Delivering CBT to Patients with BN in Rural Settings

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Delivering CBT to Patients with BN in Rural
Settings

• James E. Mitchell, M.D.
• Lee A.Christoferson Professor and Chair
• Dept. of Clinical Neuroscience
• UND School of Medicine and Health Sciences
• President
• Neuropsychiatric Research Institute
• NIMH RO1 MH 58820
• 9/99 5/05

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CBT For BN

• Bulimia nervosa a prevalent disorder among
  adolescent girls and young women
• Associated with medical complications, comorbid
  psychiatric disorders and significant impairment
• Cognitive behavior therapy is treatment of choice

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CBT for BN

• CBT not being widely utilized or disseminated
• Less than 15 of psychologist who treat BN
  patients have any formal CBT training
• Less than 10 of BN patients who receive
  treatment receive CBT

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Lack of Availability of Empirically Supported
Therapies in Rural Areas

• Train therapists? Impractical / skills likely
  atrophy
• Traveling therapists? Undesirable work/ financial
  disincentives
• Deliver therapies using new technologies such as
  Telemedicine

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TVCBT Recruit Informational Assessment
Meeting On site CBT
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Treatment Follow Up Assessment 20
sessions/16 wks. 12 wks. 52 wks.
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Demographics
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Measures

• EDE
• SCID I, II
• Working Alliance Inventory
• Therapy Suitability and Patient Expectations
  Scales
• Hill Process Rating Systems
• Cognitive Therapy Scale
• TFEQ
• Rosenberg
• Inv. Interpersonal Problems
• M-FED
• Beck, Ham-D

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Therapy Suitability/Patient Expectation
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Abstinence on EDE
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Conclusions

• Telemedicine delivered CBT effective in the
  treatment of BN
• Telemedicine delivered CBT acceptable to patients
• TV-CBT roughly equivalent to in person
• Telemedicine a viable strategy to deliver
  empirically supported therapies for psychiatric
  disorders to patients in rural areas.