Q & A: Can CBT Be Used for Patients with Anorexia Nervosa?

Q: I know that cognitive-behavioral therapy (CBT) is a preferred method for treating bulimia nervosa, and I also know that CBT has been proposed for anorexia nervosa. Is there any evidence that CBT works for patients with anorexia nervosa? (S.S., Long Beach, CA)

A: While a number of well-designed controlled studies support the use of CBT for bulimia nervosa, research concerning CBT for anorexia nervosa is much more limited. A very small study of outpatients with anorexia nervosa, conducted in England in the 1980s, compared short-term outcomes treatment with CBT vs. standard behavioral treatment vs. a comparison group of patients who received only routine outpatient management (Behav Res Ther 27:529, 1989). Only eight patients were assigned to each group. Patients received “intensive treatment” (about 18 sessions) for 6 months, followed by monthly “booster sessions” for 6 months, and were followed up 12 months after treatment. CBT patients were less likely to drop out than were behavioral therapy patients.

At follow-up, basically very few differences could be noted among the two treatment groups or, for that matter, between the treatment groups and comparison group receiving routine care. Regardless of treatment group, all patients tended to improve during the study and follow-up period. Since this was far from a definitive study, further research is indicated. A large multi-site study of CBT for anorexia nervosa, funded by the

McKnight Foundation, is currently underway. While it is too early to know how this will turn out, the investigators suggest that it’s been very difficult to recruit and retain patients for this study.

Before all the evidence is in, clinicians may want to familiarize themselves with CBT strategies for anorexia nervosa (see, for example, D. Garner and P.E. Garfinkel (eds.), Handbook of Treatment for Eating Disorders, Guilford Press, 1997). Including elements of CBT in a comprehensive individual and family therapy for anorexia nervosa is likely to be of some value and probably couldn’t hurt.

— J.Y.