This is a repository copy of Brief group cognitive‐behavioral therapy for bulimia nervosa

and binge‐eating disorder: a pilot study of feasibility and acceptability.

White Rose Research Online URL for this paper:

https://eprints.whiterose.ac.uk/197728/

Version: Published Version

Article:
Moore, E. and Waller, G. orcid.org/0000-0001-7794-9546 (2023) Brief group cognitive‐
behavioral therapy for bulimia nervosa and binge‐eating disorder: a pilot study of feasibility
and acceptability. International Journal of Eating Disorders, 56 (6). pp. 1228-1232. ISSN
0276-3478

https://doi.org/10.1002/eat.23935

Reuse
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs
(CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long
as you credit the authors, but you can’t change the article in any way or use it commercially. More
information and the full terms of the licence here: https://creativecommons.org/licenses/

Takedown
If you consider content in White Rose Research Online to be in breach of UK law, please notify us by
emailing [email protected] including the URL of the record and the reason for the withdrawal request.

[email protected]
https://eprints.whiterose.ac.uk/
Received: 25 July 2022 Revised: 6 March 2023 Accepted: 7 March 2023
DOI: 10.1002/eat.23935

BRIEF REPORT

Brief group cognitive-behavioral therapy for bulimia

nervosa and binge-eating disorder: A pilot study
of feasibility and acceptability

Elana Moore MSc 1 | Glenn Waller DPhil 2

1
South Yorkshire Eating Disorders Association,
Sheffield, UK Abstract
2
Department of Psychology, University of Objective: Brief cognitive-behavioral therapy for non-underweight eating disorders
Sheffield, Sheffield, S1 2LT, UK
(CBT-T) has been shown to be clinically useful in non-underweight samples, when deliv-
Correspondence ered one-to-one. This pilot study assessed the acceptance, compliance and feasibility
Glenn Waller, Department of Psychology,
University of Sheffield, Sheffield S1 2LT, UK. levels of a group version of CBT-T, which has the potential to enhance patient access.
Email: [email protected] Method: A group CBT-T protocol was developed and piloted in two therapy groups

Action Editor: Anja Hilbert

(N = 8). Eating disorder attitudes and behaviors, depression and anxiety were
assessed at the beginning and end of treatment.
Results: A third of all patients approached accepted the offer of group CBT-T, and
entered treatment. Among that group of treatment starters, none were lost to treat-
ment. The therapy was feasible in practical terms, including online delivery. Finally,
mean scores on measures suggested improvement in clinical profiles.
Discussion: This pilot study demonstrated that a group CBT-T is a feasible interven-
tion for non-underweight eating disorders in adults, with low acceptance but high
compliance. Group CBT-T has the potential to reduce demand on services and in turn
increase availability of treatment to those with eating disorders.
Public Significance: The present research contributes to the treatment of non-
underweight adults with eating disorders. Group CBT-T was shown to be feasible in this
pilot study. It was associated with low acceptance but strong compliance. If supported by
further research, group CBT-T has the potential to reduce waitlists, ensure throughput in
services, and ultimately improve the lives of many who are affected by eating disorders.

KEYWORDS
acceptance, binge-eating disorder, bulimia nervosa, CBT-T, compliance, feasibility, group
cognitive-behavior therapy

1 | I N T RO DU CT I O N such as bulimia nervosa (BN) and binge-eating disorder (BED)

(National Institute of Health and Care Effectiveness [NICE], 2017). Its
Cognitive-behavioral therapy (CBT-ED) is the most efficacious and effectiveness has been demonstrated in randomized control trials
effective treatment for adults with non-underweight eating disorders, (RCTs) (Byrne et al., 2011; Fairburn et al., 2009), and supported by

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.

