Results of the first randomized controlled trial of integrated cognitive-behavioral therapy for eating disorders and posttraumatic stress disorder

Abstract

Background Eating disorders (EDs) and posttraumatic stress disorder (PTSD) frequently co-occur and can share a functional relationship. The primary aim of this initial randomized controlled trial was to determine whether integrated cognitive-behavioral therapy (CBT) for co-occurring ED-PTSD was superior to standard CBT for ED in improving PTSD symptoms. Intervention safety and desirability, as well as the relative efficacy of the treatments in improving anxiety, depression, and ED symptomatology, were also examined. Methods Following a course of intensive ED treatment, individuals with ED-PTSD were recruited to participate and randomized to integrated CBT for ED-PTSD or standard CBT for ED. The sample consisted of 42 individuals with a range of ED diagnoses. Outcomes were assessed at end-of-treatment, 3-, and 6-month follow-up using interview and self-report measures. Results Mixed models revealed significant interactions of time and therapy condition on clinician-rated and self-reported PTSD symptom severity favoring Integrated CBT for ED-PTSD. Both treatments were associated with statistically significant improvements in PTSD, anxiety, and depression. Improvements were maintained at 3- and 6-month follow-up. There was good safety with both interventions, and satisfaction with both treatments was high. However, there was a stronger preference for integrated treatment. Conclusions Integrating CBTs for PTSD and ED following intensive ED treatment is safe, desirable, and efficacious for improving PTSD symptoms. Future studies with larger sample sizes are needed to determine whether Integrated CBT for ED-PTSD provides benefits over standard CBT for ED with respect to ED outcomes.

Integrating evidence-based PTSD treatment into intensive eating disorders treatment: a preliminary investigation

“…Results from the main study analyses are consistent with study hypotheses and preliminary findings from other clinical groups, providing preliminary evidence consistent with other work on integrating evidence-based PTSD treatments into ED treatment [ 6 , 36 , 37 ]. Particularly given the lack of formal guidance for approaching treatment planning for individuals with EDs and comorbidities, our findings provide tentative support for positive outcomes associated with targeting symptoms of both co-occurring disorders while in ED treatment.…”

“…The focus is on identifying and modifying “stuck points,” or maladaptive beliefs related to why the traumatic event occurred, as well as beliefs related to safety, power/control, esteem, intimacy, and trust. To date, only a handful of studies exists that examine integrated CPT for ED-PTSD, all by the same research group [ 37 ]. This integrated treatment has been manualized by combining CPT with ED interventions based on CBT-E [ 9 ].…”

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

“…Trauma is a universal problem and trauma-informed care has become the standard of care in all behavioral health care services, including those for eating and related disorders [46,128,384]. Despite any potential misgivings or risks, ED professionals would do well to acquaint themselves with evidence-based, trauma-focused treatment approaches, such as integrated cognitive behavioral therapy for EDs and PTSD [427][428][429].…”

Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results

“…First, this is not a controlled trial but is rather an example of ongoing translational research that facilitates the connection between clinical science and its practical applications to people with EDs to improve health outcomes. There is a great need to develop integrated models to treat ED-PTSD, especially in higher levels of care [ 3 , 4 , 11 , 18 , 19 , 26 , 27 , 64 , 79 ].…”