( 4 ) placebo treatment combined with intensive group psychotherapy . All three active treatment cells result ed in significant reductions in target-eating behaviors and in a significant improvement in mood relative to placebo treatment . However , the results also suggested that the amount of improvement obtained with the intensive group psychotherapy component was superior to that obtained with antidepressant treatment alone . The addition of antidepressant treatment to the intensive group psychotherapy component did not significantly improve outcome over intensive group psychotherapy combined with placebo treatment in terms of eating behavior , but did result in more improvement in the symptoms of depression and anxiety Fifteen women with bulimia nervosa were treated with a 4-month course of combined cognitive-behavioral , nutritional and antidepressant therapy ( 5 with amineptine and 10 with fluvoxamine ) . Patients were monitored before and after 1 , 2 and 4 months of therapy for body mass index ( BMI ) , for eating disorder symptoms by the Eating Disorder Inventory ( EDI ) and the Bulimic Investigation Test ( BITE ) , and for depression and anxiety by the Hamilton Rating Scale for Depression and for Anxiety ( HRS-D and -A ) . BITE symptoms and gravity improved significantly and equally in the two groups during the 4 months of therapy . Global EDI scores , depression and anxiety decreased but not significantly . BMI was normal before therapy and did not change during treatment The purpose of this study was to conduct an assessment of binge eating severity among obese persons . Two question naires were developed . A 16-item Binge Eating Scale was constructed describing both behavioral manifestations ( e.g. , eating large amounts of food ) and feeling/cognitions surrounding a binge episode ( e.g. , guilt , fear of being unable to stop eating ) . An 11-item Cognitive Factors Scale was developed measure two cognitive phenomena thought to be related to binge eating : the tendency to set unrealistic st and ards for a diet ( e.g. , eliminating " favorite foods " ) and low efficacy expectations for sustaining a diet . The results showed that the Binge Eating Scale successfully discriminated among persons judged by trained interviewers to have either no , moderate or severe binge eating problems . Significant correlation between the scales were obtained such that severe bingers tended to set up diets which were unrealistically strict while reporting low efficacy expectations to sustain a diet . The discussion highlighted the differences among obese persons on binge eating severity  and emphasized the role of cognitions in the relapse of self control of eating OBJECTIVE This study investigated the efficacy of a stepped-care trial of brief group psychoeducation ( PE ) followed by individual cognitive-behavioral therapy ( CBT ) in the treatment of bulimia nervosa . METHOD Fifty-six subjects first completed PE  and were then r and omly assigned to either a 16-week trial of CBT ( PE + CBT ) or to no further treatment follow-up ( PE-alone ) . RESULTS Compared to PE-alone , PE + CBT produced significantly greater reductions in the specific eating symptoms of binging and purging and significantly higher remission rates that were maintained over a 16-week follow-up . However , there were no differential treatment effects on measures of nonspecific psychopathology . Among PE + CBT subjects , remission in specific eating symptoms was associated with greatest improvements in non-specific psychopathology . The outcome of nonremitted PE + CBT subjects and PE-alone subjects was no different at posttreatment or follow-up . DISCUSSION These results provide limited support for offering individual CBT to subjects once they have completed an initial trial of group PE OBJECTIVE Both cognitive-behavioral therapy ( CBT ) and antidepressant medication have demonstrated efficacy in the treatment of bulimia nervosa . However , data concerning the long-term impact of such treatments have been limited . This study sought to determine if treatment with CBT and antidepressant medication was associated with better long-term outcome among women diagnosed with bulimia nervosa . METHOD Women ( N = 101 ) who completed a controlled treatment study of bulimia nervosa participated in follow-up assessment s approximately 10 years later . RESULTS Women who received treatment with CBT or antidepressant medication or both reported improved social adjustment at long-term follow-up compared with women r and omized to the placebo condition . DISCUSSION Treatments with demonstrated efficacy for short-term outcome appear to improve psychosocial function at long-term follow-up among women initially diagnosed with bulimia nervosa OBJECTIVE To evaluate the effects of adding exercise and maintenance to cognitive-behavior therapy ( CBT ) for  binge eating disorder ( BED ) in obese women . METHOD One hundred fourteen obese female binge eaters were r and omized into four groups : CBT with exercise and maintenance , CBT with exercise , CBT with maintenance , and CBT only . RESULTS AND DISCUSSION Eighty-four women completed the 16-month study . Subjects who received CBT with exercise experienced significant reductions in binge eating frequency compared with subjects who received CBT only . The CBT with exercise and maintenance group had a 58 % abstinence rate at the end of the study period and an average reduction of 2.2 body mass index ( BMI ) units ( approximately 14 lb ) . BMI was significantly reduced in the subjects in both the exercise and maintenance conditions . The results suggest that adding exercise to CBT , and extending the duration of treatment , enhances outcome and contributes to reductions in binge eating and BMI OBJECTIVE This open clinical trial examined the efficacy of treating obese patients with binge eating disorder ( BED ) with