Int J Eat Disord. 2023;1–5. wileyonlinelibrary.com/journal/eat 1

 1098108x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/eat.23935 by Test, Wiley Online Library on [27/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
2 MOORE and WALLER

open trials (Signorini et al., 2018; Turner et al., 2015). NICE (2017) between individuals with similar eating disorders, focusing on shared
identified the need for briefer therapies for eating disorders. There- behavioral presentations. Table 2 shows pretreatment characteristics.
fore, a briefer, 10-session version of CBT-ED (CBT-T) has been devel- Patients were referred to the South Yorkshire Eating Disorder
oped for non-underweight eating disorders (Waller et al., 2019). It has Association service, following self-referral or clinician referral. All were
been tested in one randomized controlled trial to date (Pellizzer assessed before being placed on the waitlist for therapy, to establish
et al., 2019), as well as several case series (Keegan et al., 2022). Briefer diagnosis and monitor risk. The waitlist consisted of two lists—one for
therapy allows more patients to access the support that they need, CBT-T, one for more generic counseling. Patients were placed on the
reducing waiting times, and lowering costs. Its benefits might be even counseling list if they had stated that they were interested in talking
greater if the therapy were delivered in a group format. Existing about their wider concerns, rather than being treated for their eating
CBT-ED groups have good outcomes (Wade et al., 2017), but briefer disorder directly.
versions could support better access for patients. Recruitment for group CBT-T involved reviewing the full waitlist
The aim of the present research was to determine acceptance, com- of patients assessed as suitable for CBT-T, and who did not meet
pliance and feasibility levels of group CBT-T for non-underweight eating exclusion criteria. Exclusion criteria were severe vomiting or laxative
disorder patients, with the longer-term aim of guiding future research in use (>5 episodes a week), Body Mass Index (BMI = weight in
the form of an RCT. Acceptance and compliance were defined respec- kg/height in m2) <17.5 kg/m2, self-harm, or active suicidality. All were
tively by the numbers of patients who agreed to the treatment and who offered group CBT-T forthwith, or the option of waiting the standard
completed therapy fully. Feasibility was defined as the ability to deliver longer time for individual CBT-T. Each participant reported at least
the therapy at a practical level. Clinical outcomes will indicate the poten- one episode of binge eating or purging per week, meeting DSM-5
tial degree of change. criteria for BED (N = 4) or BN (N = 4).

2 | METHOD 2.4 | Measures and procedure

2.1 | Design Patients completed the following well-validated measures at baseline

(Session 1) and at end of therapy (Session 10). The Eating Disorder
An uncontrolled case series open-label pre-post trial design was Examination-Questionnaire (EDE-Q v6; Fairburn, 2008) assessed eat-
used to evaluate the feasibility and acceptability of group CBT-T for ing attitudes. The Personal Health Questionnaire (PHQ-9; Kroenke
adults in a routine clinical setting. Outcomes were measured at et al., 2001) and Generalized Anxiety Disorder scale (GAD-7; Spitzer
baseline (Session 1) and the end of therapy (Session 10). All patients et al., 2006) measured depression and anxiety, respectively. Weekly
completed therapy and no data were missing. The work was con- objective binge eating and/or vomiting frequencies were taken from
ducted during Coronavirus (COVID-19) restrictions (recruitment and diaries kept during therapy. Due to remote working, BMI used self-
data collection April–July 2020), so all sessions were run via tele- reported weight (taken by patients at each session) and height.
health (Waller et al., 2020), using Zoom software (Zoom Video
Communications).
2.5 | The group CBT-T protocol

2.2 | Ethical issues CBT-T is a 10-session form of CBT for non-underweight eating disor-
ders, developed for delivery in one-to-one format (Waller
Specific ethical approval was not required as the pilot study evaluated et al., 2019). It centers on restoring nutrition and regulating eating
existing practice (National Health Service Research Authority, 2011). patterns, reducing starvation and subsequent binge eating; inhibitory
All patients gave written consent to take part and for their outcomes learning exposure to address anxiety; behavioral experiments to chal-
to be anonymously analyzed and published. lenge specific beliefs about feared foods; approaches to emotionally
triggered eating and related behaviors; individualized body image
interventions; and relapse prevention work.
2.3 | Patients The CBT-T protocol for individuals was adapted by EM (CBT-T
therapist, trained and supervised by GW) for group delivery by EM,
Eight female patients (mean age = 26.3 years; SD = 5.5) were retaining the structure and content of CBT-T with adaptations as
recruited, split into two therapy groups by diagnosis (BN and BED; detailed in Table 1. The Zoom platform was used to deliver therapy.
N = 4 each). This low number was chosen to determine the feasibil- Meetings were weekly. Patients self-weighed and reported their
ity and acceptability of the intervention before wider implementa- weight, and sent in weekly self-report measures by email. PowerPoint
tion. To examine whether acceptance and compliance differed by slides were used to guide sessions through the agenda. The adapted
diagnosis, the two groups consisted of patients with BED and BN, protocol and slides are available at: https://sites.google.com/sheffield.
respectively. This diagnostic grouping also facilitated interaction ac.uk/cbt-t.
 1098108x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/eat.23935 by Test, Wiley Online Library on [27/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
MOORE and WALLER 3

