Adolescent bulimia and psychotherapeutic efficacy - Essay Example

Research Design: Adolescent Bulimia and Psychotherapeutic Efficacy YOUR FULL OF YOUR SCHOOL OR Abstract Bulimia is an eating disorder that impacts millions of adolescent children annually. It has been suggested that psychotherapy is effective at attenuating the incidence of this condition. The purpose of this proposed research is to attempt to quantify the efficacy of that therapy. Using a standardized test for bulimic presence and severity, the Bulimic Investigatory Test, Edinburgh (BITE), this research project will obtain an age-appropriate sample from the New York City educational system and qualify a sample group. That group will then be randomized and divided into an experimental cohort and a control group. The experimental cohort will receive six weekly one-hour sessions of psychotherapy targeted at bulimia. At the end of the six weeks, the two groups will be re-tested and the results compared and analyzed using standard statistical methods. It is anticipated that the experimental group will demonstrate a statistically significant improvement in testing scores for bulimic behavior. Research Design: Adolescent Bulimia and Psychotherapeutic Efficacy Introduction Of various eating disorders within the adolescent population, bulimia is one of the most common. Occurring in a predominantly female population comprising up to 10% of the middle-to-upper class, approximately one out of 200 teenage women can be expected to suffer from this condition (Beach, 1996, p. 1). Quoting Haller, Beach avers that bulimia nervosa is properly diagnosed when an individual presents symptoms that include binge eating, self-induced purging such as vomiting, the use of laxatives, or diuretics, is overly concerned with body weight, and engages in a binge/purge cycle of behavior at least 2 times a week for a period of three months or longer (p. 3). It is well known that many adolescent girls are influenced by media presentations of image, and the female form is normally demonstrated as fashionably thin. In fact, what is actually a healthy body type is often misperceived as overweight by adolescents, who will make every effort to fit in with perceived trends to the point of engaging in unhealthy behavior. It has been suggested that this behavior is actually an expression of "maturational crisis" and that eating disorders such as bulimia "may indeed be a response to puberty, which challenges the individual's sense of control..." (Schwartzberg, 1998, p. 173). There are often co-occurring symptoms which can elevate the risk for "onset or recurrence" of bulimia nervosa; like chronic depressive symptoms which if present in early adolescence, "may play a uniquely important role" in the development of the condition (Cockell, Johnson, & Zaider, 2002, p. 324). Co-occurrence need not be present, however, as bulimic eating patterns can be guilt driven and "self-maintaining" due to the fact that "restrictive eating is maintained...binging arises from the [resulting] feelings of hunger...negative cognitions about bingeing lead to purging...[and] guilt about the binge-purge episode" (Carr, 1999, p. 694). Thus, for the purposes of this research, only the presence of bulimia need be ascertained. Regardless of whether the condition is accompanied by other pathologies, it has been shown that psychotherapy is effective in treating bulimia; in fact, Connors and Johnson stated that "perhaps the greatest advancements have occurred in the area of psychotherapy for bulimia nervosa," and that there has been a "healthy trend toward the integration of different therapeutic modalities" (1987, p. xii). Referring to Henderson & Freeman, Irving, Mccluskey-Fawcett, & Miller affirm that one important and effective tool for diagnosing bulimia is the Bulimic Investigatory Test, Edinburgh (BITE), which is a simple questionnaire that quantifies individuals using a scoring system; the score ranges from 0 (non-bulimic) to 30 (severely bulimic) (1993, p. 622). Accordingly, the BITE provides a means for achieving a standardized baseline for the purposes of analyzing the data from this study. Based on the foregoing, the research proposed herein will undertake an investigation of psychotherapeutic efficacy on bulimic adolescents. As explained below, I propose using an experimental method in combination with BITE testing and psychotherapy; the test will be employed to provide data for comparison between an experimental group receiving therapy and a control group that doest not. Prior initiating the study, permission will be obtained from the appropriate ethical review boards. Methods The methodology for this research is straightforward and will be conducted in two phases. First, potential study participants will be selected from the New York City public middle and high school system, grades 7-12. A large sample of initial participants will be recruited due to the statistical indications that only one to ten percent of the population can be expected to score high enough to be considered bulimic. It is estimated that at least 3,000 initial questionnaires will be required to obtain a sufficient sample group size using a conservative 3% expected presence of bulimia. Participants will be required to sign an informed consent form, the terms of which will be explained to them by a research assistant. The baseline questionnaire, the Bulimic Investigatory Test, Edinburgh (BITE) will be administered to all participants and evaluated for indications of bulimia. Only those participants who score above 20 (out of 30) will be considered for participation in the second phase of the project. If 3,000 questionnaires yield the expected 3% qualified respondent rate, the initial cohort will be 900 study participants in Phase 2. Those individuals who are qualified to participate in Phase 2 will be randomized by numerical assignment. Each file will contain the name of the subject, their signed consent form, and their initial BITE score. The file will be given a number by a research assistant and secured; the identity of the participant will not be available to the primary researchers. Once all participants are numbered, the group will be divided equally by a second random selection into those who will receive therapy (experimental cohort) and those who will not (control cohort). Over the course of the next six weeks, the experimental cohort will receive one hour of targeted psychotherapy each week. At the end of the therapy period, a second BITE test will be