Hay PJ, Bacaltchuk J, Stefano S Psychotherapy_For_Bulimia_Nervosa_And_Binging - 2006.pdf

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Psychotherapy for bulimia nervosa and binging (Review)
Hay PJ, Bacaltchuk J, Stefano S
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2006, Issue 1
Psychotherapy for bulimia nervosa and binging (Review)
Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd
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T A B L E O F C O N T E N T S
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW . . . . . . . . . . . . . . . . . .
4
SEARCH METHODS FOR IDENTIFICATION OF STUDIES . . . . . . . . . . . . . . . . . . .
4
METHODS OF THE REVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
DESCRIPTION OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
METHODOLOGICAL QUALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
AUTHORS' CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
FEEDBACK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
POTENTIAL CONFLICT OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
ACKNOWLEDGEMENTS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
Characteristics of included studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
Characteristics of excluded studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
44
ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46
Table 01. CBT versus wait-list control outcome in trials of bulimia nervosa (DSM-IIIR/IV) . . . . . . . . .
46
Table 02. Comparisons of CBT vs any other psychotherapy in trials of DSMIIIR/IV BN . . . . . . . . . .
46
Table 03. Other psychotherapies versus a waitlist control for DSMIIIR/IV bulimia nervosa . . . . . . . . .
46
ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46
Comparison 01. CBT compared to a wait list or no treatment control group . . . . . . . . . . . . . .
46
Comparison 02. CBT compared to any other psychotherapy (if there was more than one the therapy least like CBT was
compared) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
47
Comparison 03. Guided self-help CBTcompared to pure self-help CBT. . . . . . . . . . . . . . . . .
47
Comparison 04. CBT versus CBT augmented by ERP . . . . . . . . . . . . . . . . . . . . . .
48
Comparison 05. Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group . . . . .
48
Comparison 06. Any psychotherapy NOT CBT compared to a control therapy (to date either nutritional management
or B.T.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
Comparison 07. CBT versus a component of CBT only - most commonly a behavioural component (B.T.) . . . .
49
Comparison 08. Guided (non specialist) self-help versus waiting-list control group . . . . . . . . . . . .
50
Comparison 09. Guided self-help versus specialist psychotherapy (CBT &/or IPT) . . . . . . . . . . . .
50
Comparison 10. Pure self help versus waitlist control group . . . . . . . . . . . . . . . . . . . .
51
INDEX TERMS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
COVER SHEET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
GRAPHS AND OTHER TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
53
Analysis 01.01. Comparison 01 CBT compared to a wait list or no treatment control group, Outcome 01 Number of
people who did not show remission (100% binge free) . . . . . . . . . . . . . . . . . . . .
53
Analysis 01.06. Comparison 01 CBT compared to a wait list or no treatment control group, Outcome 06 Mean score of
bulimic symptoms at end of trial where scores were not different between groups at start of tria . . . . . .
54
Analysis 01.07. Comparison 01 CBT compared to a wait list or no treatment control group, Outcome 07 Number if
people who dropped out due to adverse events . . . . . . . . . . . . . . . . . . . . . .
55
Analysis 01.08. Comparison 01 CBT compared to a wait list or no treatment control group, Outcome 08 Number of
people who dropped out due to any reason . . . . . . . . . . . . . . . . . . . . . . . .
56
Analysis 01.10. Comparison 01 CBT compared to a wait list or no treatment control group, Outcome 10 Mean end of
trial depression scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
57
Psychotherapy for bulimia nervosa and binging (Review)
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Analysis 01.11. Comparison 01 CBT compared to a wait list or no treatment control group, Outcome 11 Mean end trial
scores of general psychiatric symptoms . . . . . . . . . . . . . . . . . . . . . . . . .
58
Analysis 01.13. Comparison 01 CBT compared to a wait list or no treatment control group, Outcome 13 Mean scores
end of trial of psychosocial/interpersonal functioning . . . . . . . . . . . . . . . . . . . .
58
Analysis 01.16. Comparison 01 CBT compared to a wait list or no treatment control group, Outcome 16 Mean weight
at end of therapy (BMI where possible) . . . . . . . . . . . . . . . . . . . . . . . . .
59
Analysis 02.01. Comparison 02 CBT compared to any other psychotherapy (if there was more than one the therapy least
like CBT was compared), Outcome 01 Number of people who did not show remission (100% binge free) . .