TABLE 1 Adaptations made to CBT-T for group presentation.

Aspect of CBT-T group Adaptations made

Introduction to the group • Initial statement of the importance of group cohesion (mutual support to find solutions; positive
reinforcement for group members' success; learning from each other) and group rules (respecting each
other's experiences and differences; confidentiality; sharing experiences).
Tracking of symptoms • Calculation and report of group mean weight change and binge/purge frequencies over the week.
• Each patient met briefly and individually with the clinician online immediately prior to entering the online
group session, and reported self-measured weight at that point and their behaviors over the previous week.
This approach has the potential to limit the impact of weighing immediately after discussing diaries (i.e.,
maximizing expectancy violation), but was necessary to ensure that factors such as shame did not interfere
with accurate reporting if it were done in a group setting.
• At this point, the patient was also asked if there were any risk factors to consider (none emerged in the
course of these groups).
• Other self-monitoring (e.g., reviewing food diaries) and outcome of homework tasks (e.g., body image
exercises conducted between sessions) were discussed with the rest of the group during each session, as per
the individual CBT-T protocol.
• Patients received a copy of their personal weight chart via email after each session, in order to make them
feel more comfortable and reduce intragroup weight/behavior comparisons.
Maintaining individual focus • Each participant took time to describe their week, including homework set from the previous session.
during the group • Throughout the group therapy, each homework task was made as personal as possible, such as behavioral
experiments for a participant's specific feared foods, even if that specific fear was not shared across the rest
of the group.
Practical adaptations to implement • For each group, one or two members of staff were present. Where available, the second therapist's primary
in group form role was to ensure that the preliminary meetings (to obtain weight and symptom count, and to monitor risk)
were expedited quickly, so that no therapy group time was lost.
• Groups were led by EM, who had extensive experience in delivering one-to-one CBT-T, and who was
supervised regularly by GW.
• All 10 sessions were 90 min long, as recommended by Institute for Health and Care Excellence (2017)
guidelines for group CBT-ED.

Abbreviations: CBT-T, ten-session cognitive-behavioral therapy for non-underweight eating disorders; CBT-ED, cognitive-behavioral therapy for eating
disorders; EM, Elana Moore (first author); GW, Glenn Waller (second author).

T A B L E 2 Eating and mood

Session 1 Session 10
characteristics at baseline (Session 1) and
the end of treatment (Session 10). N = 8 M (SD) M (SD)
for all measures at both time points.
EDE-Q Global 3.5 (0.5) 1.6 (1.1)
EDE-Q Restraint 2.5 (1.2) 0.8 (0.7)
EDE-Q Eating concern 3.4 (0.8) 1.1 (1.4)
EDE-Q Shape concern 3.9 (0.5) 2.2 (1.4)
EDE-Q Weight concern 4.1 (1.0) 2.4 (1.4)
Objective binge-eating frequency per week 3.4 (3.3) 0.3 (0.5)
Purge frequency per week 0.88 (1.5) 0 (0)
Depression (PHQ-9) 11.8 (2.1) 6.4 (4.4)
Anxiety (GAD-7) 11.0 (2.7) 5.9 (2.4)
Body Mass Index 27.6 (7.0) 27.8 (7.0)

Note: Objective binge-eating and purging frequencies taken from diary records.
Abbreviations: EDE-Q, Eating Disorders Examination-Questionnaire; PHQ-9, Patient Health
Questionnaire (nine-item version); GAD-7, Generalized Anxiety Disorder scale (seven-item version).

