The Psychology of Eating: From Healthy to Disordered Behavior

262 Treating Eating Disorders

Stage 5: Follow-up

The CBT described by Freeman (1995) involves 18 sessions of therapy with
top-up sessions at 1, 3, 6, and 12 months. In addition, once CBT has finished
patients are encouraged to continue some form of help, either in terms of
self-help groups or group therapy through organizations such as The
Women’s Therapy Centre or the Eating Disorders Association.

Effectiveness of CBT

For bulimia nervosa
Most studies of CBT have explored its impact on bulimia, and the results
show that it is more effective than drug treatment (Mitchell et al., 1990),
more effective than cognitive restructuring on its own without the behav-
ioral component (Wilson et al., 1986), and sometimes, but not always, more
effective than behavioral therapy on its own without the cognitive com-
ponent (Fairburn et al., 1993). It is not clear whether it is more effective
than interpersonal psychotherapy. CBT seems to be more effective in the
short term but not at the longer term follow-up (Fairburn et al., 1993). In
general the results show that following about 20 sessions of CBT lasting
up to 4 months, about 80 percent of patients show a reduction in the fre-
quency of binges and about 35 percent have stopped bingeing completely.
In 2007 Shapiro et al. carried out a systematic review of the evidence for
the effectiveness of CBT only, medication only, and CBT plus medication
for patients with BN. They searched databases for RCTs from 1980 to 2005
and found 47 studies that met their inclusion criteria. The results indicated
that medication decreases the binge eating, purging, and psychological
problems in the short term but has harmful side effects. The results also
showed that CBT is effective in both the short and longer term for reduc-
ing bingeing, purging, and psychological problems and does not cause harm.
This is endorsed by Mitchell, Agras, and Wonderlich (2007), who reviewed
the evidence for the treatment of BN and concluded that although medica-
tion has a role to play, CBT “remains the treatment of choice” (p. 95).

For anorexia nervosa
There is very little evidence for the effectiveness of CBT for AN. One study
(Freeman and Newton, 1992) randomly allocated 32 patients with severe
anorexia (BMI under 14) to receive CBT either as a day patient or during
inpatient treatment. At 3-year follow-up, those who had been day patients