CBT Is as Effective in the Treatment of Purging and Non-Purging Eating Disorders

NewStudy-Graphic-72x72_edited-3A new study published in Behaviour and Research Therapy examined the efficacy of cognitive behavior therapy (CBT) for women with a variety of purging behaviors. The study compared 3 groups: those who engaged in self-induced vomiting, those who engaged in multiple purging methods (i.e., laxatives and diuretics), and those who engaged in restrained eating and/or excessive exercise as a means of weight control. First, participants in each group self-reported on their shape and weight concerns, subjective feelings about bulimic episodes, and eating disorder symptoms. Those individuals who engaged in self-induced vomiting or purging methods reported a longer duration of their disorder, more objective bulimic episodes, more severe shape and weight concerns, higher scores for eating disorder symptoms, and high depressive scores than those who did not engage in purging behaviors. A portion of the sample (75%) then completed 20 weeks of CBT. At post-treatment, all three groups showed significant reductions in objective and subjective bulimic episodes, weight and shape concerns, anxiety and depressive symptoms, vomiting, laxative and diuretic use, excessive exercising, and restrained eating. Researchers concluded that despite the greater clinical severity associated with the presence of purging behaviors in eating disorders, these variable do not impact the efficacy of inpatient CBT.


Dalle Grave, R., Calugi, S. & Marchesini, G. (2009). Self-induced vomiting in eating disorders: Associated features and treatment outcome. Behaviour Research and Therapy, 47, 680-684.

Anorexia Nervosa Relapse Prevention Benefited by CBT

NewStudy-Graphic-72x72_edited-3 A recent clinical study in the International Journal of Eating Disorders found preliminary evidence supporting the notion that Cognitive Behavioral Therapy (CBT) is beneficial to preventing relapse and improving outcomes in patients with weight-restored Anorexia Nervosa (AN). The aim of the present study was to compare the relapse prevention effectiveness of CBT versus maintenance treatment as usual (MTAU) for weight-restored AN.

Participants were patients suffering from AN who were part of the inpatient or day hospital program at the Toronto General Hospital Eating Disorders Program. After participants reached a body mass index (BMI) of at least 19.5 for 2-3 weeks, they were able to begin participation in the present study. About half of the participants chose to enter into the CBT treatment condition and the rest received MTAU. Participants in the CBT group focused on addressing thoughts and behaviors about eating and weight that increase the risk of relapse, and then changing those thoughts and behaviors to healthier strategies and skills. In addition cognitive strategies were taught for a broader range of issues, such as self-esteem, interpersonal problems, and developmental issues.

Results showed that participants in the CBT group had a significantly longer time to relapse than those in the MTAU group, with 65% of the CBT group and 34% of the MTAU not having relapsed after 1 year. The authors concluded that “the current findings provide preliminary evidence that CBT may be helpful in improving outcome and preventing relapse in weight-restored AN.”

Study authors: J. C. Carter, T. L. McFarlane, C. Bewell, M. P. Olmsted, D. B. Woodside, A. S. Kaplan, R. D. Crosby

CBT Meta-Analysis Review is Most Downloaded Article in CPR

It looks as if the research efficacy of Cognitive Therapy is becoming more well-known. Clinical Psychology Review is a peer-reviewed journal that publishes substantive reviews of topics relevant to clinical psychology. The most downloaded article from this important journal is The empirical status of cognitive-behavioral therapy: A review of meta-analyses (Volume 26, Issue 1, January 2006, Pages 17-31), authored by Andrew C. Butler, Jason E. Chapman, Evan M. Forman and Aaron T. Beck.

This 2006 review summarizes CBT treatment outcomes for a wide array of psychiatric disorders and includes sixteen methodologically rigorous meta-analyses. Findings are consistent with previous review methodologies and demonstrate the efficacy of CBT for many disorders. Specifically, unipolar depression, generalized anxiety disorder, panic disorder (with or without agoraphobia), social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders all showed large effect sizes. Marital distress, anger, childhood somatic disorders, and chronic pain showed moderate effect sizes.

CBT was also shown to be somewhat superior to antidepressants in the treatment of adult depression and as effective as behavior therapy in the treatment of both adult depression and obsessive-compulsive disorder. Bulimia nervosa and schizophrenia showed large, uncontrolled effect sizes.

Severe eating disorders helped by CBT

In a recent study in the American Journal of Psychiatry, investigators reported that people with severe eating disorders can be effectively treated by cognitive behavioral therapy (CBT) that focuses on perfectionism, binge eating, and other related issues.

Two types of CBT were employed in the protocol (in addition to a wait-list control group). One CBT protocol focused exclusively on eating-disorder psychopathology and the other was a broader, more complex form that included treatment of mood intolerance, perfectionism, and low self-esteem.

The two CBT groups experienced significant improvement whereas the wait-list group experienced little change in symptoms. The authors noted that in addition to the direct benefit to people with eating disorders, another important implication of this finding is that hospital stays can be avoided for the majority of these patients.

Study authors: C. G. Fairburn, Z. Cooper, H. A. Doll, et al.