Cognitive‐behavioral therapy for binge‐eating disorder for non‐responders to initial acute treatments: Randomized controlled trial

Abstract

ObjectiveCertain treatments have demonstrated acute efficacy for binge‐eating disorder (BED) but many patients who receive “evidence‐based” interventions do not derive sufficient benefit. Given the dearth of controlled research examining treatments for patients who fail to respond to initial interventions, this study tested the efficacy of cognitive‐behavioral therapy (CBT) for patients with BED who do not respond to initial acute treatments.MethodsProspective randomized double‐blind placebo‐controlled single‐site trial, conducted August 2017–December 2021, tested 16‐weeks of therapist‐led CBT for non‐responders to initial treatment (naltrexone/bupropion and/or behavioral therapy) for BED with obesity. Thirty‐one patients (mean age 46.3 years, 77.4% women, 80.6% White, mean BMI 38.99 kg/m2) who were non‐responders to initial acute treatments were randomized to CBT (N = 18) or no‐CBT (N = 13), in addition to continuing double‐blinded pharmacotherapy. Independent assessments were performed at baseline, throughout treatment, and posttreatment; 83.9% completed posttreatment assessments.ResultsIntention‐to‐treat remission rates were significantly higher for CBT (61.1%; N = 11/18) than no‐CBT (7.7%; N = 1/13). Mixed models of binge‐eating frequency (assessed using complementary methods) converged revealing a significant interaction between CBT and time and a significant main effect of CBT. Binge‐eating frequency decreased significantly with CBT but did not change significantly with no‐CBT. Since only four patients received behavioral treatment during the acute treatments, we performed “sensitivity‐type” analyses restricted to the 27 patients who received pharmacotherapy during the acute treatment and found the same pattern of findings for CBT versus no‐CBT.ConclusionsAdult patients with BED who fail to respond to initial pharmacological treatments should be offered CBT.Public SignificanceEven with leading evidence‐based treatments for binge‐eating disorder, many patients do not derive sufficient benefit. Almost no controlled research has examined treatments for patients who fail to respond to initial interventions. This study found that that cognitive‐behavioral therapy was effective for patients with binge‐eating disorder who did not respond to initial interventions, with 61% achieving abstinence.

Recent Advances in Cognitive-Behavioural Therapy for Eating Disorders (CBT-ED)

“…In particular, strategic clinical responses to the patient’s clinical progress remain a good option [ 36 ]. For example, Grilo and colleagues [ 79 ] have supported the use of CBT-ED where other approaches have not been effective.…”

Associações Entre Transtornos Alimentares E a Obesidade

“…Outros estudos, como os conduzidos por Grilo et al 23 ou Pearl et al 15,16 nos EUA, tiveram amostras que variaram de 31 a 90 participantes.…”

“…, examinaram o papel da depressão na resposta a diferentes terapias, enquanto Forrest et al22 , avaliaram como os sintomas mudam em tratamentos comportamentais. Por fim, Grilo et al23 , focaram em pacientes com transtorno da compulsão alimentar.Além das diferentes abordagens terapêuticas avaliadas nos 11 estudos selecionados, outro aspecto relevante a ser considerado é o tempo de intervenção. Observa-se que a duração das intervenções terapêuticas variou significativamente entre os estudos, com períodos que compreenderam desde 12 semanas até 12 meses.…”

“…23 também nos EUA, em pacientes com transtorno da compulsão alimentar (TCA) que não responderam aos tratamentos iniciais, a TCC mostrou-se eficaz na redução da frequência da compulsão alimentar, destacando seu potencial em casos resistentes.…”