Are we really delivering evidence-based treatments for eating disorders? How eating-disordered patients describe their experience of cognitive behavioral therapy

Abstract

Psychotherapists report routinely not practising evidence-based treatments. However, there is little research examining the content of therapy from the patient perspective. This study examined the self-reported treatment experiences of individuals who had been told that they had received cognitive-behavior therapy (CBT) for their eating disorder. One hundred and fifty-seven such sufferers (mean age = 25.69 years) were recruited from self-help organisations.
Participants completed an online survey assessing demographics, clinical characteristics, and therapy components. The use of evidence-based CBT techniques varied widely, with core elements for the eating disorders (e.g., weighing and food monitoring) used at well below the optimum level, while a number of unevidenced techniques were reported as being used commonly. research blog (7)Cluster analysis showed that participants received different patterns of intervention under the therapist label of ‘CBT’, with evidence-based CBT being the least common. Therapist age and patient diagnosis were related to the pattern of intervention delivered. It appears that clinicians are not subscribing to a transdiagnostic approach to the treatment of eating disorders. Patient recollections in this study support the conclusion that evidence-based practice is not routinely undertaken with this client group, even when the therapy offered is described as such.

Cowdrey, N.D., & Waller G. (December 2015) Are we really delivering evidence-based treatments for eating disorders? How eating-disordered patients describe their experience of cognitive behavioral therapyBehavior Research and Therapy, 75(72).

Weighing patients within cognitive-behavioral therapy for eating disorders: How, when and why

New Study (1)Abstract
While weight, beliefs about weight and weight changes are key issues in the pathology and treatment of eating disorders, there is substantial variation in whether and how psychological therapists weigh their patients. This review considers the reasons for that variability, highlighting the differences that exist in clinical protocols between therapies, as well as levels of reluctance on the part of some therapists and patients. It is noted that there have been substantial changes over time in the recommendations made within therapies, including cognitive-behavioral therapy (CBT). The review then makes the case for all CBT therapists needing to weigh their patients in session and for the patient to be aware of their weight, in order to give the best chance of cognitive, emotional and behavioral progress. Specific guidance is given as to how to weigh, stressing the importance of preparation of the patient and presentation, timing and execution of the task. Consideration is given to reasons that clinicians commonly report for not weighing patients routinely, and counter-arguments and solutions are presented. Finally, there is consideration of procedures to follow with some special groups of patients.

 

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why:Behaviour Research and Therapy, Volume 70, Issue null, Pages 1-10 Glenn Waller, Victoria A. Mountford

 

CBT is Effective for Bulimia Nervosa

According to a new study published in the American Journal of Psychiatry, cognitive behavior therapy (CBT) is a more effective and efficient treatment for binging and purging associated with bulimia nervosa than psychoanalytic psychotherapy. In the current study, 70 patients with bulimia nervosa were randomized to receive either 2 years of weekly psychoanalytic psychotherapy (n=34) or 20 sessions of CBT during a 5-month period (n=36). The Eating Disorder Examination Interview was administered to measure participant progress, before treatment at baseline, after 5 months, and after 2 years. While both treatments resulted in improvement, there was a significant difference in outcome between the two groups. After 5 months of treatment, 42% of patients in the CBT group had stopped binging and purging compared to 6% of patients in the psychoanalytic psychotherapy group. At 2 years, 44% in the CBT group and 15% in the psychoanalytic psychotherapy group had stopped binging and purging. Despite the considerable difference in treatment duration, CBT was more effective and generally faster in relieving binging and purging.

Poulsen, S, Lunn, S. Daniel S.I., Folke, S. Mathiesen, B.B., Katznelson, H. Fairburn, C.G. (2013). A Randomized Controlled Trial of Psychoanalytic Psychotherapy or Cognitive-Behavioral Therapy for Bulimia Nervosa. American Journal of Psychiatry, doi:10.1176/appi.ajp.2013.12121511

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