2.6 | Data analysis statistically. However, mean scores at the beginning and end of
treatment were used to indicate levels of change in EDE-Q, GAD-7
Data were analyzed using SPSS (v24). No patients dropped out and PHQ-9 scores, along with frequency of binge eating and purg-
or failed to complete measures, so no data were missing. In keep- ing. Mean pre- and post-therapy EDE-Q Global scores were calcu-
ing with the preliminary nature of the study (i.e., not testing lated for the BED and BN groups, to allow comparison of levels of
hypotheses) and the small sample size, scores were not compared change.
 1098108x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/eat.23935 by Test, Wiley Online Library on [27/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
4 MOORE and WALLER

3 | RESULTS It is also important to note the number of waitlist patients offered

treatment (N = 24) was substantially larger than the number entering
3.1 | Acceptance and compliance the groups (N = 8). While the clinic focused on work with non-
underweight eating disorder patients, it was not possible to determine
A total of 24 patients were offered group CBT-T, until each group any more closely how representative this sample of eight patients was
(BN, BED) had N = 4. Sixteen patients did not take up the group of the wider clinic population, or of the 24 approached to take part.
therapy (four did not respond to contact; three needed to delay This lack of comparability was enhanced by the condition that data
therapy regardless; three could not make the group times; three could only be collected from those who chose to participate. The low
wanted one-to-one therapy; three wanted therapy in person rather acceptance level relative to that found in individual CBT-T and other
than online). Therefore, the acceptance rate was 8/24 (33%). All individual therapies (Waller et al., 2018) limits the utility of group
participating patients were white, female adults. Once recruited, the CBT-T in clinical settings, and impacts the viability of setting up future
compliance rate was 100%, as all eight patients completed all trials to determine group CBT-T's efficacy and effectiveness. Finally, it
10 group sessions. will be important to determine whether delivering such groups in-
person post-Coronavirus restrictions impacts the acceptability and
outcome of this telehealth approach.
3.2 | Feasibility These findings suggest that group CBT-T is worth further investi-
gation with larger samples and in RCTs, to ensure that the outcomes
All patients who started therapy completed all the measures. They are reliable and attributable to this specific intervention. The design of
were able to: establish and maintain video connections; make the time such RCTs needs to be considered, given existing effective treatments
to attend uninterrupted; and engage actively in the groups. for such patients. A waitlist control group where those on the waitlist
know that they will soon receive the full treatment would be appropri-
ate to determine any placebo effect (as per Fairburn et al., 2009). An
3.3 | Changes in scores across treatment alternative approach would be to compare directly with individual
CBT-T or to compare online versus face-to-face therapy, using a non-
Table 2 shows the baseline (Session 1) and end of therapy (Session inferiority design with a much larger N. Such studies should include
10) scores for the whole group on eating attitudes (EDE-Q), eating measurement of early change and follow-up, to ensure comparability
behavior frequency per week, depression (PHQ-9), anxiety (GAD-7), with other treatments (Fairburn et al., 2009; Waller et al., 2018).
and BMI. All of the scores apart from BMI showed positive clinical Such research should test the impact of group CBT-T for a more
changes over time. Descriptively, we divided to the group into BN diverse population (e.g., younger, ethnically diverse, different genders
and BED and compared scores on the EDE-Q Global scores only. BN and gender identities). In this instance, relatively small groups (N = 4)
mean scores reduced from 3.5 (SD = 0.3) to 1.3 (SD = 0.7), while BED were piloted as an initial test of feasibility and acceptability. The simi-
mean scores reduced from 3.5 (SD = 0.6) to 1.9 (SD = 1.2). Thus, lar reduction in EDE-Q Global scores for the BN and BED groups and
there was a similar level of change across the two groups. the fact that both groups showed full compliance indicates that future
RCTs should be developed around groups with non-underweight eat-
ing disorders, rather than specific diagnoses of BN or BED. However,
4 | DISCUSSION the high compliance rate might be related to the small size of the
groups yielding close working bonds between group members. Future
This pilot study has examined the feasibility and acceptability of group research should determine whether larger groups have higher attrition
CBT-T for non-underweight adults with BED and BN, delivered rates.
online. Acceptance was limited, as only a third of patients who were A further consideration is whether there were any indications
approached from the waitlist taking up the therapy. However, once that feasibility could be enhanced going forward. Two issues arose
patients started treatment, compliance and feasibility of the treatment that merit future consideration. First, three individuals were unable to
were both strong. The participants were fully compliant with complet- undertake the group because it was at an inconvenient time. Earlier
ing pre- and post-therapy measures. advertising of the group might have allowed them to take part, though
As this was a pilot study, limitations mean that the results cannot that might also have delayed treatment for those who could already
be reliably generalized. The small sample limits the study's power, and attend. Second, informing patients at assessment about the option of
the lack of a control group means the intervention's effectiveness can- individual or group treatment could have allowed the service to offer
not be assumed. Nor did the study examine the perspectives of treatment more efficiently. Finally, there was an exclusion criterion of
patients and therapists on their experiences of this group format severe purging behavior, limiting generalizability of the findings. How-
(e.g., greater group cohesion/support; anxiety about letting down ever, the physical risks of severe purging and the limited opportunities
other group members). Future research into group CBT-T should to address those risks for the individual within a group setting mean
involve a qualitative arm, to determine whether patient experience that it is probably appropriate to retain this exclusion criterion in
reflects that in individual CBT-T (Hoskins et al., 2019). future clinical and research work on group CBT-T.
 1098108x, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/eat.23935 by Test, Wiley Online Library on [27/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
MOORE and WALLER 5