performed across the study population. The data will be tabulated by the non-participatory assistant so that each individual file will have a pre- and post-therapy BITE questionnaire. The experimental cohort and control cohort data will be provided to the primary researchers, who will perform statistical analysis on the data. Results The raw data will be tabulated and formatted so that the scores from both rounds of testing can be compared for each individual. After individual score differentials are determined, the data will be presented as a function of change in score, e.g., Participant 9: - 4 Points (for a decrease in scores) or Participant 153: + 2 Points (for an increase in score). The raw point scores will be recalculated and presented as a percentage of the total for each individual, and then the individual scores will be analyzed and a mean change will be determined for each cohort. The experimental cohort data will then be compared with the scores from the control group, and processed using a standard t-test determiner. Discussion I am interested in researching the efficacy of psychotherapy for bulimia in an adolescent population residing in a major metropolitan area. This proposed study will focus on the use of an independent variable (indictors of bulimia) to establish a total research population from which two groups can be formed. Once the baseline scores have qualified the participants for the group, the population will be separated so that the dependent variable (psychotherapy) can be applied to one group. The experimental group will receive six one-hour sessions of psychotherapy at a rate of one session per week. The control group will receive no instruction or therapy at all. The baseline and post-therapy scores will use the standard BITE test, which has a proven record of accuracy for determining likelihood and severity of bulimia. My expectations are that the control group will show little change in scores between the administration of the first and second tests. Because research suggests that psychotherapy has been effective in attenuating bulimic behavior, I expect the results of this study to demonstrate improved scores within the experimental group as compared to the control group. If the control group demonstrates an unexpected fluctuation in scores, that variable coefficient will have to be considered in the group mean analysis. Obviously, if the experimental group does not show a statistically significant improvement over the control group, further study will be required to determine the cause. Also, in the event of a contrary finding, this research could be performed again with a significantly larger sample size. References Beach, W.A. (1996). Conversations about Illness: Family Preoccupations with Bulimia. Mahwah, NJ: Lawrence Erlbaum Associates. Carr, A. (1999). The Handbook of Child and Adolescent Clinical Psychology: A Contextual Approach. New York: Routledge. Cockell, S.J., Johnson, J.G., Zaider, T.I. (2002). "Psychiatric Disorders Associated with the Onset and Persistence of Bulimia Nervosa and Binge Eating Disorder during Adolescence." Journal of Youth and Adolescence, 31 (5), 319-326. Connors, M.E., Johnson, C. (1987). The Etiology and Treatment of Bulimia Nervosa: A Biopsychosocial Perspective. New York: Basic Books. Haller, E. (1992). "Eating disorders: A review and update." Western Journal of Medicine, 157, 658-662. Henderson, M. & Freeman, C.P.L. (1987). "A self rating scale for bulimia: The BITE. British Journal of Psychiatry, 150, 18-24. Irving, L.M., Mccluskey-Fawcett, K., & Miller, D.A.F. (1993). "Correlates of Bulimia Nervosa: Early Family Mealtime Experiences." Adolescence, 28 (111), 621-628. Schwartzberg, A.Z. (1998). The Adolescent in Turmoil. Westport, CT: Praeger Publishers. Informed Consent Form Title of Research: Adolescent Bulimia and Psychotherapeutic Efficacy. Investigator: INSERT YOUR NAME Prior to participating in this research, you must review each of the following sections. Your signature(s) below indicate your agreement to participate, and your acknowledgment that no representation is made regarding the results of this study. Procedures: This is a research study that compares the potential impact of psychotherapy on individuals between the ages of 12 and 18 years old. Choosing to participate in this study will involve answering a short questionnaire and a willingness to undergo six (6) weekly one hour sessions of psychotherapy. A second questionnaire will be administered after the six week period. Risk: As an informed participant answering two questionnaires and being willing to receive psychotherapy, there is no participant risk associated with this study. Benefits: There are no benefits implied for participants. Although some study participants will undergo therapy for bulimia, no assurances are made regarding the efficacy of this therapy, and no representation is made that any individual participant will undergo therapy. There are no payments or financial incentives provided to the participants in this study. Confidentiality: All information gathered in this study will remain confidential. Participant identity will not be revealed, and only the researcher named above and the sponsoring institution will have access to the study data. All data will be kept under lock, and destroyed after project completion. Costs for Participation in Research: There is no cost for participants in this study; any therapeutic treatment received will be at no charge Questions: Any questions regarding specific aspects of this research should be directed to the investigator named above at ###.###.####. For questions regarding the general nature of the study or for further information, participants can call the faculty advisor for this project, Dr. NAME PROFESSOR HERE at ###.###.####. Questions regarding personal rights under the terms of this agreement or for confirmation of ethical conformity, participants may contact the Chairman of the Institutional Review Board, Dr. NAME OF IRB CHAIR at ###.###.####. Agreement: The signature(s) below affirm that you have agreed to participate in this study, that you have read this document setting forth the terms of the research, and that you have received a copy of this informed consent document. DATE: I agree to participate in this research study: NAME: SIGNATURE: [For participants under the age of 18] As parent or guardian of the individual named above, I hereby give my permission for my minor child to participate in this study. NAME: SIGNATURE: Read More