For those suffering with bulimia nervosa, an enhanced form of cognitive-behavioral therapy (CBT) has proven far more effective than psychoanalytic psychotherapy, according to new research.

Bulimia is characterized by recurrent episodes of binge eating, extreme weight control behaviors, and over-evaluation of weight and shape.

“CBT is a highly effective treatment for bulimia nervosa and clearly more effective than the version of psychoanalytic psychotherapy tested in this trial,” said researcher Stig Poulsen, Ph.D., associate professor with the Department of Psychology at University of Copenhagen.

“Still, a large percentage of the patients were not helped sufficiently for their bulimia by cognitive behavioral therapy. This suggests that further development of treatments for bulimia nervosa is still relevant,” said Poulsen.

The psychoanalytic psychotherapy for bulimia — developed by Poulsen and a colleague — is based on the theory that bulimic symptoms stem from a need to ward off inner feelings and desires, and that patients have a difficult time acknowledging and regulating those feelings.

The enhanced CBT was developed by Christopher Fairburn, who also worked on the current study. This CBT therapy uses procedures and strategies to address dietary restraint, concerns about shape and weight, events and associated mood changes influencing eating, and the development of skills to deal with setbacks.

For the study, the researchers conducted a randomized, controlled trial in which 70 adult patients with bulimia were randomly assigned to two years of weekly 50-minute sessions of psychoanalytic psychotherapy or 20 sessions of enhanced CBT given during a period of 5 months.

Both treatments led to improvement in bulimia symptoms, but CBT was far more effective.

After 5 months, 42 percent of the CBT group and 6 percent of the psychoanalytic psychotherapy group had stopped binge eating and purging.

At two years, 44 percent of the CBT group and 15 percent of the psychotherapy group had stopped binge eating and purging.

“CBT is the preferred treatment for the disorder when compared with the version of psychoanalytic psychotherapy tested in this trial,” wrote the investigators.

But the fact that at two years, 56 percent of the CBT patients still had problems with binge eating and purging and 31 percent still met the diagnostic criteria for bulimia means “further treatment developments are needed,” the researchers added.

The new study appears in American Journal of Psychiatry.

Source: American Journal of Psychiatry

Therapist talking with client photo by shutterstock.

For Bulimia, CBT Beats Psychoanalysis