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Efficacy of psychotherapies and pharmacotherapies for Bulimia nervosa

Published online by Cambridge University Press:  05 December 2018

Jennifer Svaldi ,
Florian Schmitz ,
Julia Baur ,
Andrea S. Hartmann ,
Tanja Legenbauer ,
Charlotte Thaler ,
Jörn von Wietersheim ,
Martina de Zwaan  and
Brunna Tuschen-Caffier
Jennifer Svaldi*
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstrasse 4, 72076 Tuebingen, Germany
Florian Schmitz
Affiliation:
Department of Individual Differences and Psychological Assessment, Ulm University, Albert-Einstein-Allee 47, 89081 Ulm, Germany
Julia Baur
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstrasse 4, 72076 Tuebingen, Germany
Andrea S. Hartmann
Affiliation:
Department of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstrasse 15, 49069 Osnabrück, Germany
Tanja Legenbauer
Affiliation:
LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr University Bochum, Heithofer Allee 64, 59071 Hamm, Germany
Charlotte Thaler
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstrasse 41, 79085 Freiburg, Germany
Jörn von Wietersheim
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Ulm Medical School, Albert-Einstein-Allee 23, 89070 Ulm, Germany
Martina de Zwaan
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
Brunna Tuschen-Caffier
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstrasse 41, 79085 Freiburg, Germany
*
Author for correspondence: Jennifer Svaldi, E-mail: jennifer.svaldi@uni-tuebingen.de
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Abstract

Background

Bulimia nervosa (BN), a mental disorder that causes significant impairment, can be treated with psychological, pharmacological, nutrition-based and self-help interventions. We conducted a pre-registered meta-analysis of randomized-controlled trials (RCTs) to assess the efficacy of these interventions in up to 19 different interventions.

Methods

Database search terms were combined for BN and RCTs from database inception to March 2017. Abstinence from binge eating episodes, compensatory behaviors, the absence of a BN diagnosis and reduction of symptom severity were considered as primary outcome variables, reduction of self-reported eating pathology and depression served as secondary outcome variables. Retrieved RCTs were meta-analyzed using fixed and random effects models.

Results

RCT (79 trials; 5775 participants) effects post-treatment revealed moderate to large intervention effects for psychotherapy [mostly cognitive-behavioral therapy (CBT)] for primary outcome variables. Slightly reduced effects were obtained for self-help and moderate effects for pharmacotherapy. Similarly, psychotherapy yielded large to very large effects in regard to secondary outcome variables, while moderate to large effects were observed for self-help, Pharmacotherapy and combined therapies. Meta-analyses for the pre to post changes within group confirmed these findings. Additionally, follow-up analyses revealed the sustainability of psychotherapies in terms of large effects in primary outcome criteria, while these effects were moderate for self-help, pharmacotherapy, and combined therapies.

Conclusions

Most psychological and pharmacological interventions revealed to be effective in BN treatment. Taking effect size, sustainability of the intervention, as well as the consistency of findings and available evidence into consideration, CBT can be recommended as the best intervention for the initial treatment of BN.

Keywords

Bulimia nervosameta-analysistreatment
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 6 , April 2019 , pp. 898 - 910
Copyright
Copyright © Cambridge University Press 2018 

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