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Bulimia nervosa en de bekoring van cue–exposure

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De auteur bespreekt de twee meest populaire ontologische modellen van bulimia nervosa (het multicausaliteitsmodel en het cognitiemodel) en de resultaten van de daaruit voortvloeiende behandelmethoden. Geconcludeerd wordt dat de veelal omvattende behandelingen enkel verbetering en lang niet altijd genezing bewerkstelligen. De vraag dringt zich op waarom zo weinig patiënten na afloop van de behandeling geheel klachtenvrij zijn. Op grond van recent verworven inzichten in het ontstaan van eetpathologie wordt een nieuwe vorm van behandeling (cue–exposure) geïntroduceerd. Verslag van een gecontroleerde pilot–studie toont dat de nieuwe methode uitermate veelbelovend is. Afgerond wordt met een niet–uitputtende lijst van opwindende kwesties waar eetonderzoekers de komende jaren mee uit de voeten kunnen.

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    Anita Jansen

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Abstract

The author discusses the two most popular models of bulimia nervosa (the multicausality model and the cognitive model) and the methods of treatment flowing from them. It is concluded that both all–embracing treatment methods bring about improvement instead of recovery. From a recent theory on the learned nature of craving responses and binge eating, it follows that craving will extinguish when the CS–US bond is broken by prolonged exposure to the cues predicting excessive food intake with response prevention. A pilot–study is presented in which six obese bulimics were treated with cue exposure and response prevention. Six other patients learned to avoid or escape the binge–related cues with the aid of self control techniques. Although both treatments appeared to be effective in reducing the binge frequency, a most remarkable finding of the present study is that all patients treated by cue exposure were abstinent, directly after treatment and during the one–year follow–up. In contrast to the 100% binge–free Ss treated by cue exposure, self control techniques and relapse prevention led to abstinence in merely 33% of the Ss. Empirical and theoretical implications are discussed.

Dr. A. Jansen werkt bij de Rijksuniversiteit Limburg, vakgroep Geestelijke gezondheidkunde/Experimentele Psychopathologie, Postbus 616, 6200 MD Maastricht.

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Jansen, A. Bulimia nervosa en de bekoring van cue–exposure. DITH 12, 58–69 (1992). https://doi.org/10.1007/BF03059990

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