Psychoanalytic psychotherapy (PPT) has been widely practiced in treating eating disorders. However, previous studies analyzing the effectiveness of this approach show that most patients with eating disorders remain symptomatic following treatment. A study published November 26, 2013, in AJP in Advance shows that alternative psychotherapies may be more effective for some people in providing relief to those who struggle with eating disorders such as bulimia nervosa.
In a collaborative effort, researchers from the University of Copenhagen Department of Psychology in Denmark and Oxford University Department of Psychiatry in England conducted a study comparing the efficacies of PPT and cognitive-behavioral therapy (CBT) in patients with bulimia nervosa.
Stig Poulsen, Ph.D., found cognitive-behavioral therapy to be superior to psychoanaly-tic psychotherapy in treating bulimia nervosa.
University of Copenhagen
“Studies of psychotherapy for bulimia nervosa have established that interpersonal psychotherapy is as effective as CBT but at a slower rate,” said Stig Poulsen, Ph.D., lead author and an associate professor at the University of Copenhagen. “Knowing that longer-term PPT was being practiced frequently, at least in continental Europe, we decided to test if a long-term PPT treatment approach was just as efficient or even more efficient than CBT.”
The authors explained that previous studies have tested this hypothesis, but PPT treatment was conducted only for a year or less.
In the current study, Poulsen and colleagues analyzed eating behaviors of 70 individuals meeting DSM-IV criteria for bulimia nervosa. The participants received either two years of weekly PPT or 20 sessions of CBT over five months. PPT included 50-minute sessions and was based on the assumption that bulimic symptoms were rooted in a need to “ward off” inner feeling states and desires.
CBT sessions were also 50 minutes. CBT was initiated with a one-time 90-minute preparatory session followed by one review session after study completion. CBT focused on concerns about shape and weight, modification of patients’ eating disorder psychopathology, and development of skills to deal with setbacks. Abstinence from binge eating and purging, assessed by the Eating Disorder Examination interview, was the primary outcome measures for both the PPT and CBT groups.
After five months, 42 percent of CBT patients had stopped binge eating and purging compared with 6 percent of PPT patients. At the two-year follow-up, 44 percent in the CBT cohort and 15 percent in the PPT cohort were free of binge eating and purging.
Angela Guarda, M.D. says the findings suggest that psychoanalytic psychotherapy should not be a first-line treatment for bulimia nervosa.
Johns Hopkins Hospital
“Bulimia is a motivated behavioral disorder, and initial treatment efforts should target normalizing eating behaviors rather than insight-oriented searches for ‘root’ causes,” said Angela Guarda, M.D., director of the Eating Disorder Program at Johns Hopkins Hospital, who was not involved in the study. “No amount of insight into reasons for engaging in the behavior is helpful without the achievement of a behavioral change,” she explained to Psychiatric News.
Guarda praised the current study and said that it showed an adequate separation in the treatment effects of PPT and CBT.
While the results from the current study show that CBT is more effective than PPT in relieving bulimia associated with binge eating and purging, Poulsen noted that PPT may have other advantages.
“We have ongoing studies in which patients have reported PPT as highly rewarding, even if it did not lead to full cessation of the symptoms.” Poulsen told Psychiatric News that more studies will follow investigating the importance of PPT as it relates to treatment of eating disorders. ■