Evidence-based Psychotherapies for Eating Disorders

Evidence-based Psychotherapies for Eating Disorders

Bulik Cynthia M, Raney TJ, Shapiro Jennifer

US Psychiatry 2007;1:29-31

download article

| More
dots

Psychotherapy is essential for recovery from an eating disorder, yet it is complex and prolonged and often yields only marginal therapeutic gains.1 Various approaches exist, but few have shown efficacy in controlled clinical trials. The Research Triangle Institute (RTI) International–University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) reviewed the treatment efficacy literature for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) in studies published between 1980 and September 2005. The systematic review identified 30 treatment studies for AN, 47 for BN, and 25 for BED.2

This article presents information from that review regarding the psychotherapeutic interventions that were shown to be efficacious for AN, BN, and BED. Medication trials without psychotherapy components are not reviewed. The paper is divided by therapeutic approach; within each approach, the variations on the presentation necessary to address the specific therapeutic needs of each eating disorder type are discussed.

Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) for eating disorders focuses on how thoughts, feelings, and behaviors develop into patterns that maintain disordered eating. The intention of CBT is to use cognitive techniques to challenge unhelpful or distorted thoughts while using behavioral techniques to reduce eating disorder behaviors. The patient is asked to maintain daily monitoring logs of foods eaten, disordered eating behaviors, thoughts, feelings, and details of when, where, and with whom those behaviors occurred. Self-monitoring yields objective information for use with behavioral interventions such as cue recognition, desensitization, or reinforcement. It also reveals patterns of automatic thoughts (e.g. ‘I am fat,’ ‘I can’t eat this,‘ or ’I am weak’) that reflect broader core beliefs. Cognitive restructuring challenges these thoughts with rational alternatives. CBT is effective when beliefs change, automatic thoughts decrease, and problem behaviors are reduced. CBT is often compared with interpersonal psychotherapy (IPT) in treatment studies. IPT focuses on the patient’s relationships with peers and family with the intention of reducing presenting symptoms by modifying personal problems in those relationships. IPT examines how disputes, role transitions, grief, and skill deficits are managed and influence functioning.

Anorexia Nervosa
CBT applied to AN typically focuses on cognitions relating to fear, control, low self-esteem, body-image distortion, and perfectionism, with behavioral targets including decreasing caloric restriction, decreasing physical activity, and reducing avoidance. Two studies of patients receiving CBT while underweight failed to show evidence that CBT improved body mass index (BMI) or weight or was superior to other treatment strategies at the end of treatment or at follow-up.3,4

