CBT vs other behavioral approaches
Cognitive-behavioral therapy (CBT), which focuses on identifying and modifying unhealthy thoughts that maintain disordered eating behaviors, is the most widely studied behavioral intervention for BED. Other studied treatments include interpersonal psychotherapy (IPT), motivational interviewing (MI), and structured behavioral weight loss (BWL) (Table 3).14-24 IPT is a psychodynamically based, time-limited treatment that focuses on the interpersonal context of the disorder and on building interpersonal skills. MI emphasizes exploring and resolving ambivalence about treatment, and works to facilitate change through motivational processes. BWL is centered on making dietary and physical activity changes to achieve weight loss. Behavioral treatments have been delivered in various formats, such as an individual or group setting, by electronic interface, and via self-help approaches. Most studies compared active treatment to a control group, but some compared active treatments head-to-head.
Table 3
CBT and other behavioral interventions for BED
| Study | Intervention | Comments |
|---|---|---|
| Annunziato et al, 200914 | 2 groups received CBT and hypocaloric diet for 8 weeks followed by 14 weeks of enhanced nutritional program (ie, reduced consumption of high energy density foods and once-daily liquid meal replacement) or control (normal diet) | Enhanced nutritional program was not significantly different from the control in reducing weight, BE, or psychological features of BE; variability in adherence to the enhanced nutritional program was identified as a significant effect modifier |
| Ashton et al, 200915 | 4 sessions of group CBT in an open trial | CBT was associated with significant reductions in BE and psychological features of BE in post-bariatric surgery patients |
| Dingemans et al, 200716 | CBT vs wait-list control | CBT significantly better than the wait-list control in reducing BE and psychological features of BE, and in achieving abstinence from BE |
| Friederich et al, 200717 | 15-session CBT blended with elements of interpersonal therapy (IPT), nutritional counseling, and supervised walking program; no control group | Treatment significantly reduced weight, BE, and related psychological features of BE in patients meeting sub-threshold and full criteria for BED |
| Grilo et al, 200518 | Guided self-help CBT (CBTgsh) vs guided self-help behavioral weight loss (BWLgsh) vs non-specific attention control for 12 weeks | CBTgsh significantly better than BWLgsh and control in BE remission; CBTgsh significantly better than BWLgsh, which was significantly better than control in reducing cognitive restraint; CBTgsh significantly better than control in reducing depression and eating-related psychopathology; no differences between groups in BMI change |
| Ricca et al, 201019 | Individual (I-CBT) vs group CBT (G-CBT) for 24 weeks in patients meeting subthreshold and full criteria for BED | BE and BMI were significantly reduced in both groups at 24 weeks and 3-year follow-up. I-CBT was not better than G-CBT in reducing BE or weight at 24 weeks or 3-year follow-up; I-CBT was significantly better than G-CBT in reducing eating-related psychopathology at 24 weeks and 3-year follow-up; I-CBT was significantly better than G-CBT in recovery (ie, no longer meeting full BED criteria) at 24 weeks but not at 3-year follow-up |
| Schlup et al, 200920 | 8 weekly sessions of group CBT vs wait-list control | CBT was significantly better than wait-list control in reducing BE and eating concerns and in achieving abstinence at end of treatment; CBT was not different than control in reducing BMI; treatment-related reductions in BE and eating concerns were maintained at 12-month follow-up |
| Shapiro et al, 200721 | 10 weekly sessions of group CBT (G-CBT) vs CD-ROM delivered CBT (CD-CBT) vs wait-list control | G-CBT and CD-CBT were not different from each other but both were significantly better than wait-list control in reducing BE |
| Tasca et al, 200622 | Group CBT (G-CBT) vs group psychodynamic interpersonal therapy (G-IPT) vs wait-list control for 16 weeks | G-CBT and G-IPT were not different from each other; G-CBT and G-IPT were significantly better than wait list in reducing BE and interpersonal problems (but not BMI) and increasing cognitive restraint post-treatment; depression was reduced in both groups at 6 months but only in G-IPT at 12 months; reductions in BE maintained at 12 months |
| Wilson et al, 201023 | 10 sessions of guided self-help CBT (CBTgsh) vs 19 sessions of IPT vs 20 sessions of behavioral weight loss (BWL) over 6 months | BWL was significantly better than IPT and CBTgsh in reducing BMI and in the number of patients achieving 5% weight loss at post-treatment but effects were not sustained over time; BWL was significantly better than CBTgsh in increasing dietary restraint |
| Cassin et al, 200824 | Self-help book + motivational interviewing (SH-MI) vs self-help book alone (SH) for 16 weeks | SH-MI was significantly better than SH in reducing BE and depression |
| BE: binge eating; BED: binge eating disorder; BMI: body mass index; CBT: cognitive-behavioral therapy | ||
Studies found that CBT and IPT are effective in reducing the frequency of binge eating, whether measured by the number of binge eating episodes or days a patient reports having engaged in binge eating.14-23 However, some studies suggested that CBT can help a substantial number of patients achieve abstinence from binge eating.16,20 Adding MI to a self-help approach may improve binge eating outcomes,24 and binge eating can be successfully reduced using individual, group, and CD-ROM delivery formats.21 In direct comparisons, individual CBT outperformed group CBT in helping patients recover from BED (ie, no longer meeting diagnostic criteria),19 and CBT delivered via guided self-help outperformed BWL in helping patients achieve remission.18