**7. Conclusion**

8 New Insights into the Prevention and Treatment of Bulimia Nervosa

The middle sessions follow a similar format to each other, with the patient being asked to bring in their own material from the week to work within therapy. The therapist helps the patient to link the changes in the symptoms to the focus area, then works with the patient at active problem solving, contingency planning or practising new skills as appropriate. The therapist maintains a hopeful and realistic stance on the patient's ability to make changes and to recover. All attempts at change should be praised as it can help to enhance the patient's feelings of self worth and their confidence at trying something new. It also helps to keep them engaged in therapy and to feel that the therapist is on their side working with them. This also needs to be balanced with the patient's capacity to change so it is

All patients will have some difficulties with changing their way of eating, bingeing and vomiting. It is important to review the symptoms each week to maintain the focus and to identify change, but lack of change is also an issue. Some patients find it more difficult to make changes to their eating patterns and can really struggle to do things differently. It is part of the therapist's role to continue to encourage and support them whilst also being open and frank about change. Because the therapy is time limited this helps to motivate people to change, but lack of progress should not be ignored. Enquiring about what difficulties the patient is experiencing and helping them to develop problem-solving strategies to enhance their abilities to put therapy into practise can enable the patient to feel more attended to and can address feelings of having failed or worthlessness. As these can be key features of both eating disorders and depression they are important issues to address.

Feeling attended to and supported can help the patient to stay engaged in therapy.

Half way through IPT (session 8) therapy is reviewed. This review is planned from the beginning. It is highlighted as a time to see how things have progressed thus far, ensuring that the right focus area is being worked on and allowing room for change if needed by the

The end of therapy should not come as a surprise to the patient; the therapist will have been counting down sessions and will have planned the dates of the final session with the patient. However it can still can come as a shock. The final 2 sessions are explicitly about ending therapy, about recognising and maintaining changes made, acknowledging that which has not changed and exploring feelings about ending. This can feel very positive for a patient who has recovered or more anxiety provoking for one who has not. It is important to

Arcelus et al (2009) conducted a case series evaluation of 59 patients and found that by the middle of therapy there had been a significant reduction in eating disordered cognitions and behaviours, alongside an improvement in interpersonal functioning and depressive symptoms. The authors found that although patients did improve significantly after eight sessions, their symptomatology did not continue to improve in the same way within the last eight sessions. This may suggest that there was something in the first sessions that facilitates change, which is lost in the last sessions. This could be explained by the impetus of the initial sessions; targeting symptoms, an opportunity to change and exploring the

**5.1.2 Middle sessions: Sessions 5-14** 

important to be realistic.

patient or the therapist.

**5.1.3 Termination sessions: 15-16** 

end after the agreed number of sessions.

**5.2 Efficacy of IPT -BN(m)** 

Interpersonal difficulties are both vulnerability factors and consequences of several psychiatric disorders, including Bulimia Nervosa. Over the last several years a growing number of research studies have demonstrated the efficacy of IPT as a treatment for several conditions. Within the field of eating disorders, IPT has been shown to be effective for patients with BN, although it appears to work slower than CBT. In order to make this treatment more effective several authors in different countries have modified this treatment further. In spite of the modification that IPT has gone through, the core elements of the therapy have been retained. Throughout IPT, therapists aim to help patients to identify the interpersonal difficulties maintaining the eating disorders symptoms in order to work through them. Although IPT has been used successfully over a number of years, research evidence for the new modified versions is still required.
