Recent research suggests, for individuals suffering with bulimia nervosa, an enhanced form of cognitive-behavior therapy (CBT) is far more effective than psychoanalytic psychotherapy. The study was published online November 26 in the American Journal of Psychiatry.

Bulimia is an eating disorder, characterized by recurrent episodes of binge eating, extreme weight control behaviors, and over-evaluation of weight and shape.

The two therapies for bulimia have different approaches. Psychoanalytic psychotherapy for bulimia is based on the theory that bulimic symptoms stem from a need to halt inner feelings and desires, and that patients struggle in acknowledging and regulating those feelings. Enhanced cognitive-behavior therapy uses procedures and strategies to address dietary restraint, concerns about shape and weight, events and associated mood changes influencing eating, and the development of skills to deal with setbacks. 

Researchers from the Department of Psychology, University of Copenhagen, and the Department of Psychiatry, Oxford University, conducted a study where 70 patients with bulimia nervosa received either two years of weekly psychoanalytic psychotherapy or 20 sessions of CBT over 5 months. The Eating Disorder Examination interview was administered on the first day of treatment, after five months, and after two years.

Both treatments showed improvement in the individuals, but a difference was noticeable between cognitive-behavior and psychoanalytic psychotherapy. After 5 months, 42% of patients in CBT and 6% of patients in psychoanalytic psychotherapy had stopped binge eating and purging. After 2 years, 44% in the CBT group and 15% in the psychoanalytic psychotherapy group had stopped binge eating and purging. By the end of both treatments, substantial improvements in eating disorder features and general psychopathology were observed, but in general these changes took place more rapidly in CBT.

Researcher Stig Poulsen, Ph.D., an associate professor with the Department of Psychology at University of Copenhagen, said, “CBT is a highly effective treatment for bulimia nervosa and clearly more effective than the version of psychoanalytic psychotherapy tested in this trial”

“Still, a large percentage of the patients were not helped sufficiently for their bulimia by cognitive behavioral therapy. This suggests that further development of treatments for bulimia nervosa is still relevant,” Poulsen added.

Dr. Dalle Grave from the Department of Eating and Weight Disorders at Villa Garda Hospital, who was not involved with the study, noted that the small sample size and lack of control group were limitations of the study but had “a good internal and external validity, a combination rarely achieved by the randomized, controlled trials of the psychological treatments.” 

Research Article:

http://ajp.psychiatryonline.org/article.aspx?articleID=1785749