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. 2021 Jun 26;9(1):74.
doi: 10.1186/s40337-021-00430-8.

Effects of cognitive-behavioral and psychodynamic-interpersonal treatments for eating disorders: a meta-analytic inquiry into the role of patient characteristics and change in eating disorder-specific and general psychopathology in remission

Leif Tore Moberg  1 , Birgitte Solvang  1 , Rannveig Grøm Sæle  2 , Anna Dahl Myrvang  1
Affiliations

Effects of cognitive-behavioral and psychodynamic-interpersonal treatments for eating disorders: a meta-analytic inquiry into the role of patient characteristics and change in eating disorder-specific and general psychopathology in remission

Leif Tore Moberg et al. J Eat Disord. .

Abstract

Background: Cognitive behavior therapy (CBT) and psychodynamic-interpersonal therapies (PIT) are two widely used and conceptually different outpatient treatments for eating disorders (EDs). To better understand how these treatments works, for whom, and under what circumstances, there is a need for knowledge about how outcomes are affected by diagnosis, comorbidity, changes in psychopathology, and study design.

Method: Reports on the effects of CBT and PIT for eating disorders were searched. Rates of remission and changes in ED specific- and general psychopathology were computed. Regression models were made to predict event rates by changes in specific- and general psychopathology, as well as ED diagnosis and study design.

Results: The remission rate of CBT for binge eating disorder was 50%, significantly higher than the effect for other diagnostic groups (anorexia = 33%, bulimia: 28%, mixed samples 30%). The number of studies found for PIT was limited. All effect sizes differed from zero (binge eating disorder = 27%, anorexia = 24%, bulimia = 18%, mixed samples = 15%), but the precision of the estimates was low, with some lower-bound confidence intervals close to zero. For CBT, change in ED specific psychopathology predicted remission only when controlling for ED diagnosis, while change in general psychopathology did not predict remission at all. The predictive value of change in psychopathology for PIT, and the potential impact of comorbid personality disorders could not be analyzed due to a lack of studies. There was no difference in effects between randomized controlled trials and observational studies.

Conclusions: CBT showed consistent remission rates for all EDs but left a substantial number of patients not in remission. Extant evidence suggest that PIT is not consistently effective in achieving remission for patients with EDs, although this finding is uncertain due to a small number of eligible studies. A group of patients with eating disorders may, however, require therapy aimed at strengthening deficits in self functions not easily ameliorable by cognitive behavioral techniques alone. Further research should be aimed at identifying treatment interventions that helps patients change behavior, while strengthening self-functions to substitute eating-disordered behavior in the long-term.

Keywords: Cognitive-behavioral therapy; Eating disorders; Interpersonal therapy; Meta-analysis; Psychodynamic therapy; Psychopathology; Regression; Remission; Treatment effect.

Plain language summary

To help people with eating disorders (EDs) recover it is important to know what makes therapies effective or not. Therefore, we summarized the effects of two common therapies for eating disorders, cognitive behavior therapy (CBT) and psychodynamic-interpersonal therapy (PIT) and examined how ED diagnosis, comorbid personality disorder and changes in psychopathology could influence ED remission. We found that CBT was most consistently effective, with about 1/3 of patients in remission for anorexia, bulimia, and mixed samples, and 50% for patients with binge eating disorder. The effects of PIT were uncertain due to a lack of studies and could be only marginally effective. In CBT, changing the patients’ eating disordered thoughts or their depression or anxiety was not associated with ED remission. We discuss why this may be and suggest that CBT may be more effective because it manages to engage a subgroup of patients who are motivated to change and less depressed or anxious. Thus, patients with more severe symptoms may benefit less. We conclude that CBT may be necessary to help people recover from eating disorders, but that some patients may still require interventions aimed at strengthening self-functions to substitute eating disordered behavior in the long-term.

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Conflict of interest statement

The authors declare that they have no competing interests.

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PRISMA flow diagram for the systematic literature review
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