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The Efficacy of Cognitive-Behavioral Therapy for Eating Disorders: A Systematic Review and Meta-Analysis

American Psychological Association
Journal of Consulting and Clinical Psychology
Authors:
Jake Linardon
Jake Linardon
Jake Linardon
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Tracey D. Wade
Tracey D. Wade
Tracey D. Wade
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Xochitl de la Piedad Garcia
Xochitl de la Piedad Garcia
Xochitl de la Piedad Garcia
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Leah Brennan at Australian Catholic University
Leah Brennan
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Abstract

Objective: This meta-analysis examined the efficacy of cognitive-behavioral therapy (CBT) for eating disorders. Method: Randomized controlled trials of CBT were searched. Seventy-nine trials were included. Results: Therapist-led CBT was more efficacious than inactive (wait-lists) and active (any psychotherapy) comparisons in individuals with bulimia nervosa and binge eating disorder. Therapist-led CBT was most efficacious when manualized CBT-BN or its enhanced version was delivered. No significant differences were observed between therapist-led CBT for bulimia nervosa and binge eating disorder and antidepressants at posttreatment. CBT was also directly compared to other specific psychological interventions, and therapist-led CBT resulted in greater reductions in behavioral and cognitive symptoms than interpersonal psychotherapy at posttreatment. At follow-up, CBT outperformed interpersonal psychotherapy only on cognitive symptoms. CBT for binge eating disorder also resulted in greater reductions in behavioral symptoms than behavioral weight loss interventions. There was no evidence that CBT was more efficacious than behavior therapy or nonspecific supportive therapies. Conclusions: CBT is efficacious for eating disorders. Although CBT was equally efficacious to certain psychological treatments, the fact that CBT outperformed all active psychological comparisons and interpersonal psychotherapy specifically, offers some support for the specificity of psychological treatments for eating disorders. Conclusions from this study are hampered by the fact that many trials were of poor quality. Higher quality RCTs are essential. (PsycINFO Database Record
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The Efficacy of Cognitive-Behavioral Therapy for Eating Disorders:
A Systematic Review and Meta-Analysis
Jake Linardon
Australian Catholic University
Tracey D. Wade
Flinders University
Xochitl de la Piedad Garcia and Leah Brennan
Australian Catholic University
Objective: This meta-analysis examined the efficacy of cognitive– behavioral therapy (CBT) for eating
disorders. Method: Randomized controlled trials of CBT were searched. Seventy-nine trials were
included. Results: Therapist-led CBT was more efficacious than inactive (wait-lists) and active (any
psychotherapy) comparisons in individuals with bulimia nervosa and binge eating disorder. Therapist-led
CBT was most efficacious when manualized CBT-BN or its enhanced version was delivered. No
significant differences were observed between therapist-led CBT for bulimia nervosa and binge eating
disorder and antidepressants at posttreatment. CBT was also directly compared to other specific
psychological interventions, and therapist-led CBT resulted in greater reductions in behavioral and
cognitive symptoms than interpersonal psychotherapy at posttreatment. At follow-up, CBT outperformed
interpersonal psychotherapy only on cognitive symptoms. CBT for binge eating disorder also resulted in
greater reductions in behavioral symptoms than behavioral weight loss interventions. There was no
evidence that CBT was more efficacious than behavior therapy or nonspecific supportive therapies.
Conclusions: CBT is efficacious for eating disorders. Although CBT was equally efficacious to certain
psychological treatments, the fact that CBT outperformed all active psychological comparisons and
interpersonal psychotherapy specifically, offers some support for the specificity of psychological treat-
ments for eating disorders. Conclusions from this study are hampered by the fact that many trials were
of poor quality. Higher quality RCTs are essential.
What is the public health significance of this article?
This meta-analysis demonstrates that CBT is an efficacious psychological treatment for individuals
with eating disorders. CBT produces large and long lasting improvements in core behavioral and
cognitive symptoms of eating disorders.
