Innovative Moments and the Process of Change in the Treatment of Bulimia Nervosa

Problematic patient narratives emerging in the process of treatment have been identified as important factors in the maintenance of psychopathology, and their change is associated with desired treatment outcomes. This increased focus in psychotherapy research has triggered the investigation of innovative moments (IMs) as novelties in patient narratives in therapy. This exploratory study aims to investigate the development of IMs throughout treatment in bulimia nervosa (BN) in a sample of good and poor outcome cases, and examine their longitudinal associations with binge and purge frequency change. IMs were coded in sixty sessions across five good outcome and five poor outcome cases in different stages of treatment. Generalized estimating equation analyses indicated that IMs evolved significantly over time, with different trajectories between good and poor outcome groups. High-level IMs showed higher proportion in the good outcome group at the end of treatment indicating that the ability to elaborate on how and why change might occur (as measured by high-level IMs) plays a role in the process of change in BN. Additionally, both low- and high-level IMs predicted symptom decrease in the following session. The study provides a preliminary understanding of important patient narrative processes in psychotherapy for BN and their association with treatment change.