Testing Treatment Options for BED

Patients with binge eating disorder, or BED, face a number of challenging problems, including continuing eating binges, comorbid obesity with its associated medical problems, and high rates of co-occurring psychiatric disorders and psychosocial impairment. Some treatments that have been helpful are cognitive behavioral therapy (CBT), interpersonal therapy, dialectical behavior therapy, and behavioral weight loss programs. Medication appears to be less effective than psychotherapy and also hasn’t improved remission rates when compared with CBT.

Advantages with self-help or guided therapy

In order to develop less costly and more easily administered treatment for these patients, several researchers have reported that CBT and psychosocial techniques presented in self-help or guided self-help formats have improved binge eating symptoms. Administering self-help treatment in a group setting has several advantages, including reducing costs, the potential for wider use, and interpersonal support for group members. Dr. Carol B. Peterson and colleagues at the University of Minnesota and the University of North Dakota have reported that group self-help intervention was comparable to therapist-led and therapist-assisted CBT at the end of treatment and for at least one year of follow-up. One group was given limited support via a single 10-minute telephone call each week (limited-support group) while the other group received no weekly support (no outside support).

A study to assess therapist-led vs. self-help CBT

To assess the benefits of therapist-led and self-help CBT, Dr. Peterson and colleagues recruited 259 adults from two clinical sites, one in North Dakota and the other in Minneapolis. After completing an assessment protocol, the study participants were randomly assigned to one of three active treatments or to a wait-list condition. Binge eating, measured by the Eating Disorder Examination, was assessed at baseline, at the end of treatment, and at 6 and 12 months after treatment ended (Am J Psychiatry 2009;166:1347).

All active treatments involved 15 group sessions of 80 minutes’ duration over a 20-week period, with weekly sessions for the first 10 weeks and biweekly sessions for the remaining 10 weeks. The mean group size was 6 patients, and the groups contained from 2 to 11 persons. The content of the three active treatment conditions was identical—only the delivery varied. The sessions began with behavioral and cognitive interventions, and then moved to techniques to target associated problems, including stress management and body image. The final two sessions included strategies to avoid relapse. Each 80-minute session was divided into two parts, one focusing on psychoeducation and the second on homework review and discussion. All participants in active treatment received identical workbooks and homework.

Results

Of the 259 participants, 227 (87.6%) were women. The average age was 41.7 years and most of the women were Caucasian, had an undergraduate college degree or higher, were employed full time (61%), and were taking antidepressants. The average body mass index (kg/m²) was 39. Sixty-nine participants were assigned to the waiting list condition, 67 to the self-help condition, 63 to the therapist-assisted condition, and 60 to the therapist-led condition.

When the researchers evaluated drop-out, a larger number of participants in the therapist-led sessions completed treatment than did those in the therapist-assisted and self-help sessions. Those who did not complete the assessment were younger but didn’t differ on other demographic or clinical characteristics.

At the end of treatment or the end of the waiting period, the following abstinence rates were reported: therapist-led group, 51.7%; therapist-assisted group, 33.3%; self-help group, 17.9%; and waiting list group, 10.1%. At the 12-month follow-up, the abstinence rates were: therapist–led group, 20.8%; therapist-assisted group, 27.0%; and self-help group, 25.4%. Patients in the therapist-led and therapist-assisted groups had significantly higher abstinence rates than did patients in the waiting list group for both analyses.

The authors concluded that therapist-led group CBT for binge eating disorder led to higher binge eating abstinence rates, greater reductions in binge eating frequency, and lower attrition rates compared to those reported for patients in group self-help treatment. However, the lack of group differences at follow-up also suggests that self-help group treatment may be a viable alternative to therapist-led interventions for BED patients.