60
Analysis 02.06. Comparison 02 CBT compared to any other psychotherapy (if there was more than one the therapy least
like CBT was compared), Outcome 06 Mean bulimic symptom scores at end of treatment . . . . . . .
61
Analysis 02.07. Comparison 02 CBT compared to any other psychotherapy (if there was more than one the therapy least
like CBT was compared), Outcome 07 Number if people who dropped out due to adverse events . . . . .
62
Analysis 02.08. Comparison 02 CBT compared to any other psychotherapy (if there was more than one the therapy least
like CBT was compared), Outcome 08 Number of people who dropped out due to any reason . . . . . .
63
Analysis 02.10. Comparison 02 CBT compared to any other psychotherapy (if there was more than one the therapy least
like CBT was compared), Outcome 10 Mean depression scores at end of treatment . . . . . . . . . .
64
Analysis 02.12. Comparison 02 CBT compared to any other psychotherapy (if there was more than one the therapy least
like CBT was compared), Outcome 12 Mean end of trial scores of general psychiatric symptoms . . . . .
65
Analysis 02.14. Comparison 02 CBT compared to any other psychotherapy (if there was more than one the therapy least
like CBT was compared), Outcome 14 Mean differences in psycho-social functioning at end of treatment . .
66
Analysis 02.16. Comparison 02 CBT compared to any other psychotherapy (if there was more than one the therapy least
like CBT was compared), Outcome 16 Mean weight at end of therapy (BMI where possible) . . . . . .
67
Analysis 03.01. Comparison 03 Guided self-help CBTcompared to pure self-help CBT., Outcome 01 Number of people
who did not show remission (100% binge free) . . . . . . . . . . . . . . . . . . . . . .
69
Analysis 03.06. Comparison 03 Guided self-help CBTcompared to pure self-help CBT., Outcome 06 Average difference
in bulimic symptoms at end of treatment . . . . . . . . . . . . . . . . . . . . . . . .
70
Analysis 03.07. Comparison 03 Guided self-help CBTcompared to pure self-help CBT., Outcome 07 Number if people
who dropped out due to adverse events . . . . . . . . . . . . . . . . . . . . . . . . .
71
Analysis 03.08. Comparison 03 Guided self-help CBTcompared to pure self-help CBT., Outcome 08 Number of people
who dropped out due to any reason . . . . . . . . . . . . . . . . . . . . . . . . . .
72
Analysis 03.10. Comparison 03 Guided self-help CBTcompared to pure self-help CBT., Outcome 10 Average difference
in depression at end of treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .
73
Analysis 03.12. Comparison 03 Guided self-help CBTcompared to pure self-help CBT., Outcome 12 Average difference
in general psychiatric symptoms at end of treatment
74
. . . . . . . . . . . . . . . . . . . .
Analysis 03.14. Comparison 03 Guided self-help CBTcompared to pure self-help CBT., Outcome 14 Average difference
in psycho-social functioning at end of therapy . . . . . . . . . . . . . . . . . . . . . . .
74
Analysis 03.15. Comparison 03 Guided self-help CBTcompared to pure self-help CBT., Outcome 15 Mean weight at
end of therapy (BMI where possible) . . . . . . . . . . . . . . . . . . . . . . . . . .
75
Analysis 04.01. Comparison 04 CBT versus CBT augmented by ERP, Outcome 01 Number of people who did not show
remission (100% binge free) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
76
Analysis 04.02. Comparison 04 CBT versus CBT augmented by ERP, Outcome 02 Mean scores on bulimic rating scale
at end of treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
77
Analysis 04.03. Comparison 04 CBT versus CBT augmented by ERP, Outcome 03 Number of noncompleters due to
any reason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
78
Analysis 04.04. Comparison 04 CBT versus CBT augmented by ERP, Outcome 04 Mean scores on depression rating
scale at end of treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
79
Analysis 04.05. Comparison 04 CBT versus CBT augmented by ERP, Outcome 05 Mean scores on psychiatric symptom
rating scale at end of treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .
80
Analysis 04.06. Comparison 04 CBT versus CBT augmented by ERP, Outcome 06 Mean weight at end of therapy .
80
Analysis 05.01. Comparison 05 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group,
Outcome 01 Number of people who did not show remission (100% binge free) . . . . . . . . . . .
81
Analysis 05.02. Comparison 05 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group,
Outcome 02 Mean scores on binge and/or purge frequency at end of treatment . . . . . . . . . . .
