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Cognitive-Behavioral Treatment of Bulimia Nervosa

A Critical Appraisal

University of Toronto

Christopher G. Fairburn

University of Oxford

Ron Davis

University of Toronto

Specific distorted attitudes toward weight and shape have been identified as important in the development and maintenance of anorexia nervosa and bulimia nervosa. Cognitive-behavioral (CB) treatment methods have been proposed for these eating disorders and preliminary reports of their efficacy with bulimia nervosa are reviewed. Although the results are encouraging, several conceptual and methodological issues must be addressed in the interpretation of findings. Inadequate and inconsistent definitions of CB methods are common in the current literature. Few studies depend on manuals to operationalize interventions. In some, recruitment has depended on advertisement, whereas in others it has depended on clinical referrals. In some studies, experienced therapists have been used and in others graduate students have been employed as therapists. Despite the lack of comparability among studies, there is evidence that CB intervention leads to a marked reduction in bingeing and vomiting as well as associated psychopathology. Evaluation of the proportion of patients abstinent from bingeing and vomiting at follow-up leads to a less optimistic view of success. Individual therapy appears to be somewhat more effective than group treatment in minimizing attrition and alleviating symptoms. Future studies must be aimed at a more systematic evaluation of active components in treatment and at demonstrating durability of change.

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