A systematic review of enhanced cognitive behavioral therapy (CBT‐E) for eating disorders

Abstract

Objective To review the literature examining the efficacy and effectiveness of enhanced cognitive behavioral therapy (CBT‐E) for adults and older adolescents with eating disorders. Method A systematic search of the literature (using PsycINFO and PubMed) was conducted in order to identify relevant publications (randomized controlled trials [RCTs] and uncontrolled trials) up to June 2019. Effect sizes were reported for outcomes including treatment attrition and remission rates, eating disorder behaviors, body mass index (BMI), and core eating disorder psychopathology. The Downs and Black checklist was used to assess the quality of included studies. Results Twenty studies (10 RCTs and 10 uncontrolled trials) met criteria for inclusion. Support was found for the efficacy and effectiveness of CBT‐E for the full spectrum of eating disorders, with respect to reducing eating disorder behaviors and core psychopathology. BMI also increased, with large effects, for individuals with AN. However, the majority of the randomized trials included in this review did not demonstrate superiority of CBT‐E over comparison treatments, particularly in the longer‐term. Furthermore, rates of attrition and remission for CBT‐E among individuals without AN did not appear to differ from rates for CBT‐BN. Discussion There is evidence to support CBT‐E as an efficacious and effective treatment for adults and older adolescents with a range of eating disorder diagnoses. Future research would benefit from directly comparing CBT‐E to CBT‐BN, expanding measured outcomes to include driven exercise and subjective binge eating, increasing consistency in the definition and measurement of outcomes, and exploring factors associated with treatment retention.

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Mediators of change in cognitive behavior therapy and interpersonal psychotherapy for eating disorders: A secondary analysis of a transdiagnostic randomized controlled trial

“…Both cognitive behavior therapy for eating disorders (CBT-ED) and interpersonal psychotherapy for eating disorders (IPT-ED) are evidence-based treatments (Atwood & Friedman, 2020;NICE, 2017;Norris, Gleaves, & Hutchinson, 2019). They are theoretically distinct and are hypothesized to work in different ways (Murphy, Cooper, Hollon, & Fairburn, 2009).…”

Evidence-Based and Novel Psychological Therapies for People with Anorexia Nervosa

“…Generally, studies show that CBT-E produces good outcomes regarding increases in BMI and decreases in eating disorder psychopathology and conclude that it is an effective and viable treatment option for anorexia. However, there does not yet appear to be any consistent convincing evidence to suggest it is superior to comparable psychotherapies [42][43][44][45][46][47][48][49][50]. There is some evidence to suggest that CBT-E may be feasible to deliver in a group setting for patients with eating disorders, including those with anorexia, without losing the desired positive outcomes regarding weight gain and reduction in eating disorder psychopathology [51], however sample sizes are small and so this requires further examining.…”