The Efficacy of Cognitive-Behavioral Therapy for Eating Disorders:
A Systematic Review and Meta-Analysis
Australian Catholic University
Tracey D. Wade
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-
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.
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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