Keywords: cognitive– behavioral therapy, eating disorders, bulimia nervosa, binge eating
Supplemental materials: http://dx.doi.org/10.1037/ccp0000245.supp
Cognitive– behavioral therapy (CBT) is the most widely inves-
tigated eating disorder treatment. Randomized controlled trials
(RCTs) demonstrate that specific forms of CBT produce large
improvements in eating disorder symptoms in individuals with
bulimia nervosa (BN), binge eating disorder (BED), Other Spec-
ified Feeding and Eating Disorders (OSFED), and anorexia ner-
vosa (AN; Byrne et al., 2017;Fairburn et al., 2015,1991). Clinical
guidelines recommend specific forms of CBT as the treatment of
choice for BN, BED, and OSFED, and also as one of the front-
running treatments for AN (Hay et al., 2014;Herpertz et al., 2011;
National Institute of Clinical Excellence, 2017).
The results across RCTs have been synthesized in meta-
analyses. A summary of these meta-analyses is presented in Table
1 of the supplementary materials. Compared with wait-list or
active controls, therapist-led CBT consistently results in greater
improvements in eating disorder symptoms in BN and BED (Hay,
Bacaltchuk, Stefano, & Kashyap, 2009;Linardon, Wade, De la
Piedad Garcia, & Brennan, 2017). Moreover, specific modes (e.g.,
E-therapy CBT) or formats (e.g., group-based CBT) have also
been shown to be superior to wait-list controls in BN and BED
(Loucas et al., 2014;Polnay et al., 2014). In contrast, one meta-
analysis has examined the effects of CBT for AN (Hay, Claudino,
Touyz, & Abd Elbaky, 2015), estimating effect sizes for two
comparisons: CBT compared with treatment as usual, and CBT
compared with interpersonal psychotherapy (IPT) or short-term
focal psychodynamic therapy. Effect sizes were based on two
Jake Linardon, School of Psychology, Australian Catholic University;
Tracey D. Wade, School of Psychology, Flinders University; Xochitl de la
Piedad Garcia and Leah Brennan, School of Psychology, Australian Cath-
olic University.
Correspondence concerning this article should be addressed to Jake
Linardon, Faculty of Health Sciences, Australian Catholic University, 115
Victoria Parade/Locked Bag 4115, Melbourne, Victoria, Australia, 3065.
E-mail: jake.linardon@acu.edu.au
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Journal of Consulting and Clinical Psychology © 2017 American Psychological Association
2017, Vol. 85, No. 11, 1080–1094 0022-006X/17/$12.00 http://dx.doi.org/10.1037/ccp0000245
1080
... CBT can be delivered in several formats, including individual, group, guided self-help (including digital guided self-help) and unguided self-help. Each of the treatment formats in CBT for eating disorders has been examined in multiple randomized trials (Linardon et al., 2017) and a considerable number of trials have also compared different formats with each other (e.g. Barakat et al., 2023;de Zwaan et al., 2017;Shapiro et al., 2007). ...
... Studies were identified through an earlier meta-analysis of CBT for eating disorders (Linardon et al., 2017) and an update of this meta-analysis up to 1 January 2024. For the update, we conducted new searches in PubMed, Embase, PsycINFO and CINAHL (deadline 1 January 2024), based on the search strings developed for the previous meta-analysis. ...
... We included 28 RCTs meeting inclusion criteria from the previous meta-analysis (Linardon et al., 2017). For the update, we identified 756 records (505 after removal of duplicates). ...
