Cognitive Behavioral Therapy for Anorexia Nervosa

Status: Modest Research Support for Post-Hospitalization Relapse Prevention Status: Controversial for Acute Weight Gain

Description

Cognitive Behavioral Therapy (CBT) as a post-hospitalization outpatient intervention for anorexia nervosa is designed to prevent relapse once a patient has gained weight in the context of inpatient treatment. CBT for acute weight gain is designed to restore weight on an outpatient basis. CBT for anorexia nervosa, designed for late adolescents and adults with this disorder, is typically conducted on an individual basis over the course of one year. Biweekly session are recommended initially while weekly sessions are sufficient once weight is stable. This treatment is explicitly focused on the achievement and maintenance of a healthy weight, particularly one at which (for females) return of menses is possible. CBT for anorexia nervosa employs behavioral strategies including the establishment of a regular pattern of eating and systematic exposure to forbidden foods, while simultaneously addressing cognitive aspects of the disorder such as motivation for change and disturbance in the experience of shape and weight. CBT for anorexia nervosa also emphasizes schema-level change and challenges the seemingly inextricable tie between personal identity and the illness.

Key References (in reverse chronological order)

• Halmi, K.A., Agras, W.S., Crow, S., Mitchell, J., Wilson, G.T., Bryson, S.W., & Kraemer, H.C. (2005). Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. Archives of General Psychiatry, 62(7), 776-781.
• Pike, K.M., Walsh, B.T., Vitousek, K., Wilson, G.T., and Bauer, J. (2003). Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. American Journal of Psychiatry, 160, 2046-2049.
• McIntosh VVW, Jordan J, Carter F, Luty SE, McKenzie JM, Bulik CM, Frampton CMA, Joyce PR (2005), Three psychotherapies for anorexia nervosa: A randomized, controlled trial. Am J Psychiatry 162: 741-747
• Walsh BT, Kaplan AS, Attia E, Olmstead M, Parides M, Carter JC, Pike KM, Devlin MJ, Woodside B, Roberto CA, Rockert W (2006), Fluoxetine after weight restoration in anorexia nervosa: A randomized controlled trial. JAMA 295: 2605-2612

Clinical Resources

• Pike, K.M., Devlin, M.J., & Loeb, K.L. (2004). Cognitive-behavioral therapy in the treatment of anorexia nervosa, bulimia nervosa, and binge eating disorder. In J.K. Thompson (Ed.), Handbook of Eating Disorders and Obesity, (pp. 130-162). New Jersey: John Wiley & Sons.
• Garner, D.M., Vitousek, K.M., & Pike, K.M. (1997). Cognitive-behavioral therapy for anorexia nervosa. In D.M. Garner & P.E. Garfinkel (Eds.), Handbook of Treatment for Eating Disorders (2nd Ed.), (pp. 94-144). New York: The Guilford Press.

Training Opportunities

• Christopher G. Fairburn, DM, FRCPsych (Oxford University) at credo@medsci.ox.ac.uk
• Kathleen M. Pike, PhD (Columbia University) at kmp2@columbia.edu
• Kelly Vitousek, PhD (University of Hawaii) (research only)
• G. Terence Wilson, PhD (Rutgers University) (research only)