Article type
Year
Abstract
Introduction:
Objectives: The review aims to evaluate the differing psychotherapeutic treatments that have been evaluated in randomised controlled trials of those with binge eating syndromes. Specifically cognitive-behavioural(CBT) therapy is compared with waiting list or a non-treatment group, any other psychotherapy, CBT in a "pure self-help" form and CBT augmented by exposure and response therapy.
Methods: Studies evaluating psychotherapy for bulimia nervosa, binge eating disorder and those with a binge eating syndrome of EDNOS type are included. Trials are subjected to quality analyses. The search strategy comprises a) hand-searching of The International Journal of Eating Disorders b) the following databases: MEDLINE, EXTRAMED, EMBASE, PSYCHLIT, CURRENT CONTENTS, CCDANCTR & the CCCTR c) citation list search d) writing to authors. PH evaluated 100% and JB 10% of the trials for their quality and data. Data is analysed by REVMAN. Relative risk (RR) analyses are conducted of binary outcome data. Weighted mean difference analyses are conducted of continuous variable outcome data. Chi-square tests for homogeneity are done and funnel plots to evaluate presence of publication bias.
Results: To date 1359 trials have been generated by searching and 57 trials have been evaluated. Because of a relatively high number of exclusions (n=12) the trial inclusion criteria were broadened to include those with non-blinded outcome assessment, providing 24 trials for analyses. Because of incomplete published and available data, at best up to 5 studies had data available for any single analysis. The maximum number of total patients included in a single analysis was 396. The majority of studies (22, 92%)evaluate patients with bulimia nervosa of a purging type. CBT was superior to waiting list controls with respect to abstinence from binge eating (RR 0.64 CI .53-.78). CBT was not superior to other psychotherapies with respect to abstinence from binge eating (RR .79, CI .54-1.17). CBT in a full or less intensive form was not significantly superior to CBT in a pure self-help form. Augmentation of CBT with exposure therapy was not more effective than CBT alone. NonCBT-psychotherapies also had significantly greater abstinence rates in comparisons with wait-list controls but there is a paucity of such studies (RR 0.67, CI .56-.81, n=3). Funnel plots suggested a bias towards publication of positive outcome studies only.
Discussion: There is small body of evidence for the effectiveness of cognitive-behaviour therapy in bulimia nervosa and similar syndromes but the quality of trials is very variable (the majority are not blinded) and sample sizes are often very small. More trials are needed, particularly for binge eating disorder and other EDNOS syndromes and evaluating other psychotherapies and less intensive psychotherapies.
Objectives: The review aims to evaluate the differing psychotherapeutic treatments that have been evaluated in randomised controlled trials of those with binge eating syndromes. Specifically cognitive-behavioural(CBT) therapy is compared with waiting list or a non-treatment group, any other psychotherapy, CBT in a "pure self-help" form and CBT augmented by exposure and response therapy.
Methods: Studies evaluating psychotherapy for bulimia nervosa, binge eating disorder and those with a binge eating syndrome of EDNOS type are included. Trials are subjected to quality analyses. The search strategy comprises a) hand-searching of The International Journal of Eating Disorders b) the following databases: MEDLINE, EXTRAMED, EMBASE, PSYCHLIT, CURRENT CONTENTS, CCDANCTR & the CCCTR c) citation list search d) writing to authors. PH evaluated 100% and JB 10% of the trials for their quality and data. Data is analysed by REVMAN. Relative risk (RR) analyses are conducted of binary outcome data. Weighted mean difference analyses are conducted of continuous variable outcome data. Chi-square tests for homogeneity are done and funnel plots to evaluate presence of publication bias.
Results: To date 1359 trials have been generated by searching and 57 trials have been evaluated. Because of a relatively high number of exclusions (n=12) the trial inclusion criteria were broadened to include those with non-blinded outcome assessment, providing 24 trials for analyses. Because of incomplete published and available data, at best up to 5 studies had data available for any single analysis. The maximum number of total patients included in a single analysis was 396. The majority of studies (22, 92%)evaluate patients with bulimia nervosa of a purging type. CBT was superior to waiting list controls with respect to abstinence from binge eating (RR 0.64 CI .53-.78). CBT was not superior to other psychotherapies with respect to abstinence from binge eating (RR .79, CI .54-1.17). CBT in a full or less intensive form was not significantly superior to CBT in a pure self-help form. Augmentation of CBT with exposure therapy was not more effective than CBT alone. NonCBT-psychotherapies also had significantly greater abstinence rates in comparisons with wait-list controls but there is a paucity of such studies (RR 0.67, CI .56-.81, n=3). Funnel plots suggested a bias towards publication of positive outcome studies only.
Discussion: There is small body of evidence for the effectiveness of cognitive-behaviour therapy in bulimia nervosa and similar syndromes but the quality of trials is very variable (the majority are not blinded) and sample sizes are often very small. More trials are needed, particularly for binge eating disorder and other EDNOS syndromes and evaluating other psychotherapies and less intensive psychotherapies.