Delivery formats of cognitive behavior therapy in adults with eating disorders: a network meta-analysis
Article
  • Apr 2025
Although CBT has been found to be effective in the treatment of eating disorders, it is not clear if there are differences between treatment formats. We conducted a network meta-analysis (NMA) of randomized trials of broadly defined CBT comparing individual, group, guided self-help (GSH) and unguided self-help (USH) with each other or with a control condition. The NMA used a frequentist graph-theoretical approach and included 36 trials (53 comparisons; 3,136 participants). Only one trial was aimed at anorexia nervosa. All formats resulted in large, significant effects when compared to waitlists, with no significant difference between formats (group: g = 1.08, 95% CI: 0.84; 1.31; GSH: g = 0.94, 95% CI: 0.75; 1.13; individual: g = 1.06, 95% CI: 0.77; 1.36; USH: g = 0.62, 95% CI: 0.30; 0.93). No significant difference was found between any format and care-as-usual. Analyses limited to binge eating disorder supported the effects of individual, group and GSH formats, with no significant differences between them. Few trials with low risk of bias were available. CBT for eating disorders can probably be delivered effectively in any format, without significant differences between the formats. These results should be considered with caution because of the non-significant differences when compared to care-as-usual and the considerable risk of bias.
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... As evidenced, while previous systematic reviews have compared guided to non-guided selfhelp platforms, there is a gap in research collating findings regarding the effectiveness of only unguided internet-based computer self-help platforms for people with EDs [16,43,49]. Moreover, unguided internet-based computer self-help platforms are potentially effective in reducing risk for people with ED symptoms [47,48,50]. Therefore, this systematic review aims to evaluate the effectiveness of unguided internet-based computer self-help platforms for several outcomes: (1) global ED symptoms, (2) ED-related behaviours, such as thin idealisation, body dissatisfaction, quality of life, depression, perseverative thinking, and resistance to change, and (3) preventing the onset of EDs. ...
... Traditionally, especially pre-COVID-19, many therapeutic interventions were delivered face-to-face. For EDs, face-to-face family-based treatment for EDs and CBT-ED were the most commonly utilised therapeutic interventions supported by numerous evidence-based clinical effectiveness studies [36,50,61,62]. After COVID-19, interventions that were previously delivered face-to-face transitioned to internet-based computer self-help platforms to educate and provide resources aimed at effectively preventing and treating ED symptoms and related behaviours. ...
... When compared to face-to-face CBT, the findings are similar. A meta-analysis containing 79 studies [50] demonstrated that therapist-led CBT reduced short-term remission and binge or purge frequency in BN and BED compared to waitlisted conditions. A meta-analysis of 16 studies exploring ICBT effectiveness found that ICBT was effective in preventing ED in at-risk patients (-0. ...
Effectiveness of unguided internet-based computer self-help platforms for eating disorders (with or without an associated app): A systematic review
Article
Full-text available
  • Apr 2025
Background Following the COVID-19 pandemic, internet-based computer self-help platforms for eating disorders (EDs) became increasingly prevalent as a tool to effectively prevent and treat ED symptoms and related behaviours. This systematic review explored the effectiveness of unguided internet-based computer self-help platforms for EDs. Methods From inception to the 31st of May 2024, a systematic search of Ovid MEDLINE, Embase, Global Health, and APA PsycInfo was conducted. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcome quality assessments were conducted according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results 12 RCTs, with a total of 3400 participants, were included. 2 studies explored the effectiveness as primary prevention, 7 as secondary prevention, and 3 as tertiary intervention. The gathered literature demonstrated unguided internet-based computer self-help platforms as effective in reducing ED core symptoms and related behaviours, with psychoeducation, cognitive behavioural, and dissonance-based approaches being the most prevalent approaches. Conclusions Unguided internet-based computer self-help platforms are effective in the short-term reduction of ED symptoms and associated behaviours and should be implemented in the early stages of a tiered healthcare system for ED treatments. Trial registration Prospero (CRD42024520866).
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... The BED treatment literature suggests specific psychological interventions, most notably cognitive behavioral therapy (CBT) interventions, are the treatment of choice (Grilo and Juarascio 2023). Meta-analyses reveal that CBT outperforms inactive (e.g., waitlist) and other psychological treatments (Linardon et al. 2017); one exception is that CBT outperforms interpersonal psychotherapy at the end of treatment but not at follow-up (Linardon et al. 2017). The literature regarding pharmacotherapy for BED is evolving. ...
