Meta‐analysis of the effects of cognitive‐behavioral therapy for binge‐eating–type disorders on abstinence rates in nonrandomized effectiveness studies: Comparable outcomes to randomized, controlled trials?

Abstract

Objective The efficacy of cognitive‐behavioral therapy (CBT) for eating disorders is well‐established. The extent to which CBT tested in controlled research settings generalizes to real‐world circumstances is unknown. We conducted a meta‐analysis of nonrandomized studies of CBT for eating disorders, with three aims: (a) to estimate the prevalence of patients who achieve binge‐purge abstinence after CBT in routine practice; (b) to compare these estimates with those derived from two recent meta‐analyses of randomized controlled trials (RCTs) of CBT for bulimia nervosa (BN) and binge‐eating disorder (BED); (c) to examine whether the degree of clinical representativeness of studies was associated with effect sizes. Method Twenty‐seven studies, mainly involving BN, were included. Pooled event rates were calculated using random effects models. Results The percentage of treatment completers who achieved abstinence at post‐treatment was 42.1% (95% CI = 34.7–50.0). The intention‐to‐treat (ITT) estimate was lower (34.6% [95% CI = 29.3–40.4]). However, abstinence rates varied across diagnoses, such that the completer and ITT analysis abstinence estimates were larger for BED samples (completer = 50.2%, 95% CI = 29.4–70.9; ITT = 47.2%, 95% CI = 29.8–65.2) than for BN (completer = 37.4%, 95% CI = 29.1–46.5; ITT = 29.8%, 95% CI = 24.9–35.3) and atypical eating disorder samples (completer = 37.8%, 95% CI = 20.2–59.3; ITT = 28.8%, 95% CI = 18.2–42.4). No relationship between the degree of clinical representativeness and the effect size was observed, and our estimates were highly comparable to those observed in recent meta‐analyses of RCTs. Discussion Findings suggest that CBT for eating disorder can be effectively delivered in real‐world settings. This study provides evidence for the generalizability of CBT from controlled research settings to routine clinical services.

Is physical exercise and dietary therapy a feasible alternative to cognitive behavior therapy in treatment of eating disorders? A randomized controlled trial of two group therapies

“…Nevertheless, both therapies performed well in an outpatient group setting, with a summarized response rate (i.e., the total of participants that either reached full or partial remission) to therapy of ~50% after PED‐t and ~30% after CBT. This corresponds well with previous findings on treatment outcome from group‐CBT, that is, ~0–52% remission after group‐CBT (Linardon, ; Linardon, Messer, & Fuller‐Tyszkiewicz, ; Linardon & Wade, ).…”

Meta‐analysis on the long‐term effectiveness of psychological and medical treatments for binge‐eating disorder

“…A meta-regression analysis did not confirm study design and risk of bias as moderators of posttreatment effects on the primary outcomes, suggesting that NRCTs and UCTs, or studies with a high or unclear risk of bias did not lead to an overestimation of effects when compared with RCTs or studies with a low risk of bias. The latter results are consistent with similar CBT-related abstinence from binge eating in meta-analyses on a few nonrandomized studies (Linardon, Messer, & Fuller-Tyszkiewicz, 2018) and RCTs (Linardon, 2018) and lend additional support to the robustness of the results. Nevertheless, with an increased necessity of dissemination and implementation of evidencebased treatments as well as effectiveness evaluations in routine care settings (Kazdin, Fitzsimmons-Craft, & Wilfley, 2017), considering pertinent sources of risk (e.g., blinding of assessors, confounding variables) at the time of study planning is recommended.…”

Binge eating disorder revisited: what’s new, what’s different, what’s next

“…9 Psychological treatments including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) have been recommended as first line 10,11 and are supported by several different meta-analytic reviews. [12][13][14][15][16][17][18] Although CBT and IPT can reduce binge eating behavior, access to such treatments may be limited because of local availability and/or cost. Moreover, 33-50% of patients with BED do not appear to benefit completely or sufficiently from psychological and behavioral treatment.…”