Effects of Cognitive-behavioral and Psychodynamic-interpersonal Treatments for Eating Disorders: A Meta-analytic Inquiry Into the Role of Patient Characteristics, and Change in Eating Disorder-specific and General Psychopathology in Remission.

Abstract

Background: Knowledge about the outcomes of different psychotherapeutic approaches for eating disorders in terms of remission is limited. Also, knowledge is limited about how therapies and patient characteristics interact to affect outcomes, and by which therapeutic processes. Method: Reports on the psychotherapeutic treatment of eating disorders by CBT and PIT were searched. Rates of remission and changes in eating disorder specific and general psychopathology were computed and meta-analytically synthesized. Regression models were made to predict summary event rates by patient characteristics and changes in specific and general psychopathology. Results: Only CBT produced remission rates (34.2%) significantly different from waitlist conditions, and only CBT led to significantly greater change in specific psychopathology than waitlist/nutritional counseling conditions. However, CBT and PIT were equally effective in changing general psychopathology. Reduction in general psychopathology predicted higher remission for PIT. For CBT, change in specific psychopathology predicted remission only when controlling for differences between diagnostic categories. Change in general psychopathology predicted remission only for PIT. The presence of comorbid personality disorder decreased the effect of CBT. Discussion: A subgroup of eating disorder patients may require therapy aimed at strengthening deficits in self functions not easily ameliorable by cognitive behavioral techniques alone. However, although effective in changing specific and general psychopathology, PIT is not effective in producing behavioral change. Further research should be aimed at identifying treatment interventions that effectuate both behavior change, and strengthening self-functions to substitute eating-disordered behavior as a means to meet psychological needs.