by Joye C. Anestis, M.S.
The DSM-IV features 3 eating disorder (ED) diagnoses, anorexia nervosa and bulimia nervosa, by far the most well-known, and eating disorder not otherwise specified (EDNOS), the most prevalent of the ED diagnoses. Ironically, while EDNOS is the most diagnosed ED, treatment research has often neglected this population, focusing mostly on anorexia and bulimia. We know that CBT is the "gold standard" treatment for bulimia, but we don't know if this treatment is equally effective for the EDNOS population. Christopher Fairburn and his colleagues have attempted to remediate this problem by revising traditional CBT for bulimia into a transdiagnostic approach for all three EDs. A new study published in the American Journal of Psychiatry features a randomized control trial of this new treatment.
Fairburn et al. describe transdiagnostic CBT as an "enhanced" version of CBT that features 2 versions of the treatment: a "focused" form which focuses exclusively on the eating disorder and a "broad" form which addresses some of the other issues commonly found in eating disordered patients (e.g., self-esteem, perfectionism, interpersonal problems, mood intolerance). This was a well-conducted RCT of the two treatments - the sample was primarily female, participants with BMI < 17.5 were excluded - so only participants with bulimia (38.3%) & EDNOS (61.7%) remained. The results indicate that the two versions of the CBT were overall equally effective, regardless of diagnosis. So this is a novel finding for the treatment of EDNOS! The authors also suggest that the "focused" form of the treatment should be the "go-to" treatment for most clients, and the "broad" form should be used with client who have additional psychopathology that warrants treatment of the domains it addresses.
This was my first encounter with Fairburn's transdiagnostic CBT, and the article doesn't give very much detail about it. I am curious about how different the "focused" version of the treatment is from the traditional CBT for bulimia. I also wonder how different the domains covered in the "broad" transdiagnostic CBT are from the domains covered in dialectical behavior therapy (which also is successful in the treatment of bulimia). Finally, the authors didn't give a rationale for excluding folks with anorexia - I wonder how they would have responded (although my hunch is that they would not have displayed a treatment effect, as CBT is not the treatment of choice for anorexia).What do you think? Has anyone had experience with this enhanced CBT? Do you have other questions about the study?
To learn more about this treatment, please see Cognitive Behavior Therapy and Eating Disorders
by Christopher Fairburn.
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