Cognitive behavioural therapy the best intervention for bulimia nervosa
While most psychological and pharmacological interventions appear to be effective for treating bulimia nervosa, cognitive behavioural therapy (CBT) should be the treatment of choice, according to a meta-analysis.
Researchers conducted a systematic review of randomized controlled trials involving adolescent and adult populations with bulimia. Primary outcome variables included abstinence from binge eating episodes, compensatory behaviors, the absence of a bulimia nervosa diagnosis and reduction in symptom severity. Secondary outcome variables were improvements in self-reported eating pathology and depression.
The meta-analysis included 79 trials representing 5,775 patients and was performed for the following major intervention categories: psychotherapy, self-help, other nonpharmacological interventions, pharmacotherapy and combination therapies.
Pooled data showed that psychotherapy, mostly CBT, yielded moderate to large effects for the primary outcome variables. Pharmacotherapy delivered moderate effects, whereas self-help interventions produced small effects.
For secondary outcome variables, psychotherapy yielded large to very large effects. On the other hand, self-help, pharmacotherapy and combined therapies produced moderate to large effects.
On follow-up analyses, the large intervention effects of psychotherapies were sustained, as well as the the moderate effects of self-help, pharmacotherapy and combined therapies.
Overall, the present data suggest that CBT can be recommended as the best intervention for bulimia, while guided CBT-based self-help can be considered as an alternative, researchers said. Pharmacotherapy, on the other hand, is moderately effective and may be suited for patients who prefer drug treatment.
More studies are needed to identify mediators and moderators of treatment success, as well as risk factors for relapse, given the large proportion of patients who fail to fully abstain from binge-purge behavior, researchers added.