phentermine and fluoxetine in the setting of cognitive-behavioral therapy ( CBT ) . METHOD Sixteen obese women received individual CBT along with phentermine/fluoxetine . Treatment goals included elimination of binge eating , weight loss , and reduced psychological distress . Following active treatment , patients were offered once-monthly maintenance treatment for 3 years . RESULTS Patients showed significant reduction in binge frequency , weight loss , and psychological distress at the end of active treatment , but regained most of the weight within 1 year . At 18-month follow-up , there was an ongoing reduction in binge eating for patients who continued maintenance . DISCUSSION Treatment produced comparable binge suppression and more weight loss than most reported studies of CBT alone . However , there is significant weight regain , particularly following medication discontinuation . This study does not support the long-term clinical utility of adding phentermine/fluoxetine to CBT for BED Evidence for the effectiveness of existing treatments of patients with eating disorders is weak . Here we describe and evaluate a method of treatment in a r and omized controlled trial . Sixteen patients , r and omly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa , were trained to eat and recognize satiety by using computer support . They rested in a warm room after eating , and their physical activity was restricted . The patients in the  control group ( n = 16 ) received no treatment . Remission was defined by normal body weight ( anorexia ) , cessation of binge eating and purging ( bulimia ) , a normal psychiatric profile , normal laboratory test values , normal eating behavior , and resumption of social activities . Fourteen patients went into remission after a median of 14.4 months ( range 4.9–26.5 ) of treatment , but only one patient went into remission while waiting for treatment ( P = 0.0057 ) . Relapse is considered a major problem in patients who have been treated to remission . We therefore report results on a total of 168 patients who have entered our treatment program . The estimated rate of remission was 75 % , and estimated time to remission was 14.7 months ( quartile range 9.6 ≥ 32 ) . Six patients ( 7 % ) of 83 who were treated to remission relapsed , but the others ( 93 % ) have remained in remission for 12 months ( quartile range 6–36 ) . Because the risk of relapse is maximal in the first year after remission , we suggest that most patients treated with this method recover Objective : The aims of the paper are to determine whether nutritional counselling is associated with an improvement in bulimic symptomatology , whether this improvement is maintained during post-treatment follow-up , and whether the addition of fluoxetine 3 × 20 mg/day confers additional benefit . Method : Psychological , pharmacological and combined psychopharmacological treatments of bulimia nervosa were review ed briefly . Sixty-seven patients referred to specialist eating disorder services who fulfilled strict diagnostic criteria were treated with intensive nutritional counselling and r and omly assigned to either fluoxetine 3 × 20 mg/day or placebo . After a 1-week ‘ wash-out ’ , active treatment was given over 8 weeks , followed by post-treatment interviews at 12 and 20 weeks . Results : Both groups of patients improved significantly during treatment . In some respects , the fluoxetine group did slightly better as demonstrated by the items ‘ restraint ’ , ‘ weight concern ’ and ‘ shape concern ’ ( p<0.05 vs p<0.0001 ) on the Eating Disorder Examination ( EDE ) . Fluoxetine patients decreased their energy intake and lost a modest amount of weight . They went on to regain weight during the follow-up period , returning to levels higher than they were initially . These patients also appeared more likely to have a recurrence of symptoms , as shown by the fall in percentage of binge-free patients and by changes in the EDE . Conclusion : Nutritional counselling is an effective means of treating bulimia nervosa , with improvement maintained up to 3 months follow-up . The addition of fluoxetine may confer some benefit during active treatment , but its discontinuation may contribute to a higher rate of recurrence of symptoms post treatment . Of course , this study can not be extrapolated to the efficacy of fluoxetine when used as the only form of treatment in patients for whom intensive nutritional counselling or other structured psychological programs are not available In a crossover study , 11 bulimic patients divided into two groups of six and five patients underwent six sessions of exposure and response prevention of bingeing ( ERPB ) or exposure and response prevention of vomiting ( ERPV ) over 3 weeks . After a buffer period of 3 weeks , they were crossed over to six sessions of the other treatment . High drop-out rates , particularly during the ERPB phases , precluded full use of the crossover design . The two treatments yielded similar reduction in binge-vomit frequencies and in other between-session measures . Within-session measures , however , showed significant differences between the two treatments .  ERPB  was less time-consuming and led to greater reductions of urges to binge , anxiety , and liking of food . Overall improvement of patients in both groups was reasonable and further supports the usefulness of exposure techniques in the treatment of bulimic patients OBJECTIVE The study aims were to evaluate the prevalence and distribution of respective eating disorder behaviors ( DSM-IV criteria ) in a representative community-based sample . METHOD Data were obtained from 3,001 interviews of a r and omly 
    Output:
    
CBT in a full or less intensive form is not significantly superior to CBT in a pure self-help form .
Augmentation of CBT with exposure therapy is not more effective than CBT alone .