If these acceptability and feasibility findings are supported in (CBT-T) for eating disorders: A qualitative investigation. International
future RCTs and effectiveness research, then group CBT-T might be Journal of Eating Disorders, 53, 530–537. https://doi.org/10.1002/eat.
23039
particular suitable in specific clinical situations and for particular
Keegan, E., Waller, G., & Wade, T. D. (2022). A systematic review and
patients (e.g., those with limited funds, time and access to clinical ser- meta-analysis of a 10-session cognitive behavioural therapy for non-
vices). The lower cost per patient, viability of online delivery (over- underweight eating disorders. Clinical Psychologist, 26, 241–254.
coming issues of distance from services) and relatively brief therapy https://doi.org/10.1080/13284207.2022.2075257
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of
duration of group CBT-T mean that both services and patients could
a brief depression severity measure. Journal of General Internal Medi-
benefit in terms of availability, cost and waiting times. The acceptance cine, 16, 606–613. https://doi.org/10.1080/13642537.2017.1386226
levels demonstrated here mean that this therapy will not be univer- National Health Service Health Research Authority. (2011). National
sally viable, but it still offers a treatment option to a wide range of research ethics service guidance: Does my project require review by a
research ethics committee? https://www.hra.nhs.uk/documents/2013/
non-underweight patients with eating disorders.
09/does-my-project-require-rec-review.pdf
National Institute for Health and Care Excellence (NICE). (2017). Eating
AUTHOR CONTRIBUTIONS disorders: Recognition and treatment. National Institute for Health and
Elana Moore: Conceptualization; data curation; formal analysis; method- Care Excellence.
Pellizzer, M. L., Waller, G., & Wade, T. D. (2019). A pragmatic effectiveness
ology; writing – original draft; writing – review and editing. Glenn Waller:
study of 10-session cognitive behavioural therapy (CBT-T) for eating
Project administration; supervision; writing – review and editing.
disorders: Targeting barriers to treatment provision. European Eating
Disorders Review, 27(5), 557–570. https://doi.org/10.1002/erv.2684
FUND ING INFORMATION Signorini, R., Sheffield, J., Rhodes, N., Fleming, C., & Ward, W. (2018). The
No funding was sought for this work. effectiveness of enhanced cognitive behavioural therapy (CBT-E): A
naturalistic study within an out-patient eating disorder service. Beha-
vioural and Cognitive Psychotherapy, 46, 21–34. https://doi.org/10.
CONF LICT OF IN TE RE ST ST AT E MENT 1017/S1352465817000352
GW receives royalties from treatment manual used in this research. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief mea-
EM has no interests to declare. sure for assessing generalized anxiety disorder: The GAD-7. Archives
of Internal Medicine, 166, 1092–1097. https://doi.org/10.1001/archin
te.166.10.1092
DATA AVAI LAB ILITY S TATEMENT Turner, H., Marshall, E., Stopa, L., & Waller, G. (2015). Cognitive-
