Intervention Review

Psychological treatments for bulimia nervosa and binging

  1. Phillipa PJ Hay1,*,
  2. Josué Bacaltchuk2,
  3. Sergio Stefano2,
  4. Priyanka Kashyap3

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 31 MAY 2007

DOI: 10.1002/14651858.CD000562.pub3


How to Cite

Hay PPJ, Bacaltchuk J, Stefano S, Kashyap P. Psychological treatments for bulimia nervosa and binging. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD000562. DOI: 10.1002/14651858.CD000562.pub3.

Author Information

  1. 1

    Building 3, Mental Health School of Medicine, Penrith South, New South Wales, Australia

  2. 2

    Universidade Federal de São Paulo, Department of Psychiatry, São Paulo - SP, Brazil

  3. 3

    St. Xavier's College, University of Mumbai, Department of Life Sciences and Biochemistry, Mumbai, India

*Phillipa PJ Hay, Mental Health School of Medicine, Building 3, Campbelltown Campus University of Western Sydney, Locked Bag 1797, Penrith South, New South Wales, 2570, Australia. p.hay@uws.edu.au.

Publication History

  1. Publication Status: Edited (conclusions changed)
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

A specific manual-based form of cognitive behavioural therapy (CBT) has been developed for the treatment of bulimia nervosa (CBT-BN) and other common related syndromes such as binge eating disorder. Other psychotherapies and modifications of CBT are also used.

Objectives

To evaluate the efficacy of CBT, CBT-BN and other psychotherapies in the treatment of adults with bulimia nervosa or related syndromes of recurrent binge eating.

Search methods

Handsearch of The International Journal of Eating Disorders since first issue; database searches of MEDLINE, EXTRAMED, EMBASE, PsycInfo, CURRENT CONTENTS, LILACS, SCISEARCH, CENTRAL and the The Cochrane Collaboration Depression, Anxiety & Neurosis Controlled Trials Register; citation list searching and personal approaches to authors were used. Search date June 2007.

Selection criteria

Randomised controlled trials of psychotherapy for adults with bulimia nervosa, binge eating disorder and/or eating disorder not otherwise specified (EDNOS) of a bulimic type which applied a standardised outcome methodology and had less than 50% drop-out rate.

Data collection and analysis

Data were analysed using the Review Manager software program. Relative risks were calculated for binary outcome data. Standardised mean differences were calculated for continuous variable outcome data. A random effects model was applied.

Main results

48 studies (n = 3054 participants) were included. The review supported the efficacy of CBT and particularly CBT-BN in the treatment of people with bulimia nervosa and also (but less strongly due to the small number of trials) related eating disorder syndromes.

Other psychotherapies were also efficacious, particularly interpersonal psychotherapy in the longer-term. Self-help approaches that used highly structured CBT treatment manuals were promising. Exposure and Response Prevention did not enhance the efficacy of CBT.

Psychotherapy alone is unlikely to reduce or change body weight in people with bulimia nervosa or similar eating disorders.

Authors' conclusions

There is a small body of evidence for the efficacy of CBT in bulimia nervosa and similar syndromes, but the quality of trials is very variable and sample sizes are often small. More and larger trials are needed, particularly for binge eating disorder and other EDNOS syndromes. There is a need to develop more efficacious therapies for those with both a weight and an eating disorder.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Psychological treatments for people with bulimia nervosa and binging

Bulimia nervosa (BN) is an eating disorder in which people binge on food and then try to make up for this by extreme measures such as making themselves sick, taking laxatives or starving themselves. We reviewed studies of psychotherapies, including a specific form of psychotherapy called cognitive behavioural therapy (CBT-BN). We compared psychotherapy to control groups who got no treatment (e.g. people on waiting lists) and the specific CBT-BN with other types of psychotherapy. We found that CBT was better than other therapies, and better than no treatment, at reducing binge eating. Other psychotherapies were also better than no treatment in reducing binge eating. Some studies found that self-help using the CBT manual can be helpful, but more research and larger trials are needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

心因性暴食症(Bulimia nervosa)與暴食的心理治療

一個特定的以手冊為基礎的認知行為治療(CBT)已被發展來治療心因性暴食症(CBTBN)與其他常見的相關症候群,例如暴食。其他的心理治療與修正後的認知行為治療也被使用。

目標

評估認知行為治療、CBTBN與其他的心理治療,在治療成人罹患心因性暴食症或反覆暴食相關症候群的效果。

搜尋策略

用手動搜尋初期迄今的The International Journal of Eating Disorders 。搜尋MEDLINE、EXTRAMED、EMBASE 、PsycInfo、CURRENT CONTENTS、LILACS、SCISEARCH、CENTRAL與The Cochrane Collaboration Depression 、Anxiety & Neurosis Controlled Trials Register等資料庫。搜尋參考文獻並與作者聯繫,搜尋至2007年6月。

選擇標準

對心因性暴食症、暴食和或暴食型的其他飲食疾患(eating disorder not otherwise specified)的成人患者進行心理治療的隨機對照試驗,使用標準化的結果評估方法,且退出率少於50%。

資料收集與分析

使用Review Manager軟體來分析資料。對二分變項計算相對危險(Relative risks) 。對連續結果變項計算標準化平均差異(Standardised mean differences)。使用隨機效果模式來進行分析。

主要結論

納入48個研究(共3054位參與者)。回顧支持CBT,特別是CBTBN,在治療暴食症與相關飲食症候群(但因為試驗的數目少,證據較不強)的效果。其他心理治療也是有效的,特別是長期的人際心理治療。使用高度結構化的認知行為治療手冊的自助取向也是有效的。暴露與反應預防並沒有提高CBT的療效。單獨使用心理治療難以降低或改變暴食症或相似飲食疾患患者的體重。

作者結論

有少量的證據顯示認知行為治療(CBT)在治療暴食症與類似症候群上有療效,但試驗的品質有很大的差異,樣本數通常也很小。需要更多與更大的試驗,特別是對暴食與其他的飲食症候群。需要發展更有效的治療來處置同時有體重問題與飲食疾患的患者。

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以心裡治療處置心因性暴食症與暴食的病人:心因性暴食症(BN)是一種飲食疾患,患者暴食然後又藉由極端的方式,例如讓他們自己不舒服、服用瀉藥或饑餓來嘗試彌補。我們回顧心理治療的研究,包括一種特定型式的心理治療,稱為認知行為治療(CBTBN)。我們比較心理治療與沒有治療的控制組(例如等候名單的患者),也比較特定的認知行為治療(CBTBN)與其他的心理治療。我們發現,認知行為治療(CBTBN)在降低暴食上的效果比其他的心理治療好,也比沒接受治療好。其他的心理治療在降低暴食的效果也比沒有接受治療好。有些研究發現自行取用認知行為治療手冊是有助益的,但是仍需要更多的研究與更多參與者的試驗。