... The BED treatment literature suggests specific psychological interventions, most notably cognitive behavioral therapy (CBT) interventions, are the treatment of choice (Grilo and Juarascio 2023). Meta-analyses reveal that CBT outperforms inactive (e.g., waitlist) and other psychological treatments (Linardon et al. 2017); one exception is that CBT outperforms interpersonal psychotherapy at the end of treatment but not at follow-up (Linardon et al. 2017). The literature regarding pharmacotherapy for BED is evolving. ...
Randomized Controlled Trial of Weight Management Versus Weight Management With Concurrent Cognitive‐Behavioral Therapy for Binge‐Eating Disorder in US Veterans With High Weight
Article
Full-text available
Objective To determine the effectiveness of adding a brief psychological eating‐disorder treatment (CBT) to weight management for addressing DSM‐5 binge‐eating disorder (BED) in US military Veterans with high weight. Method One hundred and nine Veterans, with DSM‐5 BED, seeking weight management services were randomly assigned to VA's Weight Management Program (MOVE!), or MOVE! plus a brief, clinician‐led cognitive‐behavioral therapy (MOVE! + CBT). Primary (eating disorder psychopathology and binge eating), secondary (mental health, quality of life, and eating‐ and appearance‐related), and exploratory (weight) outcomes were analyzed with mixed‐effects models for four timepoints (baseline, 3‐month [post‐treatment], and 9‐ and 15‐month follow‐ups). Results MOVE! + CBT reported significantly less overall eating disorder psychopathology compared to MOVE! at all post‐randomization timepoints: difference at 3 months −0.18 (−0.3, −0.06, p = 0.003), 9 months −0.15 (−0.3, 0, p = 0.05), and 15 months −0.27 (−0.42, −0.12, p < 0.001). There were no differences between groups in binge‐eating frequency. MOVE! + CBT remission rates were 28% at 3 months, 42% at 9 months, and 27% at 15 months. MOVE! remission rates were 22% at 3 months, 26% at 9 months, and 20% at 15 months. MOVE! + CBT was superior at post‐treatment through 15 months on eating‐, weight‐, and shape‐related (p's < 0.05), but few other, secondary outcomes. A 5% weight loss ranged from 26% to 38% for MOVE! + CBT, and 17% to 33% for MOVE!. Discussion Weight management alone and with concurrent CBT resulted in significant improvements in BED. The addition of CBT enhanced some specific outcomes but not weight loss. Findings provide evidence‐based clinical guidance and population‐level impact for addressing BED in the context of high weight, especially among Veteran populations. Trial Registration: Clinical Trial Registry Number: NCT03234881(Weight Loss Treatment for Veterans with Binge Eating)
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... The patient's misinterpretation of CGM trend data, particularly the direction of trend arrows, highlighted a significant gap in health literacy, contributing not only to inappropriate carbohydrate correction but also to a fear of food intake, which contributed to restrictive food intake [11]. A meta-analysis examining the role of CBT in eating disorders concluded that CBT is an effective treatment approach for this population [12]. ...
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... Self-help is often categorized as guided, when it includes support from a health professional, or unguided, when no additional support is provided. Both approaches have demonstrated efficacy for improving BED symptoms and are generally superior to inactive controls (Linardon et al., 2017). Self-help for BED may be equivalent to psychotherapy on some posttreatment outcomes, including general ED psychopathology, with improvements potentially sustained at follow-up, although long-term data beyond 12 months are sparse (Hilbert et al., 2019). ...
