A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders

Abstract

Eating disorders may be viewed from a transdiagnostic perspective and there is evidence supporting a transdiagnostic form of cognitive behaviour therapy (CBT-E). The aim of the present study was to compare CBT-E with interpersonal psychotherapy (IPT), a leading alternative treatment for adults with an eating disorder. One hundred and thirty patients with any form of eating disorder (body mass index >17.5 to <40.0) were randomized to either CBT-E or IPT. Both treatments involved 20 sessions over 20 weeks followed by a 60-week closed follow-up period. Outcome was measured by independent blinded assessors. Twenty-nine participants (22.3%) did not complete treatment or were withdrawn. At post-treatment 65.5% of the CBT-E participants met criteria for remission compared with 33.3% of the IPT participants (p < 0.001). Over follow-up the proportion of participants meeting criteria for remission increased, particularly in the IPT condition, but the CBT-E remission rate remained higher (CBT-E 69.4%, IPT 49.0%; p = 0.028). The response to CBT-E was very similar to that observed in an earlier study. The findings indicate that CBT-E is potent treatment for the majority of outpatients with an eating disorder. IPT remains an alternative to CBT-E, but the response is less pronounced and slower to be expressed.Current controlled trialsISRCTN 15562271.

Models of eating disorders: a theoretical investigation of abnormal eating patterns and body image disturbance

“…Body image disturbance and maladaptive behaviors lead to excessive concentration on eating, social withdrawal, severity of obsessive thoughts and behaviours in relation to the body, and excessive satiety. These symptoms reinforce other maintaining mechanisms [15,22]. Anorexia and bulimia also differ in the level of the relationship between food restriction and binge episodes.…”

“…The line of argument for transdiagnostic mechanisms is the transformation of the symptoms of one type of eating disorder into another type during the course of treatment (and afterwards) (e.g. symptoms of anorexia nervosa converted to symptoms of bulimia nervosa), and the fact that the symptoms of eating disorders are nontransformed into other mental illnesses [22]. It is worth pointing out that this evidence leads to the use of the transdignostic model of eating disorders in enhanced cognitive-behavior therapy (CBT-E) [23].…”

“…The basis for the transdiagnostic model of eating disorders was the cognitive-behavioral model of anorexia and bulimia [22]. The core psychopathology of eating disorders is a dysfunctional cognitive schema related to low self-esteem, high perfectionism, mood intolerance and difficulties in relationships with other people [15].…”

“…The core psychopathology of eating disorders is a dysfunctional cognitive schema related to low self-esteem, high perfectionism, mood intolerance and difficulties in relationships with other people [15]. These psychopathological symptoms of bulimia nervosa play a relevant role in the emergence of an excessive preoccupation with figure, weight and their control, self-monitoring, and restrictive eating [22]. The only symptoms of bulimia which are not related to the core psychopathology are paroxysmal overeating and inappropriate use of compensatory behaviors (self-induced vomiting and laxatives).…”

Análisis de las variables clínicas y sociodemográficas de los pacientes diagnosticados de un trastorno de la conducta alimentaria que buscan ayuda y su remisión a diferentes dispositivos sanitarios

“…El tratamiento derivado de la teoría transdiagnóstica ha demostrado ser más eficaz que otros tratamientos psicológicos alternativos y la condición de lista de espera a la hora de lograr una mejoría de los síntomas, tanto de la BN a corto y a largo plazo (Poulsen et al, 2014Wonderlich et al, 2014), como de otros TCANE (Fairburn et al, 2015) y de la AN (Zipfel et al, 2014).…”