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Interesting Study of Psychoanalytic Psychotherapy vs CBT in the Treatment of Bulimia

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spoonAn interesting study has been published recently that compares psychoanalytic psychotherapy and cognitive-behavioral therapy in the treatment of bulimia (abstract of the study). I thought it worth noting here.

In this randomized, controlled trial 70 patients with bulimia nervosa received either 2 years of weekly psychoanalytic psychotherapy or 20 sessions of CBT over 5 months. The main outcome measure was the Eating Disorder Examination interview, which was administered blind to treatment condition at baseline, after 5 months, and after 2 years.

Both treatments resulted in improvement, but a marked difference was observed between CBT and psychoanalytic psychotherapy. 20 sessions of CBT delivered over five months was more effective in relieving binging and purging than 2 years of weekly psychoanalytic psychotherapy and was generally faster in alleviating eating disorder features and general psychopathology.

According to a colleague, the data show that at 5 months, about 7 times as many people responded to CBT as responded to psychoanalytic therapy and after 2 years about 3 times as many people responded to CBT as responded to psychoanalytic therapy. In other words, CBT worked for more people and worked faster.

The authors of the study conclude that we need to develop a more structured and symptom-focused version of psychoanalytic psychotherapy for bulimia nervosa. However, a cognitive-behavioral colleague points out that we could do that, or we could just use CBT.

Another colleague discussed this study with a psychoanalytic therapist and their response was that they’d like to see a 5- or 10-year follow-up. I’d love to see a long-term follow-up as well. My bet is that CBT would do well on follow-up but that periodic booster sessions might well be useful in maintaining gains with either treatment.

Binge image available from Shutterstock.

James Pretzer, Ph.D. is the Director of the Cleveland Center for Cognitive Therapy and is Assistant Clinical Professor of Psychology in the Department of Psychiatry at the Case Western Reserve University School of Medicine. He received his Ph.D. in Clinical Psychology from Michigan State University and completed a post-doctoral fellowship at the Center for Cognitive Therapy at the University of Pennsylvania where he worked closely with Aaron T. Beck, M.D., David Burns, M.D., and other leading cognitive therapists. Jim and his wife, Barbara Fleming, Ph.D., have been actively involved in applying Cognitive Therapy in areas such as the treatment of personality disorders and marital problems. They have also been providing advanced training in Cognitive Therapy for mental health professionals for over thirty years (see http://www.behavioralhealthassoc.com/educationalPrograms.php). Jim is a co-author, with Art Freeman, Barbara Fleming, and Karen Simon, of Clinical Applications of Cognitive Therapy (second edition, 2004) and he is a co-author, with Aaron T. Beck and colleagues, of Cognitive Therapy of Personality Disorders (second edition, 2004). He has also authored and co-authored a number of papers and book chapters on a range of topics in Cognitive Therapy. Jim has presented his work at conventions of the Association for the Advancement of Behavior Therapy, the World Congress of Behavior Therapy, and the American Psychological Association, as well as in workshops locally, regionally, and internationally. His work has been translated and published in a number of languages including German, Japanese, and Swedish.

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Published on December 6, 2013   Filed under Cognitive Therapy

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