Treating Bulimia Nervosa with Cognitive-Behavioral Therapy and Interpersonal Psychotherapy
Conclusion and Implications for Future Research
Research suggests that interpersonal psychotherapy achieves comparable effects to cognitive -behavioral therapy for the treatment of bulimia nervosa in young women. However, further investigation is needed to explore whether certain types of patients respond preferentially to IPT compared to CBT. The role of certain patient characteristics such as self esteem, motivation to change, and expectations for change in mediating treatment outcomes needs to be explored. This is significant in enhancing the efficacy and efficiency of each treatment by tailoring it to individual needs and characteristics.
Moreover, although CBT has been identified as the leading treatment for bulimia nervosa in young women and IPT has been shown to have comparable effects (albeit achieving improvements more slowly), both treatment modalities have significant limitations. In some cases, only about 50% of patients abstain from binge eating and purging. Therefore, additional research is necessary to enhance both treatments as well as to explore different treatment strategies for those patients who derive little or no benefit from CBT or IPT.
Additionally, the finding that IPT is slower than CBT in achieving its therapeutic effects despite providing good long term maintenance of change necessitates further research on increasing its utility. For instance, it could be the case that IPT was slower than CBT in engendering its effects because of how the treatment was implemented. In particular, IPT for bulimia nervosa has been implemented in a manner that avoids any overlap with the application of CBT (for instance IPT disregards the interaction of interpersonal problems with the symptoms of bulimia nervosa).
This is a noticeable departure from the original application of IPT for the treatment of depression which placed significant emphasis on the interaction between the symptoms of the disorder and the interpersonal context (Klerman et al., 1984).Therefore, future research on IPT should focus on examining the interaction between interpersonal problems and the core characteristics of bulimia nervosa (such as eating patterns, and attitudes about weight and shape). These adaptations in the implementation and content of IPT may potentially enhance its efficacy and efficiency in treating bulimia nervosa in young women.
Agras, W.S., Walsh, T., Fairburn, C.G., Wilson, G.T., & Kraemer, H.C. (2000). A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57(5), 459-466.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington, DC: Author, 1994.
Chen E.Y., Matthews L., Allen C., Kuo J.R. & Linehan M.M. (2008). Dialectical behavior therapy for clients with binge-eating disorder or bulimia nervosa and borderline personality disorder. International Journal of Eating Disorders 41(6): 505–512.
Craighead, L.W., & Agras, W.S. (1991). Mechanisms of action in cognitive-behavioral and pharmacological interventions for obesity and bulimia nervosa. Journal of Consulting and Clinical Psychology, 59, 115-125.
Fairburn C.G., Jones R., & Peveler R.C. (1991). Three psychological treatments for bulimia nervosa. A comparative trial. Archives of General Psychiatry, 48, 463–9.
Fairburn C.G., Jones R, & Peveler R.C. Psychotherapy and bulimia nervosa. (1993). Longer-term effects of interpersonal psychotherapy, behavior therapy, and cognitive behavior therapy. Archives of General Psychiatry, 50, 419–28.
Fairburn, C. G., (1994). Interpersonal psychotherapy for bulimia nervosa. The Clinical Psychologist, 47(4), 21-22.
Fairburn C.G (1997) Interpersonal psychotherapy for bulimia nervosa. In: Garner DM, Garfinkel PE (eds) Handbook of Treatment for Eating Disorders. New York: Guildford Press, 67–93.
Fairburn C, Cooper Z. & DollH. (2000). The natural course of bulimia nervosa and binge eating disorder in young women. Archives of General Psychiatry, 57, 659–65.
Garfinkel P.E., Lin B., & Goering P. (1995).Bulimia nervosa in a Canadian community sample: prevalence, co-morbidity, early experiences and psychosocial functioning. American Journal of Psychiatry, 152, 1052–8.
Hay P.J, Bacaltchuk J., Stefano S. & Kashyap P. (2009). Psychological treatments for bulimia nervosa and binging. Cochrane Database of Systematic Reviews 4: CD000562.
Hoek H.W. & van Hoeken D. (2003).Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34, 383–96.
Kendler K.S., Maclean C., Neale M., Kessler R., Heath A., & Eaves L. (1991).The genetic epidemiology of bulimia nervosa. American Journal of Psychiatry, 148, 1627–37.
Klerman G.L, Weissman M.M., Rounsaville B.J. & Chevron E.S. Interpersonal Psychotherapy for Depression. New York, NY: Basic Books, 1984.
Mitchell J.E & Crow S. (2006). Medical complications of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 19, 438–443.
O’Brien, K. M., & Vincent, N. K. (2003). Psychiatric co morbidity in anorexia and bulimia nervosa: Nature, prevalence, and causal relationships. Clinical Psychology Review, 23, 57-74.
Whittal M.L, Agras WS, & Gould R.A. (1999). Bulimia nervosa: A metaanalysis of psychosocial and pharmacological treatments. Behavior Therapy, 30, 117–135.
Wilson, G.T. (1997). Cognitive behavioral treatment of bulimia nervosa. The Clinical Psychologist, 50(2), 10-12.
Wilson, G. T., & Fairburn, C. G. (2002). Treatments for eating disorders. In P. E. Nathan, & J. M. Gorman (Eds.), A guide to treatments that work (2nd ed., pp. 559–592). New York: Oxford University Press.
Wilson, G. T. (2005). Psychological treatment of eating disorders. Annual Review of Clinical Psychology, 1, 439-465.
Wilson, G. A., Grilo, C. M., & Vitousek, A. M. (2007). Psychological treatment of eating disorders. American Psychologist Special Issue: Eating Disorders, 62, 199-216.
Zhu A.J & Walsh B.T (2002) Pharmacologic treatment of eating disorders. Canadian Journal of Psychiatry 47(3): 227–234.