Comparing a novel, virtual, group-based guided self-help to unguided self-help for the treatment of binge-eating disorder in adults: a randomized controlled trial
Article
  • May 2025
  • Eat Disord
Binge Focused Therapy (BFT) is a 3-session, group-based, guided self-help treatment for binge-eating disorder (BED). In this parallel-group randomized controlled trial (RCT), adults with BED were randomized to virtual BFT or a traditional unguided self-help approach (Overcoming Binge Eating; Fairburn, 2013). Self-report measures were collected at baseline, week 6, week 10 (posttreatment), 6- and 12-month follow-up. We hypothesized BFT (n = 82) would lead to better BED outcomes and lower dropout than unguided self-help (n = 82). Our intention-to-treat analysis demonstrated a significant effect of treatment group on BED symptomatology (primary outcome; β= - 5.04, p < .001, 95% CI [ - 7.57, - 2.52]), binge frequency (β= - 3.24, p = .001, 95% CI [ - 5.22, - 1.26]), general ED symptomatology (β= - 0.91, p < .001, 95% CI [ - 1.17, - 0.65]), clinical impairment (β= - 6.27, p < .001, 95% CI [ - 8.78, - 3.77]), confidence to change binge eating (β = 1.22, p < .001, 95% CI [0.56, 1.89]), BED remission (OR = 4.98, p = .003, 95% CI [1.72, 14.40]), and treatment attrition (β = 0.456, p < .001), with the BFT group reporting greater improvements and lower dropout. We did not find evidence of a significant effect of group on binge-eating abstinence (OR = 2.01, p = .103, 95% CI [0.87, 4.64]). BFT may be an effective BED treatment that could overcome common barriers to treatment implementation and accessibility.
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... During M1-M3, retention was high (99.2%) with significant BMI reduction, likely from glycogen and water loss [4,78,[122][123][124][125][126][127][128]. Retention declined at M6 (23.6%) and M9 (8.4%) alongside modest weight regain and muscle mass increases-possibly reflecting carb reintroduction and glycogen restoration [129,130]. ...
Anthropometric Trajectories and Dietary Compliance During a Personalized Ketogenic Program
Article
Full-text available
  • Apr 2025
Background/Objectives: Ketogenic diets (KDs) have gained attention for their potential to promote weight loss and metabolic improvements. However, data on long-term body composition changes and adherence rates in real-world settings remain limited. Objective: This study aimed to assess the effects of a personalized ketogenic dietary program on anthropometric parameters over a 9-month period and to evaluate adherence across time. Methods: A total of 491 adults participated in a longitudinal intervention involving a structured ketogenic nutrition plan with follow-up at 3, 6, and 9 months. Body weight, fat mass (FM), skeletal muscle mass (SMM), and other composition metrics were measured at each visit. Results: Significant reductions in body weight (–12.6 kg) and fat mass (–10.3 kg) were observed after 3 months (p < 0.001), with minimal changes at 6 months and partial regain by Month 9. SMM remained relatively stable throughout the study. Retention dropped substantially after 3 months, dropping from 487 to 115 participants at Month 6 and 41 at Month 9. Despite this, participants who completed the program maintained significant anthropometric improvements. Conclusions: A well-formulated ketogenic diet may promote rapid fat loss while preserving lean mass in the short term. However, long-term adherence poses significant challenges. Strategies to enhance dietary sustainability and retention are essential for maximizing the benefits of KDs in clinical practice.
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The Relationship Between Personality Traits and Eating Behavior in Middle-Aged Women
Research
  • Jun 2025
The aim of the empirical study presented in this thesis was to identify and describe the relationship between personality traits and eating behavior in middle-aged women, based on the analysis of risk factors for the development of eating disorders.