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Psychotherapy for bulimia nervosa and binging (Review)
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Analysis 05.04. Comparison 05 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group,
Outcome 04 Mean scores on depression rating scale at end of treatment. . . . . . . . . . . . . .
83
Analysis 05.05. Comparison 05 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group,
Outcome 05 Mean scores on general psychiatric symptom rating scales at end of treatment . . . . . . .
84
Analysis 05.06. Comparison 05 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group,
Outcome 06 Number of treatment non-completers . . . . . . . . . . . . . . . . . . . . .
84
Analysis 05.07. Comparison 05 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group,
Outcome 07 Numbers not completing due to adverse events. . . . . . . . . . . . . . . . . .
85
Analysis 05.08. Comparison 05 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group,
Outcome 08 Mean weight at end of therapy . . . . . . . . . . . . . . . . . . . . . . .
86
Analysis 05.09. Comparison 05 Any psychotherapy, NOT CBT, compared to a no treatment or waitlist control group,
Outcome 09 EDE restraint scale scores at end of treatment . . . . . . . . . . . . . . . . . .
86
Analysis 06.01. Comparison 06 Any psychotherapy NOT CBT compared to a control therapy (to date either nutritional
management or B.T.), Outcome 01 Number of people who did not show remission (100% binge free) . . .
87
Analysis 06.02. Comparison 06 Any psychotherapy NOT CBT compared to a control therapy (to date either nutritional
management or B.T.), Outcome 02 Mean scores of bulimic symptoms at end of trial where scores were not different
between groups at start
88
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 06.03. Comparison 06 Any psychotherapy NOT CBT compared to a control therapy (to date either nutritional
management or B.T.), Outcome 03 Number of people who dropped out due to adverse events . . . . . .
89
Analysis 06.04. Comparison 06 Any psychotherapy NOT CBT compared to a control therapy (to date either nutritional
management or B.T.), Outcome 04 Number of people who dropped out due to any reason . . . . . . .
89
Analysis 06.05. Comparison 06 Any psychotherapy NOT CBT compared to a control therapy (to date either nutritional
management or B.T.), Outcome 05 Mean end of trial depression scores . . . . . . . . . . . . . .
90
Analysis 06.06. Comparison 06 Any psychotherapy NOT CBT compared to a control therapy (to date either nutritional
management or B.T.), Outcome 06 Mean end of trial scores on measures of social or interpersonal functioning
91
Analysis 06.07. Comparison 06 Any psychotherapy NOT CBT compared to a control therapy (to date either nutritional
management or B.T.), Outcome 07 Mean weight at end of therapy (Body Mass Index where possible) . . .
92
Analysis 07.01. Comparison 07 CBT versus a component of CBT only - most commonly a behavioural component
(B.T.), Outcome 01 Number of people who did not remit (were not 100% binge free) . . . . . . . . .
93
Analysis 07.02. Comparison 07 CBT versus a component of CBT only - most commonly a behavioural component
(B.T.), Outcome 02 Mean binge eating frequency at end of therapy . . . . . . . . . . . . . . .
94
Analysis 07.03. Comparison 07 CBT versus a component of CBT only - most commonly a behavioural component
(B.T.), Outcome 03 Mean depression scores at end of therapy . . . . . . . . . . . . . . . . .
95
Analysis 07.04. Comparison 07 CBT versus a component of CBT only - most commonly a behavioural component
(B.T.), Outcome 04 Number of subjects not completing therapy . . . . . . . . . . . . . . . .
96
Analysis 07.05. Comparison 07 CBT versus a component of CBT only - most commonly a behavioural component
(B.T.), Outcome 05 Body mass index or weight at end of treatment . . . . . . . . . . . . . . .
97
Analysis 07.06. Comparison 07 CBT versus a component of CBT only - most commonly a behavioural component
(B.T.), Outcome 06 Mean general psychiatric symptom severity scores at end of treatment . . . . . . .
98
Analysis 07.07. Comparison 07 CBT versus a component of CBT only - most commonly a behavioural component
(B.T.), Outcome 07 Mean social adjustment scores at end of therapy . . . . . . . . . . . . . . .
99
Analysis 07.08. Comparison 07 CBT versus a component of CBT only - most commonly a behavioural component
(B.T.), Outcome 08 Mean bulimic symptom severity scores at end of treatment (eg Global EDE score) . . .
100
Analysis 08.01. Comparison 08 Guided (non specialist) self-help versus waiting-list control group, Outcome 01
Number not abstinent from binge eating at end of treatment . . . . . . . . . . . . . . . . .
