A Multicenter Comparison of Cognitive-Behavioral Therapy and Interpersonal Psychotherapy for Bulimia Nervosa

TLDR

Cognitive‑behavioral therapy is generally regarded as the most effective treatment for bulimia nervosa, though some evidence suggests interpersonal psychotherapy may achieve comparable outcomes, albeit more slowly. This study aimed to replicate the comparison between CBT and IPT for bulimia nervosa. A randomized, multisite trial enrolled 220 DSM‑III‑R bulimia patients who received 19 weekly sessions of either CBT or IPT over 20 weeks, with outcomes assessed up to one year post‑treatment. CBT produced higher recovery (29% vs 6%) and remission rates (48% vs 28%) at treatment end and was faster to achieve improvement, but by one‑year follow‑up the differences disappeared (40% vs 27% recovered), leading the authors to recommend CBT as the preferred therapy.

Abstract

<h3>Background</h3> Research suggests that cognitive-behavioral therapy (CBT) is the most effective psychotherapeutic treatment for bulimia nervosa. One exception was a study that suggested that interpersonal psychotherapy (IPT) might be as effective as CBT, although slower to achieve its effects. The present study is designed to repeat this important comparison. <h3>Method</h3> Two hundred twenty patients meeting<i>DSM-III-R</i>criteria for bulimia nervosa were allocated at random to 19 sessions of either CBT or IPT conducted over a 20-week period and evaluated for 1 year after treatment in a multisite study. <h3>Results</h3> Cognitive-behavioral therapy was significantly superior to IPT at the end of treatment in the percentage of participants recovered (29% [n=32] vs 6% [n=7]), the percentage remitted (48% [n=53] vs 28% [n=31]), and the percentage meeting community norms for eating attitudes and behaviors (41% [n=45] vs 27% [n=30]). For treatment completers, the percentage recovered was 45% (n=29) for CBT and 8% (n=5) for IPT. However, at follow-up, there were no significant differences between the 2 treatments: 26 (40%) CBT completers had recovered at follow-up compared with 17 (27%) IPT completers. <h3>Conclusions</h3> Cognitive-behavioral therapy was significantly more rapid in engendering improvement in patients with bulimia nervosa than IPT. This suggests that CBT should be considered the preferred psychotherapeutic treatment for bulimia nervosa.