Table 17.
Cognitive behavioural therapy for Bulimia Nervosa
| Certainty assessment | Impact | Certainty | Importance | ||||||
|---|---|---|---|---|---|---|---|---|---|
| № of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | |||
| CBT vs FBT - Remission (assessed with: abstinence from BP for 4 weeks) | |||||||||
| 2 | randomised trials | not serious | not serious | not serious | not serious | none | RCT n = 130 aged 12–18 years. 18 sessions over 6 months. 20% remitted in CBT group versus 39% remitted in FBT group (p < 0.04, NNT = 5). RCT n = 85 (guided self care CBT) remitted 6/44 in CBT group versus 4/41 in family group. no significant difference. |
⨁⨁⨁⨁ HIGH |
CRITICAL |
| CBT vs. Psychodynamic - Remission Rates (assessed with: Diagnostic Criteria) | |||||||||
| 1 | randomised trials | not serious | not serious | not serious | not serious | none |
one RCT 81 females mean age 18.7 years (range 14–20). 33.3% remitted in the CBT group and 31.0% in the psychodynamic group. No significant differences. Mean of 37 sessions. Both groups improved, there were small between groups effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favour of CBT and for eating concern (d = 0.35) in favour of PDT. |
⨁⨁⨁⨁ HIGH |
CRITICAL |
| Binge Purge Behaviour (assessed with: EDE) | |||||||||
| 2 | Case Series | very serious a,b | not serious | not serious | not serious | none | Two large case series (n = 68 including 2 males, 66 females, and n = 34 all female). Total age range 12–19. Number of sessions 16–20. Frequency of binge and purge episodes decreased significantly pre to post treatment. |
⨁◯◯◯ VERY LOW |
CRITICAL |
| very serious a,b | not serious | not serious | not serious | none | Case series of 68 adolescents - EDE significantly improved global EDE score from 3.6 to 1.8 from pre to post treatment. |
⨁◯◯◯ VERY LOW |
CRITICAL | ||
| Binge Purge Frequency (assessed with: Frequency), Psychological Symptoms (EDE or EAT) | |||||||||
| 5 | Case Reports | very serious a,b | not serious | not serious | not serious | none | Case reports involving 9 patients in total. Frequency of binge and purge behaviours described as decreased. |
⨁◯◯◯ VERY LOW |
CRITICAL |
| very serious a,b | not serious | not serious | not serious | none | 7 cases -EDE or EAT significantly improved. |
⨁◯◯◯ VERY LOW |
CRITICAL | ||
Explanations
ano randomization
bno control condition
Bibliography:
RCT – Le Grange 2015 [50], Schmidt 2007 [49] (CBT vs. FBT) Stefini 2017 [107] (CBT vs. psychodynamic)
Case Series - Dalle Grave 2015 [108], Lock 2005 [109]
Case Reports – Schapman-Williams 2006 [110], Cooper 2007 [111], Anbar 2005 [112], Schapman-Williams 2007 [113], Sysko 2011 [114]