101
Analysis 08.02. Comparison 08 Guided (non specialist) self-help versus waiting-list control group, Outcome 02 Mean
bulimic symptom scores (where possible binge eating weekly frequency) at end of treatment . . . . . . .
102
Analysis 08.03. Comparison 08 Guided (non specialist) self-help versus waiting-list control group, Outcome 03 Mean
depression symptom scores on any depression rating scale at end of treatment . . . . . . . . . . . .
103
Analysis 08.04. Comparison 08 Guided (non specialist) self-help versus waiting-list control group, Outcome 04 Mean
interpersonal and social functioning on any appropriate rating scale at end of treatment. . . . . . . . .
104
Analysis 08.05. Comparison 08 Guided (non specialist) self-help versus waiting-list control group, Outcome 05 Mean
general psychiatric symptom severity scores on any appropriate scale at end of treatment. . . . . . . . .
105
Psychotherapy for bulimia nervosa and binging (Review)
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Analysis 08.06. Comparison 08 Guided (non specialist) self-help versus waiting-list control group, Outcome 06
Number of participants withdrawing because of an adverse event. . . . . . . . . . . . . . . . .
105
Analysis 08.07. Comparison 08 Guided (non specialist) self-help versus waiting-list control group, Outcome 07
Number of participants who withdrew from the study for any reason.. . . . . . . . . . . . . . .
106
Analysis 08.08. Comparison 08 Guided (non specialist) self-help versus waiting-list control group, Outcome 08 Mean
weight (BMI where possible) at end of treatment. . . . . . . . . . . . . . . . . . . . . .
107
Analysis 09.01. Comparison 09 Guided self-help versus specialist psychotherapy (CBT &/or IPT), Outcome 01 Non-
Abstinence rates for binge eating at end of therapy . . . . . . . . . . . . . . . . . . . . .
108
Analysis 09.02. Comparison 09 Guided self-help versus specialist psychotherapy (CBT &/or IPT), Outcome 02 Mean
end of trial bulimic symptoms (where possible binge eating frequency) . . . . . . . . . . . . . .
109
Analysis 09.03. Comparison 09 Guided self-help versus specialist psychotherapy (CBT &/or IPT), Outcome 03
Number of people who dropped out for any reason . . . . . . . . . . . . . . . . . . . . .
110
Analysis 09.04. Comparison 09 Guided self-help versus specialist psychotherapy (CBT &/or IPT), Outcome 04 Mean
scores on depression rating scale at end of treatment
111
. . . . . . . . . . . . . . . . . . . .
Analysis 09.05. Comparison 09 Guided self-help versus specialist psychotherapy (CBT &/or IPT), Outcome 05 Mean
end of trial scores of psychosocial or interpersonal functioning . . . . . . . . . . . . . . . . .
112
Analysis 09.06. Comparison 09 Guided self-help versus specialist psychotherapy (CBT &/or IPT), Outcome 06 Mean
scores on EDE restraint scale . . . . . . . . . . . . . . . . . . . . . . . . . . . .
113
Analysis 09.07. Comparison 09 Guided self-help versus specialist psychotherapy (CBT &/or IPT), Outcome 07 6
month objective bulimic episodes . . . . . . . . . . . . . . . . . . . . . . . . . . .
114
Analysis 09.08. Comparison 09 Guided self-help versus specialist psychotherapy (CBT &/or IPT), Outcome 08 6
month interpersonal functioning . . . . . . . . . . . . . . . . . . . . . . . . . . .
115
Analysis 09.09. Comparison 09 Guided self-help versus specialist psychotherapy (CBT &/or IPT), Outcome 09 6
month depression scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
116
Analysis 10.01. Comparison 10 Pure self help versus waitlist control group, Outcome 01 Mean end of trial interpersonal
functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
117
Analysis 10.02. Comparison 10 Pure self help versus waitlist control group, Outcome 02 Mean end of trial depression
scores
118
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Analysis 10.03. Comparison 10 Pure self help versus waitlist control group, Outcome 03 Number of dropouts due to
any reason . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
119
Analysis 10.04. Comparison 10 Pure self help versus waitlist control group, Outcome 04 Number of people who did
not show remission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
120
Analysis 10.05. Comparison 10 Pure self help versus waitlist control group, Outcome 05 Mean difference in binge
frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
121
Psychotherapy for bulimia nervosa and binging (Review)
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