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Open Pilot Trial of a Coached Digital Program for Lower-Income Adults With Eating Disorders
Article
Objective This study evaluated the feasibility, acceptability, and preliminary effectiveness of the first digital intervention tailored for lower‐income adults with eating disorders, who are poorly served by the public health care system. Method Adults ( N = 30) with public insurance or without insurance coverage who endorsed ≥ 6 binge eating episodes, ≥ 6 vomiting episodes, and/or ≥ 6 laxative/diuretic episodes in the past three months with a body mass index ≥ 18.5 kg/m ² were enrolled in this open pilot trial. Participants received access to the coached digital CBT‐based intervention, which included individualized guidance and twice‐weekly SMS feedback from a program coach over three months. Results Almost all participants (93.3%, n = 28) accessed the program after enrollment, completing about half (M = 4.15, SD = 2.68) of the 8 sessions and sending an average of 32.5 (SD = 35.2) texts to their coach over three months. From pre‐ to post‐intervention, there were large improvements in eating disorder psychopathology ( d = 0.79, p < 0.001) and moderate decreases in binge eating ( d = 0.62, p = 0.003) and self‐induced vomiting episodes ( d = 0.43, p = 0.031). There were also large improvements in clinical impairment ( d = 0.83, p < 0.001) and moderate to large reductions in anxiety ( d = 0.47, p = 0.019) and depression ( d = 0.84, p < 0.001). Most participants indicated that they were somewhat to very satisfied with the program (67.9%, n = 19). Discussion The results from this pilot trial testing a brief online guided self‐help intervention are promising, with relatively high treatment engagement, indicating good feasibility and acceptability and signals of preliminary effectiveness. Future research is needed to examine longer‐term effectiveness relative to other active treatments or waitlist control.
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Self-Guided Psychological Interventions for the Treatment and Prevention of Eating Disorders: A Meta-Analysis of Randomized Controlled Trials
Article
  • Apr 2025
  • EUR EAT DISORD REV
Background Self‐guided interventions may broaden the dissemination of evidence‐based prevention and treatment protocols for eating disorders. We conducted a meta‐analysis comparing self‐guided prevention and treatment approaches for eating disorders to (1) control groups and (2) professionally guided self‐help programs. Methods Forty‐six trials were included. Interventions ranged from web, to app, to CD‐ROM to book‐based programs. Random effects meta‐analyses were conducted on numerous symptom and risk outcomes. Results Only four trials recruited an unselected sample, with self‐guided programs reducing shape/weight concerns over control groups ( g = 0.18). Among high risk/symptomatic samples ( k = 25), self‐guided interventions reduced several behavioural and cognitive symptoms ( gs = 0.31–0.50) over control groups, with effects being robust when adjusting for higher risk of bias and small sample trials. Among clinical samples ( k = 17), evidence for the effectiveness of self‐guided interventions over control groups on symptom measures was only found for binge‐eating disorder, as too few studies sampled other diagnostic subtypes. Among 10 trials that compared guided to unguided self‐help, we observed a significant effect in symptom reduction in favour of guided self‐help ( g = −0.26). Dropout did not differ between guided and unguided self‐help (OR = 0.97). Conclusion Self‐guided interventions may be an effective, low intensity intervention format for high risk individuals or for binge‐eating disorder presentations.
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Cognitive–Behavioral Self-Help for Binge Eating Disorder: A Controlled Effectiveness Study
Article
Full-text available
  • Aug 1998
The aim of this study was to evaluate the effectiveness of 2 methods of administering a cognitive–behavioral self-help program for binge eating disorder. The study was designed to reproduce many of the conditions that apply in settings in which self-help interventions are most relevant. Seventy-two women with binge eating disorder were randomly assigned to 1 of 3 conditions for 12 weeks: pure self-help (PSH), guided self-help (GSH), or a waiting list (WL) control condition (followed by PSH or GSH). They were then followed up for 6 months. Both PSH and GSH had a substantial and sustained impact with almost half the participants ceasing to binge eat. There was little change in the WL condition. Cognitive–behavioral self-help may be of value both as an initial treatment for binge eating disorder and as a form of secondary prevention.
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Exposure Plus Response-Prevention Treatment of Bulimia Nervosa
Article
Full-text available
  • Aug 1988
A controlled study evaluating the effectiveness of exposure plus response-prevention treatment of bulimia nervosa was conducted in a sample of 47 women. This was a four-group comparison involving three treatment conditions and a waiting-list control group. The three treatment conditions were (a) exposure plus response prevention conducted in a single setting (clinic), (b) exposure plus response prevention conducted in multiple settings (clinic, patients' homes, and restaurants), and (c) cognitive—behavioral therapy without exposure plus response prevention. All treatment was provided to groups of 3 patients at a time. Outcome was evaluated at posttreatment and at a 6-month follow-up. The three treatment groups improved significantly on most outcome measures, whereas the waiting-list control group showed little change. At follow-up, there was a slightly better outcome on vomiting behavior and amount of food consumed in one of the test meals for the exposure plus response-prevention groups relative to the no-exposure group. However, on all other measures, the degree of improvement from pretreatment to follow-up was the same for all three treatment groups.
