Can Cognitive-Behavioral Therapy Eliminate the Binge-Purge Cycle of Bulimia?

Posted by The Evidence Blog on June 12, 2012

One of our newest health technology assessments focuses on cognitive-behavioral therapy as a treatment for bulimia, a common eating disorder. Bulimia is characterized by recurrent and frequent episodes of compulsive binge eating, lack of control over eating binges, and the subsequent use of extreme methods to compensate for binge eating, such as self-induced vomiting, excessive exercise, fasting, and use of laxatives, enemas, and/or diuretics. Many sufferers of bulimia, who are often young women, have an obsession with body shape, body weight, and body size. According to the National Eating Disorders Association, in the United States, eating disorders such as bulimia or anorexia affect up to 10 million women and 1 million men.

Treatment for bulimia usually involves a team approach, and includes interventions such as psychotherapy, medications such as antidepressants, nutrition education, dietary counseling, and, for patients with severe bulimia who also have health complications, hospitalization. Cognitive-behavioral therapy is a form of psychotherapy that concentrates on the cognitive distortions and behavioral abnormalities associated with the disorder. The primary goal of cognitive-behavioral therapy is to reduce the behavioral symptoms of binging and purging by restructuring the distorted thoughts and beliefs about body shape and weight.

Treating bulimia can be challenging, and some patients find that their symptoms never go away completely. It’s not uncommon for people to experience relapse periods of binging and purging even after they have undergone treatment for the disorder, especially when they are under a lot of stress.

In our investigation of cognitive-behavioral therapy, we examined these relevant questions:

  • Does cognitive-behavioral therapy improve or eliminate the core and compensatory symptoms associated with bulimia?
  • Does this approach lead to abstinence and relapse prevention?
  • How does cognitive-behavioral therapy compare with alternative treatments?
  • Is this treatment safe for patients?
  • Have definitive patient selection criteria been established for the use of cognitive-behavioral therapy?

We found that treatment protocols for cognitive-behavioral therapy vary across the studies that we reviewed. However, all of these protocols include well-established, specific elements of treatment, and all are associated with positive results, which strengthen the evidence base. Additionally, cognitive-behavioral therapy is a structured, well-defined, and well-established approach that lends itself to successful delivery using nontraditional methods, such as the Internet and smart phones, which may increase compliance.

Hayes clients can access this report, along with the Hayes Rating applied to this technology, through our Knowledge Center. If you are not a Hayes client, but would like more information about this report, please contact us.

Topics: Hayes Blog

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