Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up

Abstract

Objective-The aim of this study was to compare two cognitive-behavioral treatments for outpatients with eating disorders, one focusing solely on eating disorder features and the other a more complex treatment that also addresses mood intolerance, clinical perfectionism, low selfesteem, or interpersonal difficulties.Method-A total of 154 patients who had a DSM-IV eating disorder but were not markedly underweight (body mass index over 17.5), were enrolled in a two-site randomized controlled trial involving 20 weeks of treatment and a 60-week closed period of follow-up. The control condition was an 8-week waiting list period preceding treatment. Outcomes were measured by independent assessors who were blind to treatment condition.Results-Patients in the waiting list control condition exhibited little change in symptom severity, whereas those in the two treatment conditions exhibited substantial and equivalent change, which was well maintained during follow-up. At the 60-week follow-up assessment, 51.3% of the sample had a level of eating disorder features less than one standard deviation above the community mean. Treatment outcome did not depend on eating disorder diagnosis. Patients with marked mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties appeared to respond better to the more complex treatment, with the reverse pattern evident among the remaining patients.Conclusions-These two transdiagnostic treatments appear to be suitable for the majority of outpatients with an eating disorder. The simpler treatment may best be viewed as the default version, with the more complex treatment reserved for patients with marked additional psychopathology of the type targeted by the treatment.DSM-IV recognizes two specific eating disorders, anorexia nervosa and bulimia nervosa, together with a residual diagnostic category termed "eating disorder not otherwise specified" (1). In outpatient settings, the most common eating disorder diagnosis is eating disorder not otherwise specified, followed by bulimia nervosa and then anorexia nervosa (2-5). Despite its prevalence, there have been no studies of the treatment of eating disorder not otherwise specified. Some treatment studies have included subthreshold cases of anorexia nervosa or bulimia nervosa (6, 7), and there has been interest in binge eating disorder (8), a subtype of eating disorder not otherwise specified, but such cases constitute less than half those with eating disorder not otherwise specified (5 Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts which the features of anorexia nervosa and bulimia nervosa are combined in various ways (5). The treatment of these patients has not been studied.Given that the clinical features of bulimia nervosa and eating disorder not otherwise specified are very similar, it has been postulated that treatments that have beneficial effects on bulimia nervosa should also benefit patients with eating disorder not otherwise specified (9). Were this to be the case, such tr...

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

“…However, different clinical pictures need to be considered. bulimic-type ED patients may benefit from more elaborate forms of interventions, such as the CBT-E [7,12,13,27], in case of more severe 5-HT abnormalities [63], and particularly if they are at least partly linked to affective instability mediated by 5-HT functioning or severe developmental disruptions that can affect both 5-HT functioning and affective instability [63]. Apart from the biological perceptive, cognitive factors may also play a central role in understanding the nature of the association between dietary restraint and binge eating.…”

“…Although recent randomized control trials provided support for its efficacy in any form of eating disorder (ED) [27,28], this does not necessarily provide evidence for the adequacy of the CB-E theoretical model on which the treatment is based. In fact, there has recently been increased interest on testing some conceptual relationships of the CB-E model in non-clinical adolescent and adult samples [17,20,24].…”

Psychological treatments: A call for mental-health science

“…They can now be addressed with a specific form of cognitive behavioural therapy (CBT) 1 that targets attitudes to body shape and disturbances in eating habits. For depression, CBT can be as effective as antidepressant medication and provide benefits that are longer lasting 2 .…”

Effectiveness of cognitive behavioral therapy supported by virtual reality in the treatment of body image in eating disorders: One year follow-up

“…Fairburn et al (2009) enhanced Cognitive Behavioral Treatment (CBT) for eating disorders with other components addressing important aspects of these disorders including perfectionism, interpersonal problems, and self-esteem. Several studies (Rosen 1996;Farrell et al, 2006;Nye and Cash, 2006) suggest that interventions based on body image distortion could improve evidence-based treatments for eating disorders (NICE, 2004) However, there has been no controlled study proving the effectiveness of body image treatment in eating disorders (Nye and Cash, 2006).…”