CBT for Eating Disorders

ResearchBlogging.orgI’ve stated before that I am firmly in the cognitive-behavioral therapy (CBT) camp. I read in a paper assigned for my last class that people do not choose theoretical orientation die to efficacy. I disagree. I initially started reading books by Aaron Beck and Albert Ellis because CBT has a wealth of research behind it, and I found that it just seemed to make logical sense.

In a randomized controlled study by Fairburn et al. published in the American Journal of Psychiatry, researchers studied the use of a specific form of CBT designed to treat eating disorders. There are two forms of the therapy, CBT-Ef, which is a focused form that highlights issues directly related to eating disorders such as body image, extreme dieting, binging, and purging, and CBT-Eb, a broad form which also touches on other psychopathology, such as depression, low self-esteem, mood intolerance, and interpersonal difficulties.

When the results were tallied, researchers looked at complex psychopathology and simple psychopathology. Subjects in the complex psychopathology group tended to be assessed as having more mood intolerance, interpersonal difficulties, and self-esteem issues. The results are kind of interesting:

cbtgraph

As you can see from the graph, CBT-Ef works best with simple psychopathology, but does not work nearly as well with complex psychopathology. The CBT-Eb group shows similar results with both simple and complex psychopathology.

It looks like the focused approach is not really necessary, but can give better results when used with clients with less complex psychopathology. The broad approach seems to be preferable, but less effective.

This study shows us the importance of clinical judgment. Clinicians need to be able to assess the complexity of their clients’ psychopathology in order to find the right emphasis for therapy. In these two therapies, the first four weeks are the same regardless of whether a clinician is using the focused or broad approach, giving clinicians plenty of time to assess their clients’ needs.

Fairburn, C., Cooper, Z., Doll, H., O’Connor, M., Bohn, K., Hawker, D., Wales, J., & Palmer, R. (2009). Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up American Journal of Psychiatry, 166 (3), 311-319 DOI: 10.1176/appi.ajp.2008.08040608

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4 Responses to CBT for Eating Disorders

  1. John Grohol says:

    I find it interesting that professionals can look at the same data and come to completely different conclusions.

    “The broad approach seems to be preferable, but less effective.”

    Strangely, this is only true at specific time periods measured, not across the board. What is far more interesting here is what can account for the variations at end of treatment and the 40 week mark between the two types of therapies that are not seen at the 20 week and 60 week mark (where all therapies are the same except for Ef/complex)?

  2. Danny McCaslin says:

    Hi, John. Thanks for the comment.
    I knew that my wording of that would bite me in the ass. If we attribute the differences between the more complex and less complex psychopathology scores, we see that people with a more complex psychopathology seem not to show the same level of recovery overall. They respond better to the broad treatment, but people with less complex psychopathology do not respond as well to the broad treatment. People in the Ef/complex group respond poorly (which is to be expected.)
    I missed this in the article previously, but 17 of the patients had some form of therapy or “booster sessions” during the post-treatment period. That could explain some of the variation in scores in the 20-week and 40-week follow-up. Also, now that I really look at the data, there doesn’t appear to be much variation at all at 60 weeks, aside from the Ef/complex group. I would expect some variation in scores over the span of 60 weeks. Hell, we’re talking about almost 1 1/4 years, and that’s a lot of time to see relative stability.
    So I’ll revise my statement to match the researchers: It really looks like Ef would be the best default group, and that clinicians can assess need and move to Eb if needed during the first four weeks of treatment where the protocol remains the same.
    Cheers!
    Danny

  3. […] Phrenologist’s Notebook, CBT for Eating Disorders A nice summary of how general and specific cognitive behavioral therapy can deal with more […]

  4. CED says:

    Dr. Stewart Agras, author of Eating Disorders: State of the Art Treatment, believes that CBT is more effective than medication, supportive-expressive psychotherapy, stress-management, and interpersonal therapy. Dr. Agras says that CBT acts more quickly than IPT (interpersonal psychotherapy). We were able to interview Dr. Agras on our eating disorder blog. To check out what he had to say about CBT and GSH (guided self help, a shortened version of CBT), visit: http://eatingdisorder.org/blog/2009/04/06/q-a-with-stewart-agras-md/

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