Cognitive Behavioral Therapy for Bulimia Nervosa

Status: Strong Research Support

Description

Cognitive Behavioral Therapy (CBT) for bulimia nervosa directly targets the core features of this disorder, namely binge eating, inappropriate compensatory behaviors, and excessive concern with body shape and weight. This treatment focuses on how these symptoms cycle to perpetuate themselves in the present, as opposed to why they originally developed in the past. CBT for bulimia nervosa is conducted in approximately twenty weekly sessions, which encompass three phases. The first phase includes psychoeducation regarding weight and the adverse physiological effects of binge eating, purging, and extreme dieting, and helps the patient establish a regular pattern of eating and an appropriate weight monitoring schedule. In the second phase, the focus shifts to reducing shape and weight concerns and dieting behavior, and identifying precipitants to any remaining binge-purge episodes. The third phase is devoted to maintenance planning and the prevention of relapse in the future. In CBT, the therapist works collaboratively with the patient to disrupt the factors maintaining the binge-purge cycle with the goal to achieve abstinence from these behaviors. This treatment is typically administered individually, but it can be delivered in group format. Therapists can also guide patients in a self-help version of CBT for bulimia nervosa. CBT has the strongest scientific evidence of all the tested psychological treatments for bulimia nervosa. An enhanced version of CBT has recently been developed and tested at Oxford University to treat the spectrum of eating disorders, including bulimia nervosa.

Key References (in reverse chronological order)

• Walsh, B.T., Fairburn, C.G., Mickley, D., Sysko, R., & Parides, M.K. (2004). Treatment of bulimia nervosa in a primary care setting. American Journal of Psychiatry, 161, 556-561.
• Carter, J., Olmstead, M., Kaplan, A., McCabe, R., Mills, J., & Aime, A. Self-help for bulimia nervosa: A randomized controlled trial. American Journal of Psychiatry, 160, 973-978.
• Agras, W.S., Walsh, T., Fairburn, C.G., Wilson, GT, & Kraemer, H.C. (2000). A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57(5), 459-466.
• Walsh, B.T., Wilson, G.T., Loeb, K.L., Devlin, M.J., Pike, K.M., Roose, S.P., Fleiss, J., & Waternaux, C. (1997). Medication and psychotherapy in the treatment of bulimia nervosa. American Journal of Psychiatry, 154, 523-531.
• Fairburn, C.G., Norman, P.A., Welch, S.L., O'Connor, M.E., Doll, H.A., & Peveler, R.C. (1995). A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Archives of General Psychiatry, 52, 304-312.
• Fairburn, C. G., Jones, R., Peveler, R. C., Hope, R. A., & O'Connor, M. (1993). Psychotherapy and bulimia nervosa: The longer-term effects of interpersonal psychotherapy, behaviour therapy and cognitive behaviour therapy. Arch Gen Psychiatry, 50, 419-428.
• Full reference list

Clinical Resources

• Fairburn, C. G. (1995). Overcoming binge eating. New York: Guilford Press.
• Fairburn, C. G., Marcus, M.D., & Wilson, G. T. (1993). Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment and treatment (pp. 361-404). New York: Guilford Press.

Training Opportunities

• Contact Christopher G. Fairburn, DM, FRCPsych (Oxford University) at credo@medsci.ox.ac.uk
• Marsha Marcus, PhD (University of Pittsburgh) at marcusmd@upmc.edu (research only)
• G. Terence Wilson, PhD (Rutgers University) (research only)