To view full article click here

References:
  1. National Collaborating Centre for Mental Health,Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders,London:British Psychological Society and Royal College of Psychiatrists,2004.
  2. Berkman N,et al.,Management of Eating Disorders.Evidence Report/Technology Assessment No.135,2006,Rockville,MD: (Prepared by the RTI International-University of North Carolina Evidence-Based Practice Center under Contract No.290-02-0016). AHRQ Publication No.06-E010.
  3. McIntosh V,et al.,Three psychotherapies for anorexia nervosa:a randomized controlled trial,Am J Psychiatry,2005;162:741–7.
  4. Channon S,et al.,A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa,Behav Res Ther, 1989;27(5):529–35.
  5. McIntosh VVW,et al.,Specialist supportive clinical management for anorexia nervosa, Int J Eat Disord,2006;39(8):625–32.
  6. Pike K,et al.,Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa,Am J Psychiatry,2003;160:2046–9.
  7. Chen E,et al.,Comparison of group and individual cognitive- behavioral therapy for patients with bulimia nervosa,Int J Eat Disord,2003;33:241–54.
  8. Agras WS,et al.,A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa,Arch Gen Psychiatry,2000;57(5):459–66.
  9. Fairburn CG,et al.,Three psychological treatments for bulimia nervosa:A comparative trial,Arch Gen Psychiatry,1991;48:463–9.
  10. Goldbloom DS,et al.,A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa:short-term outcome,Behav Res Ther,1997;35(9):803–11.
  11. Agras W,et al.,One-year follow-up of psychosocial and pharmacologic treatments for bulimia nervosa,J Clin Psychiatry, 1994;55(5):179–83.
  12. Walsh B,et al.,Medication and psychotherapy in the treatment of bulimia nervosa,Am J Psychiatry,1997;154(4):523–31.
  13. Cooper P,J Steere,A comparison of two psychological treatments for bulimia nervosa:implications for models of maintenance,Behav Res Ther,1995;33:875–85.
  14. Agras W,et al.,Cognitive-behavioral and response-prevention treatments for bulimia nervosa,J Consult Clin Psychol,1989;57: 215–21.
  15. Wilfley D,et al.,A randomized comparison of group cognitive- behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder, Arch Gen Psychiatry,2002;59(8):713–21.
  16. Gorin A,et al.,Effectiveness of spouse involvement in cognitive behavioral therapy for binge eating disorder,Int J Eat Disord, 2003;33(4):421–33.
  17. Hilbert A,Tuschen-Caffier B,Body image interventions in cognitive-behavioural therapy of binge-eating disorder:A component analysis,Behav Res Ther,2004;42(11):1325–39.
  18. Munsch S,et al.,A randomized comparison of cognitive behavioral therapy and behavioral weight loss treatment for overweight individuals with binge eating disorder,Int J Eat Disord, 2007;40(2):102–13.
  19. Grilo C,et al.,Cognitive behavioral therapy guided self-help and orlistat for the treatment of binge eating disorder:A randomized, double-blind,placebo-controlled trial,Biol Psychiatry, 2005;57(10):1193–1201.
  20. Agras W,et al.,Weight loss,cognitive-behavioral,and desipramine treatments in binge eating disorder:An additive design,Behav Ther,1994;25:225–38.
  21. Grilo C,et al.,Efficacy of cognitive behavioral therapy and fluoxetine for the treatment of binge eating disorder:A randomized double-blind placebo-controlled comparison,Biol Psychiatry,2005;57(3):301–9.
  22. Dare C,et al.,Psychological therapies for adults with anorexia nervosa:Randomised controlled trial of out-patient treatments, Br J Psychiatry,2001;178(3):216–21.
  23. Lock J,Le Grange D,Can Family-Based Treatment of Anorexia Nervosa Be Manualized?,J Psychother Pract Res,2001;10(4): 253–61.
  24. Dare C,et al.,Psychological therapies for adults with anorexia nervosa:randomised controlled trial of out-patient treatments, Br J Psychiatry,2001;178:216–21.
  25. Crisp A,et al.,A controlled study of the effect of effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa,Br J Psychiatry,1991;159:325–33.
  26. Gowers S,et al.,Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa,Int J Eat Disord,1994;15:165–77.
  27. Robin A,et al.,Family therapy versus individual therapy for adolescent females with anorexia nervosa,J Dev Behav Pediatr, 1994;15(2):111–16.
  28. Robin AL,et al.,Family versus individual therapy for anorexia: impact on family conflict,Int J Eat Disord,1995;17(4):313–22.
  29. Eisler I,et al.,Family Therapy for Adolescent Anorexia Nervosa:The Results of a Controlled Comparison of Two Family Interventions, J Child Psychol Psychiatry,2000;41(6):727.
  30. Geist R,et al.,Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa,Can J Psychiatry,2000;45:173–8.
  31. Lock J,et al.,A comparison of short- and long-term family therapy for adolescent anorexia nervosa, J Am Acad Child Adolesc Psychiatry,2005;44(7):632–9.
  32. Russell GFM,et al.,An evaluation of family therapy in anorexia and bulimia nervosa,Arch Gen Psychiatry,1987;44:1047–56.
  33. Eisler I,et al.,Family and individual therapy in anorexia nervosa. A 5-year follow-up,Arch Gen Psychiatry,1997;54:1025–30.
  34. Bailer U,et al.,Guided self-help versus cognitive-behavioral group therapy in the treatment of bulimia nervosa, Int J Eat Disord, 2004;35(4):522–37.
  35. Thiels C,et al.,Guided Self-Change for Bulimia Nervosa ncorporating Use of a Self-Care Manual, Am J Psychiatry, 1998;155(7):947–53.
  36. Carter J,et al.,Self-help for bulimia nervosa:a randomized controlled trial,Am J Psychiatry,2003;160:973–8.
  37. Cooper P,Bulimia nervosa: a guide to recovery,London:Robinson, 1993.
  38. Durand M,King M,Specialist treatment versus self-help for bulimia nervosa:a randomised controlled trial in general practice, Br J Gen Pract,2003;53:371–7.
  39. . Carter J,Fairburn C,Cognitive-behavioral self-help for binge eating disorder:A controlled effectiveness study,J Consult Clin Psychol,1998;66(4):616–23.
  40. Peterson C,et al.,Group cognitive-behavioral treatment of binge eating disorder: A comparison of therapist-led versus self-help formats,Int J Eat Disord, 1998;24(2):125–36.
  41. Linehan M,Cognitive Behavioral Therapy of Borderline Personality Disorder,New York,NY:Guilford Press,1993.
  42. Safer DL,et al.,Dialectical behavior therapy for bulimia nervosa, Am J Psychiatry,2001;158(4):632–4.
  43. Telch C,et al.,Dialectical behavior therapy for binge eating disorder,J Consult Clin Psychol,2001;69(6):1061–5.

Copyright® 2012 Touch Group PLC. All rights reserved.
Touch Neurology is for informational purposes and should not be considered medical advice, diagnosis or treatment recommendations.