Anonymised data are available to other researchers upon reasonable behavioural therapy for outpatients with eating disorders: Effective-
request. ness for a transdiagnostic group in a routine clinical setting. Behaviour
Research and Therapy, 68, 70–75. https://doi.org/10.1016/j.brat.2015.
03.001
E TH I CS S T A TE M E N T Wade, S., Byrne, S., & Allen, K. (2017). Enhanced cognitive behavioral ther-
Specific ethical approval was not required as the pilot study evaluated apy for eating disorders adapted for a group setting. International Jour-
existing practice (National Health Service Research Authority, 2011). nal of Eating Disorders, 50(8), 863–872. https://doi.org/10.1002/eat.
22723
All patients gave written consent to take part and their outcomes to
Waller, G., Pugh, M., Mulkens, S., Moore, E., Mountford, V. A., Carter, J.,
be anonymously analyzed and published. Wicksteed, A., Maharaj, A., Wade, T. D., Wisniewski, L., Farrell, N. R.,
Raykos, B., Jorgensen, S., Evans, J., Thomas, J. J., Osenk, I.,
RE GI STE R ED Paddock, C., Bohrer, B., Anderson, K., … Smit, V. (2020). Cognitive-
behavioral therapy in the time of coronavirus: Clinician tips for work-
With Open Science Framework, January 2022 (DOI 10.17605/OSF.
ing with eating disorders via telehealth when face-to-face meetings
IO/RMAV4).
are not possible. International Journal of Eating Disorders, 53, 1132–
1141. https://doi.org/10.1002/eat.23289
ORCID Waller, G., Tatham, M., Turner, H., Mountford, V. A., Bennetts, A.,
Glenn Waller https://orcid.org/0000-0001-7794-9546 Bramwell, K., Dodd, J., & Ingram, L. (2018). A 10-session cognitive
behavioral therapy (CBT-T) for eating disorders: Outcomes from a case
series of nonunderweight adult patients. International Journal of Eating
RE FE R ENC E S Disorders, 51, 262–269. https://doi.org/10.1002/eat.22837
Byrne, S. M., Fursland, A., Allen, K. L., & Watson, H. (2011). The effective- Waller, G., Turner, H., Tatham, M., Mountford, V. A., & Wade, T. D. (2019).
ness of enhanced cognitive behavioral therapy for eating disorders: An Brief cognitive behavioural therapy for non-underweight patients: CBT-T
open trial. Behaviour Research and Therapy, 49, 219–226. https://doi. for eating disorders. Routledge.
org/10.1016/j.brat.2011.01.006
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guil-
ford Press.
Fairburn, C. G., Cooper, Z., Doll, H. A., O'Connor, M. E., Bohn, K., How to cite this article: Moore, E., & Waller, G. (2023). Brief
Hawker, D. M., & Palmer, R. L. (2009). Transdiagnostic cognitive- group cognitive-behavioral therapy for bulimia nervosa and
behavioral therapy for patients with eating disorders: A two-site trial binge-eating disorder: A pilot study of feasibility and
with 60-week follow-up. American Journal of Psychiatry, 166, 311–319.
acceptability. International Journal of Eating Disorders, 1–5.
https://doi.org/10.1176/appi.ajp.2008.08040608
Hoskins, J. I., Blood, L., Stokes, H. R., Tatham, M., Waller, G., & Turner, H.
https://doi.org/10.1002/eat.23935
(2019). Patients' experiences of brief cognitive behavioural therapy