Empirical Status Of Therapy For Bulimia Nervosa

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The efficacy of CBT for BN has been evaluated in nearly 30 controlled studies. The percentage reduction in binge eating and purging across all clients receiving CBT is typically 80% or more compared to virtually 0% reduction in wait-list controls. Approximately 50% of those treated with CBT report complete cessation of all binge eating and purging at treatment termination. Large effect sizes for CBT are found for both behavioral symptoms (e.g., binge frequency = 1.28) and cognitive symptoms (e.g., eating attitudes = 1.35) (Whittal, Agras, & Gould, 1999; see also Lewandowski, Gebing, Anthony, & O'Brien, 1997). Furthermore, symptom reduction and cessation are fairly well-maintained across time with the majority of clients retaining therapeutic changes 1 year after treatment. The study with the longest follow-up period found that two-thirds of clients treated with CBT had no eating disorder at a 5-year posttreatment assessment (Fairburn et al., 1995). Furthermore, CBT has effects on the associated features of BN. In addition to reduction in binge eating and purging, those treated with CBT show decreases in dietary restraint, depression, and shape-weight concerns as well as increases in social functioning and self-esteem.

In comparison to alternative forms of treatment for BN, CBT has superior response rates. CBT has most often been compared to antidepressant medication in the treatment of BN. In a meta-analysis including 9 double-blind, placebo-controlled medication trials and 26 randomized CBT trials, CBT was found to be significantly more effective than medication in reducing binge eating, purging, depression, and weight-shape concerns (Whittal et al., 1999). In comparison to alternative psychotherapies, CBT has been found to have significantly higher response rates than supportive psychotherapy, behavior therapy, psychodynamic therapy, stress management, and nutritional counseling. The one exception to this pattern of findings concerns interpersonal psychotherapy (IPT): CBT and IPT show similar long-term outcomes. However, in comparison to IPT, CBT is significantly more fast-acting and has significantly higher acute response rates (Agras, Walsh, Fairburn, Wilson, & Kraemer, 2000). The rapid response to CBT for BN has now been documented in several studies which report that approximately 60-70% of the reduction in binge eating and purging occurs within the first 6 sessions of CBT. For all of these reasons, CBT is identified as the treatment of choice for BN in each of the recent meta-analyses of BN treatment.

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