Cognitive-behavioral treatment of bulimia nervosa. A critical appraisal.
CBT quickly cuts bulimic behaviors, yet long-term abstinence is modest and early studies were shaky.
01Research in Context
What this study did
The authors read every CBT-for-bulimia paper they could find. They looked at how well the studies were run. They asked: Do the numbers really show CBT works?
This was a narrative review, not a new experiment. The team simply summarized and critiqued the early research.
What they found
CBT helped people binge and vomit less while they were in treatment. Long-term, most patients still had some symptoms. Many studies had weak designs, so the gains might be smaller than they looked.
How this fits with other research
Burack et al. (2004) updated the theory 17 years later. They stitched CBT ideas together and showed the field had moved on.
Vanderlinden et al. (2012) tested weekly CBT in adults with binge-eating disorder and obesity. Bingeing dropped and stayed down for 3.5 years. Their real-world data echo the short-term win Rutter et al. (1987) saw, but again long-term abstinence was only partial.
Pigott (1987), writing in the same year, said pick your tool to match the symptom: use pure behavior methods for behavioral issues, CBT for thoughts, and broader therapy for mood. Rutter et al. (1987) would agree; they warned that CBT alone is not a cure-all.
Why it matters
If you plan CBT for any repetitive behavior, expect early gains but plan for maintenance. Add booster sessions or combine modalities, just as Pigott (1987) suggested. Track long-term data yourself; the early bulimia trials did not, and it left a blind spot you can avoid with your own clients.
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02At a glance
03Original abstract
Specific distorted attitudes toward weight and shape have been identified as important in the development and maintenance of anorexia nervosa and bulimia nervosa. Cognitive-behavioral (CB) treatment methods have been proposed for these eating disorders and preliminary reports of their efficacy with bulimia nervosa are reviewed. Although the results are encouraging, several conceptual and methodological issues must be addressed in the interpretation of findings. Inadequate and inconsistent definitions of CB methods are common in the current literature. Few studies depend on manuals to operationalize interventions. In some, recruitment has depended on advertisement, whereas in others it has depended on clinical referrals. In some studies, experienced therapists have been used and in others graduate students have been employed as therapists. Despite the lack of comparability among studies, there is evidence that CB intervention leads to a marked reduction in bingeing and vomiting as well as associated psychopathology. Evaluation of the proportion of patients abstinent from bingeing and vomiting at follow-up leads to a less optimistic view of success. Individual therapy appears to be somewhat more effective than group treatment in minimizing attrition and alleviating symptoms. Future studies must be aimed at a more systematic evaluation of active components in treatment and at demonstrating durability of change.
Behavior modification, 1987 · doi:10.1177/01454455870114002