A Multicenter Comparison of Cognitive-Behavioral Therapy and Interpersonal Psychotherapy for Bulimia Nervosa

Abstract

Background: Research suggests that cognitivebehavioral therapy (CBT) is the most effective psychotherapeutic treatment for bulimia nervosa. One exception was a study that suggested that interpersonal psychotherapy (IPT) might be as effective as CBT, although slower to achieve its effects. The present study is designed to repeat this important comparison.

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study

“…While clinical perfectionism was the only maintaining variable directly linked to dietary restraint, interpersonal problems and mood intolerance were directly linked to binge eating, emphasizing the direct key role that both factors may have in its occurrence [11,21,22,44,48,52,53]. The positive and significant relationships between mood intolerance and binge eating are in accordance with CB-E model, which postulate that binge eating has a regulatory function and occur in an attempt to reduce the negative affective states [13].…”

“…This finding, as well as the evidence that interventions for binge eating that do not focus on reducing OSW and/or dietary restraint (i.e. interpersonal therapy, dialectical-behaviour therapy) decrease binge eating relative to assessment-only control conditions [1,2,11,54,55], seems incompatible with the theoretical assertion of both CB models, i.e. OSW affects binging indirectly through increasing the likelihood of dietary restraint [6,13].…”

“…Due to the psychological and physiological effects of dietary restraint, when these inflexible dietary rules, which are extremely difficult to maintain, are broken, all attempts to control eating are abandoned and a binge occurs [6]. Although several randomised controlled trials have shown that CBT is more effective than a wide range of alternative treatments [1,2,5,11], amongst BN treatment completers, only 40-50 % have a full and lasting response [12][13][14]. The developers of the original CB theory argued that four additional factors might account for the persistence of dysfunctional cognitions (OSW) and eating-disordered behaviours in some patients that present obstacles for change: (a) interpersonal problems; (b) core low selfesteem; (c) clinical perfectionism; and (d) mood intolerance [12,13].…”

Pathoplasticity of bulimic features and interpersonal problems

“…However, psychotherapy outcome research has found that two of the most well-validated psychosocial therapeutic packages for a host of psychiatric conditions, cognitive behavioral therapy and interpersonal psychotherapy, tend to be of relatively equal efficacy in reducing bulimic symptoms, 39 and that both are subject to high rates of dropout and relapse. 40 Data supporting a reciprocal relationship between interpersonal problems and bulimic features suggests that differential treatment processes may be more directly associated with outcomes for people with bulimia, implying that treatment matching research that specified and manipulated therapeutic process/ interpersonal variables and measured content/ diagnostic variables may usefully augment studies that compare therapeutic packages designed to be applied fairly uniformly across individuals with differing interpersonal styles.…”

Cognitive-behavioral therapy and nutritional counseling in the treatment of bulimia nervosa and binge eating

“…Controlled studies document that CBT has been more effective than alternative treatments in reducing dietary restraint (Agras et al, 2000;Wilson & Fairburn, 1998). This is not surprising, given that specific CBT strategies are used to effect such changes.…”