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

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.

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