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Comparison of Two Group Treatments for Bulimia
Article
Full-text available
  • Feb 1985
The present study examined the relative efficacy of two group treatments for bulimia. Both groups met weekly for 16 weeks and utilized weekly graphing of vomiting and extensive self-monitoring. The cognitive-behavioral group was instructed to make specific changes in their eating and vomiting behavior, whereas the nondirective group was given no such instructions. Subjects were 28 women between the ages of 18 and 46 who binged and vomited at least twice weekly prior to treatment. The cognitive-behavioral treatment tended to have fewer dropouts and yielded significantly greater decreases in binging and vomiting than did the nondirective treatment. At 3-month follow-up, 38% of the cognitive-behavioral and 11% of the nondirective group participants continued to abstain from bingeing and vomiting, but these differences were not statistically significant. The results suggest that behavioral groups offer a promising approach to the treatment of bulimia.
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A randomised controlled trial of three psychological treatments for anorexia nervosa
Article
Full-text available
  • May 2017
Background: There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy. Method: A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25-40 sessions over a 10-month period. Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and psychosocial impairment. Results: Treatment was completed by 60% of participants and 52.5% of the total sample completed 12-month follow-up. Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes; all resulted in clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission (mean = 28.3%) at 12-month follow-up. Conclusion: The findings add to the evidence base for these three psychological treatments for adults with AN, but the results underscore the need for continued efforts to improve outpatient treatments for this disorder. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN 12611000725965) http://www.anzctr.org.au/.
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Psychotherapy for bulimia nervosa on symptoms of depression: A meta-analysis of randomized controlled trials
Article
Objective: Depressive symptoms are an important risk factor and consequence of binge eating and purging behavior in bulimia nervosa (BN). Although psychotherapy is effective in reducing symptoms of BN in the short- and long-term, it is unclear whether psychotherapy for BN is also effective in reducing depressive symptoms. This meta-analysis examined the efficacy of psychotherapy for BN on depressive symptoms in the short- and long-term. Method: Randomized controlled trials (RCTs) on BN that assessed depressive symptoms as an outcome were identified. Twenty-six RCTs were included. Results: Psychotherapy was more efficacious at reducing symptoms of depression at post-treatment (g = 0.47) than wait-lists. This effect was strongest when studies delivered therapist-led, rather than guided self-help, treatment. No significant differences were observed between psychotherapy and antidepressants. There was no significant post-treatment difference between CBT and other active psychological comparisons at reducing symptoms of depression. However, when only therapist-led CBT was analyzed, therapist-led CBT was significantly more efficacious (g = 0.25) than active comparisons at reducing depressive symptoms. The magnitude of the improvement in depressive symptoms was predicted by the magnitude of the improvement in BN symptoms. Discussion: These findings suggest that psychotherapy is effective for reducing depressive symptoms in BN in the short-term. Whether these effects are sustained in the long-term is yet to be determined, as too few studies conducted follow-up assessments. Moreover, findings demonstrate that, in addition to being the front-running treatment for BN symptoms, CBT might also be the most effective psychotherapy for improving the symptoms of depression that commonly co-occur in BN.
