Because the UCSD eating disorder treatment center used cognitive behavioral therapy (CBT) to help treat my eating disorder, the review “Cognitive Behavioural Therapy for anorexia nervosa: A systematic review” by Galsworthy-Francis and Allan (2014; Clinical Psychology Review) piqued my interest.
Introduction: A goal of CBT is to help patients identify and alter dysfunctional thinking, emotional responses, and behavior. Considering anorexic patients have distorted thinking about their body shape, food, and eating, 88 – 92% of clinicians attending eating disorder conferences recommend that eating disorder patients undergo CBT. While CBT is considered the treatment of choice for bulimia, with strong research support, evidence on the usefulness of CBT for treating anorexia is limited. This article reviewed recent literature on CBT for anorexia, examining randomized control trials as well as alternative studies.
Methods: Only studies from 1995 – present were assessed. All studies reported more than a single clinical case and utilized quantitative analysis as well as assessed patients before and after the treatment intervention. A total of 16 studies fulfilled the authors’ inclusion criteria (5 randomized control trials, 2 non-randomized controlled trials, and 9 individual clinical trials, including case series trials).
Results: For the randomized control trials, the average patient’s body mass index (BMI) was higher after CBT, which was only statistically significant in one trial. CBT trended towards decreases in eating disorder symptoms and improvement in mood, but it was not better than other treatments. There were similar findings for the non-randomized controlled trials. The results for the individual clinical trials were less conclusive but still suggested that CBT can contribute to weight gain and BMI improvements.
Discussion: CBT is not conclusively better than other treatments for anorexia, though it can be helpful. Dropout in CBT trended towards lower than for other treatments. CBT also improved depressive symptoms, self-esteem, and negative thinking in anorexia, but CBT has already been shown to be effective in individually treating these conditions. There were some limitations in the overall quality of the reviewed studies, including mixing adolescents and adults in the same sample (even though family treatment is the treatment of choice for adolescents); disproportionate number of female participants; absence of ethnic diversity; variations in the CBT approach; and substantial variability in the BMI status of the participants at the start of CBT. Still, CBT may improve treatment follow-through, which is important considering that anorexia treatment dropout is 50%.
Conclusion: There is inconsistent information on the usefulness of CBT in treating anorexia. Further research is necessary to determine the type of CBT that is most useful for treating anorexia. (So, this study really did not provide much of a clue about how CBT should be incorporated into the treatment of anorexia besides just recommending that more studies are needed…)