The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review

Abstract

Although third-wave behaviour therapies are being increasingly used for the treatment of eating disorders, their efficacy is largely unknown. This systematic review and meta-analysis aimed to examine the empirical status of these therapies. Twenty-seven studies met full inclusion criteria. Only 13 randomized controlled trials (RCT) were identified, most on binge eating disorder (BED). Pooled within- (pre-post change) and between-groups effect sizes were calculated for the meta-analysis. Large pre-post symptom improvements were observed for all third-wave treatments, including dialectical behaviour therapy (DBT), schema therapy (ST), acceptance and commitment therapy (ACT), mindfulness-based interventions (MBI), and compassion-focused therapy (CFT). Third-wave therapies were not superior to active comparisons generally, or to cognitive-behaviour therapy (CBT) in RCTs. Based on our qualitative synthesis, none of the third-wave therapies meet established criteria for an empirically supported treatment for particular eating disorder subgroups. Until further RCTs demonstrate the efficacy of third-wave therapies for particular eating disorder subgroups, the available data suggest that CBT should retain its status as the recommended treatment approach for bulimia nervosa (BN) and BED, and the front running treatment for anorexia nervosa (AN) in adults, with interpersonal psychotherapy (IPT) considered a strong empirically-supported alternative.

Randomized controlled psychotherapy trials in eating disorders: Improving their conduct, interpretation and usefulness

“…Slow responders (at session 4) to guided self‐help were randomized to a more intensive treatment option (dialectical behavior therapy or CBT), resulting in both groups having the same long‐term outcomes as the fast responders. The analysis of mediators, moderators, and predictors of response to treatment should continue to be a research priority in RCTs of eating disorders (Linardon et al, ).…”

“…CBT might also be the most effective psychotherapy for improving the symptoms of depression that commonly co‐occur in BN (Linardon, Wade, de la Piedad Garcia, & Brennan, b). Furthermore, comparisons to third wave behavior therapies indicate that CBT should retain its status as the recommended treatment approach for BN (Linardon, Fairburn, Fitzsimmons‐Craft, Wilfley, & Brennan, ).…”

Changes in the sense of agency: Implications for the psychotherapy of bulimia nervosa‐ A case study

“…Eating disorders are sets of behaviors and thought processes that can cause severe suffering and have a profound impact on a person's life. Although many different psychotherapeutic approaches have been developed for eating disorders, recent meta‐analyses have shown that no one treatment model succeeds better than others (Linardon, Fairburn, Fitzsimmons‐Craft, Wilfley, & Brennan, ; Steinert, Munder, Rabung, Hoyer & Leichsenring, ).…”

Cognitive behavioural therapy for eating disorders: how do clinician characteristics impact on treatment fidelity?

“…A growing body of research has provided strong empirical support for cognitive behavioural therapy (CBT) based interventions for BN and BED in comparison with psychopharmacology and other types of psychological interventions [2, 3]. A range of psychological therapies have been found to be effective, but findings to date have shown that the most robust and established approach is the use of CBT [2–6]. This is reflected in the recommendation of CBT for the treatment of BN and BED in National Institute for Care and Excellence (NICE) [7] guidelines and most recent version of clinical practice guidelines developed by a multi-disciplinary team with the Royal Australian and New Zealand College of Psychiatrists [8].…”