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The effects of cognitive-behavioral therapy for eating disorders on quality of life: A meta-analysis
Article
Objective: Meta-analyses have documented the efficacy of cognitive-behavioral therapy (CBT) for reducing symptoms of eating disorders. However, it is not known whether CBT for eating disorders can also improve quality of life (QoL). This meta-analysis therefore examined the effects of CBT for eating disorders on subjective QoL and health-related quality of life (QoL). Method: Studies that assessed QoL before and after CBT for eating disorders were searched in the PsycInfo and Medline database. Thirty-four articles met inclusion criteria. Pooled within and between-groups Hedge's g were calculated at post-treatment and follow-up for treatment changes on both subjective and HRQoL using a random effects model. Results: CBT led to significant and modest improvements in subjective QoL and HRQoL from pre to post-treatment and follow-up. CBT led to greater subjective QoL improvements than inactive (i.e., wait-list) and active (i.e., a combination of bona fide therapies, psychoeducation) comparisons. CBT also led to greater HRQoL improvements than inactive, but not active, comparisons. Prepost QoL improvements were larger in studies that delivered CBT individually and by a therapist or according to the cognitive maintenance model of eating disorders (CBT-BN or CBT-E); though this was not replicated at follow-up CONCLUSIONS: Findings provide preliminary evidence that CBT for eating disorders is associated with modest improvements in QOL, and that CBT may be associated with greater improvements in QOL relative to comparison conditions.
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Cognitive-Behavioral and Psychodynamic Therapy in Female Adolescents With Bulimia Nervosa: A Randomized Controlled Trial
Article
  • Feb 2017
  • J AM ACAD CHILD PSY
Objective The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents. Method In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder−oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated. Results The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35−2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT (d = 0.51−0.82) and PDT (d = 0.24−1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favor of CBT and for eating concern (d = −0.35) in favor of PDT. Conclusion CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information—Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095.
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Predictors, Moderators, and Mediators of Treatment Outcome Following Manualised Cognitive-Behavioural Therapy for Eating Disorders: A Systematic Review
Article
  • Nov 2016
This systematic review synthesised the literature on predictors, moderators, and mediators of outcome following Fairburn's CBT for eating disorders. Sixty-five articles were included. The relationship between individual variables and outcome was synthesised separately across diagnoses and treatment format. Early change was found to be a consistent mediator of better outcomes across all eating disorders. Moderators were mostly tested in binge eating disorder, and most moderators did not affect cognitive-behavioural treatment outcome relative to other treatments. No consistent predictors emerged. Findings suggest that it is unclear how and for whom this treatment works. More research testing mediators and moderators is needed, and variables selected for analyses need to be empirically and theoretically driven. Future recommendations include the need for authors to (i) interpret the clinical and statistical significance of findings; (ii) use a consistent definition of outcome so that studies can be directly compared; and (iii) report null and statistically significant findings.
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An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating
Article
  • Nov 2016
Background. Early weak treatment response is one of the few trans-diagnostic, treatment-agnostic predictors of poor outcome following a full treatment course. We sought to improve the outcome of clients with weak initial response to guided self-help cognitive behavior therapy (GSH). Method. One hundred and nine women with binge-eating disorder (BED) or bulimia nervosa (BN) (DSM-IV-TR) received 4 weeks of GSH. Based on their response, they were grouped into: (1) early strong responders who continued GSH (cGSH), and early weak responders randomized to (2) dialectical behavior therapy (DBT), or (3) individual and additional group cognitive behavior therapy (CBT+). Results. Baseline objective binge-eating-day (OBD) frequency was similar between DBT, CBT+ and cGSH. During treatment, OBD frequency reduction was significantly slower in DBT and CBT+ relative to cGSH. Relative to cGSH, OBD frequency was significantly greater at the end of DBT (d = 0.27) and CBT+ (d = 0.31) although these effects were small and within-treatment effects from baseline were large (d = 1.41, 0.95, 1.11, respectively). OBD improvements significantly diminished in all groups during 12 months follow-up but were significantly better sustained in DBT relative to cGSH (d = −0.43). At 6- and 12-month follow-up assessments, DBT, CBT and cGSH did not differ in OBD. Conclusions. Early weak response to GSH may be overcome by additional intensive treatment. Evidence was insufficient to support superiority of either DBT or CBT+ for early weak responders relative to early strong responders in cGSH; both were helpful. Future studies using adaptive designs are needed to assess the use of early response to efficiently deliver care to large heterogeneous client groups.
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